Evaluating effectiveness of the GSFCH & LCP in care homes.

Background: The palliative care needs of older people residing in care homes are not always recognised. Approximately two-thirds of people in care homes have dementia. However, people with advanced dementia are not always recognised as having a terminal condition and, consequently, their end-of-life care needs are not well understood. The Gold Standards Framework in Care Homes (GSFCH) and the Liverpool Care Pathway for the Dying Patient (LCP) (care home version) are advocated to improve the quality of end-of-life care in care homes. However, evidence on the efficacy of such tools to improve outcomes or change practice is lacking. Aim: The aim of this research was to evaluate the impact on the quality of end-of-life care of the GSFCH and LCP in care homes with nursing. Methods: Qualitative interviews were conducted with 22 bereaved relatives/friends before, and 14 bereaved relatives/friends and six care home managers after, implementation of the GSFCH and LCP into seven care homes with nursing. Content analysis guided by the 7Cs of the GSFCH was conducted. Results: Care home staff changed their attitudes about dying. This enabled more informed end-of-life decision-making involving families/friends, staff and GPs. Findings suggest that improvements in care of the dying occurred following implementation of both tools. Conclusion: The GSFCH and LCP improve end-of-life care by influencing end-of-life culture, decision-making and practice.