NHS funded Live in Nursing Case Studies
1. Hertfordshire PCT
JK was a 65 year old gentleman with Motor Neurone Disease living at home. He had a tracheostomy, PEG in situ for all his nutritional requirements and medication and used a Bi-pap ventilator 20 hours daily. JK communicated with the use of a light writer and, although greatly restricted in his movements, he enjoyed an enhanced quality of life by being at home. A stay in a Residential Nursing Home had proven very unsatisfactory and distressing to JK, so Consultus was commissioned to provide live in nursing.
A schedule of hours was arranged with the PCT from the outset and the Nurses worked a standard 10 hours per day, seven days a week. The PEG feed would be set up to run overnight and the patient was also ventilated at this time. If the Nurses were required at night then the Client would ring for them but this was not a regular occurrence. Any extra time, outside of the agreed schedule of hours, was discussed with the PCT if the Nurses were unable to retrieve this time during the day. Consultus liaised with a Senior District Nurse who organised JK's Continuing Care package.
2. Powys LHB
LB was a 71 year old male from Mid-Wales. He lived at home with his wife thanks to the support of the Local Health Board, which funded his Continuing Care package. He received regular help from a District Nurse, Respiratory Nurse and domestic assistance from the local authority. LB suffered from Pulmonary Fibrosis, Asthma, Skin Cancer, Cervical Spondylosis, Tinnitus, Depression and short term memory loss. He received Oxygen continuously via nasal prongs and used two concentrators and a humidifier. He could walk unaided for short distances but needed a back-up Oxygen cylinder and mask available at all times.
Consultus was approached by LB's Continuing Care Manager and subsequently engaged to provide regular live in Respite Care. Consultus provided a Nurse for one week each month to allow his main Carer, LB’s wife, to take a much needed break. The Health Board met this cost and, by so doing, allowed LB’s wife to continue to care for him so he could remain at home where he was happiest.
3. Welsh PCT
KH was a 57 year old woman living at home with family. She was suffering from end stage Motor Neurone Disease and was immobile with a syringe driver in situ. She was prone to panic attacks and choking; it took 3 people to move her and night calls were increasingly necessary. Local agency Nurses called during the day to assist with nursing care and hoisting, but at other times she was left alone with her family. A stay in a Residential Nursing Home had been very unsuccessful as KH valued her privacy, dignity and family environment. Consultus was approached by the Local Health Board (LHB) and agreed to provide KH with live-in nursing. KH required 24 hour nursing care, so two live in Nurses were provided; one assigned for days, the other for nights. A schedule of hours was worked out initially with LHB and the Nurses strictly adhered to this. KH’s family reported that they were immensely grateful for the difference Consultus Nurses had made to her quality of life and well-being during her last few weeks.
4. West Midlands PCT
DB was aged 90 and lived on her own in the West Midlands. She had a stroke four years previously, suffered poor circulation and had Congestive Heart Failure. DB required the administration of oxygen regularly and initially was able to mobilise short distances; later she required full nursing care in bed. DB had been very independent and made it clear that she wanted to remain at home near her church and friends. While funding was being negotiated, DB arranged a private Nurse from Consultus so that she could leave hospital where she had been for several weeks following a deterioration in her condition. The Nurse received a hand-over from hospital staff and accompanied DB home, where she administered oxygen, medication and provided all personal and nursing care; she also liaised very closely with the GP and District Nurse.
The PCT ultimately decided to part-fund the live-in nursing service and agreed to pay 8 hours of daily nursing care including the Nurses’ travel expenses. Consultus invoiced the family separately for the remaining hours of care. By agreeing to this package, DB was able to enjoy her last months in the comfort of her own home.
5. Welsh PCT
Mr G is a 63 year old gentleman who lives on his own with family members nearby. He suffers with COPD, has a history of bowel obstructions and is fed by Total Parental Nutrition (TPN). He has a large abdominal stoma consisting of multi fistulae; the stoma bag needs to be changed every two days. Mr G had spent over 18 months in hospital before a Continuing Care package was agreed with Consultus. Initially, a schedule of hours was agreed with the PCT for the Nurse to work a 10 hour day (09.00 – 21.00), with one hour agreed overtime each day from 22.00 to 23.00. The Nurse is flexible with her hours and if she has worked longer on one day, then she will endeavour to adjust her hours the next day. The Nurse starts the TPN feed overnight and takes it down in the morning. There are generally no night calls, although the Nurse is available, if required. Consultus liaises very closely with the Intergrated Health Care Manager in Wales and all Nurses receive extensive training in TPN feeding.
6. Cheshire PCT
Mrs R is a 71 year old widow who lives on her own in Cheshire. She had a benign meningioma which was removed 3 years ago. Unfortunately, whilst in hospital recovering from this surgery she suffered a stroke. Following a prolonged period in hospital and subsequently in a nursing home ,she was finally discharged home with a Consultus Nurse.
Mrs. R suffers with dysphagia, is fed by PEG and needs regular suctioning; communication is via an alphabet card.
The Continuing Care Manager approached Consultus and asked us to provide a live-in package for 10 hours a day. It was agreed from the outset that any overtime or night calls would be paid by the family. This arrangement works well and Consultus issues two separate invoices for this Client.
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