P-92 Improving advance care planning in care homes for people with frailty and dementia using the gold standards framework (GSF) quality improvement training and accreditation programmes

Abstract

Background Advance Care Planning (ACP) is vital to improving care for elderly people with long-term conditions, frailty and dementia. The Gold Standards Framework (GSF) Care Homes Training Programme used by over 2500 UK care homes mainstreams offering ACP discussions to every resident. Aim To clarify the sustained use of ACP for residents in care homes, in GSF Accredited/Reaccredited care homes – what are the impact, threats to sustainability and lessons learnt? Methods ACP training includes experiential and taught sessions as part of GSF. Mixed methodology with both quantitative and qualitative assessments, key outcomes ratios, After Death Analyses, case studies, portfolio, etc., lead to the GSF Quality Hallmark Award. Particular attention is given to standardised use of ACP for all residents and the effect of these discussions on care, staff morale and retention. Results Evidence from over 500 GSF Accredited and 200 Reaccredited homes reveals sustained improvements in EOLC and ACP, showing a positive impact on the quality of care received toward the end of life. More proactive care is apparent, fulfilment of preferences leading to reduced crises and hospitalisation, enabling more to die at home. Staff morale and retention appeared to improve, the greatest threat being staff turnover. Conclusion The GSF Reaccredited/Accredited homes have maintained and improved their standards of care and ACP uptake ensuring consistency, continuity and sustainability. GSF Accredited care homes can sustain ‘gold standard’ care, despite staff turnover. GSF is becoming part of the UK industry standard as a national model of best practice.