Empowering Care Home Staff to Deliver Quality End of Life Care: The Impact of the Six Steps to Success Programme on End of Life Care in Care Homes in North West England

Background: Inappropriate admissions to hospital from care homes at the end-of-life (EoL), identified within the UK Department of Health's End-of-Life Care (EoLC) Strategy resulted in the call for improved education surrounding EoLC for care home staff. In response, the Six Steps to Success , an organisational change programme, was developed for use with care home staff. The aim of the programme is to ensure all residents receive high quality EoLC provided by a care home that encompasses the philosophy of palliative care and that allows people to die where they choose. Aims To explore the impact of the Six Steps to Success programme on EoLC in care homes in Northwest England. Methods: The mixed-method evaluation consisted of three phases; i) examination of audit data collected on care homes from cohort 1 that had completed the programme by November 2012 (quality markers and measures; post death information; knowledge skills and confidence audit); ii) questionnaires (n=16) and interviews (n=9) with Six Steps Facilitators (N=18) and iii) case studies on care homes (n=6), randomly chosen from a selection matrix of homes that had completed the programme and volunteered to take part taking account of geographical spread (urban/rural) and type of care home. Analysis involved descriptive statistical comparisons and frequencies; qualitative data were subject to content analysis to identify themes. Results: All care homes demonstrated improvements in Advance Care Planning (ACP). Knowledge skills and confidence around EoLC improved markedly amongst care home staff, with 92% improvement for Spirituality skills and 79% improvement for ACP knowledge. Residents dying in their preferred place of death increased from 81.5% to 83.1%. Conclusions: EoLC in care homes has undoubtedly improved. The Six Steps to Success programme has helped care home staff deliver better end-of-life care for their residents ensuring their wishes and preferences at end-of-life are met.