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SERVICE PROVISION AND ACTIVITY

5.2 Day Care Provision,

One of the goals of specialist palliative care is to provide care for patients in the most appropriate setting. As patients and relatives often express a choice for care at home, there has been a shift in focus to community-based services. The evolution of day care can be seen in relation to the overall development of services in the community.

The NACPC has recommended that all specialist palliative care units should provide day care facilities for patients and carers.

At December 2004 there were five specialist inpatient units providing day care services. These were St Francis Hospice in the Northern Area (ERHA); Our Lady’s Hospice in the South West Area of the ERHA; the Galway Hospice Foundation at Renmore; Milford Care Centre, Limerick and Marymount Hospice, Cork (see map, p. 58). Each unit provided an average of three day care days per week, typically accommodating around 11 patients per day. The five units together provided day care services for 538 patients, accounting for 5,961 attendees, over 2004 (see Table 5.3). It is notable that all of these existing day care services are associated with established specialist palliative care inpatient units. However, there will be an exception to this rule in Kilkenny where, despite the absence of a specialist inpatient unit in the area, a day care service is expected to commence in late 2005.

Table 5.3 Specialist palliative care: day care activity nationally, 2004

5 3.2 11.4 538 5961

Those areas with specialist inpatient facilities that have yet to develop day care provision are the East Coast Area (ERHA) and the North-Western Health Board area.

5.2.1 Range of day care services

During the data collection phase of the Baseline Study, descriptions were gathered from each of the specialist inpatient units providing day care services, with a view to gaining a picture of the range of services available within their day care provision. This approach acknowledges that there is a range of models of day care in operation across the country. The diverse descriptions offered here are only a ‘first glance’ and in no way obviate the need for more rigorous qualitative and quantitative research into the evolution of day care services in the field of palliative care in Ireland.

Number of units offering day care

services

Average number of days per week

Average number of places per day

Number of patients annually Number of day care attendees annually SERVICE PROVISION AND ACTIVITY

59

Our Lady’s Hospice, Harold’s Cross

The day care service at Our Lady’s Hospice has changed following a recent review. Based on the review, a predominantly social model of care has now moved to a model of care which is rehabilitative in approach. The aim is to provide support and enhance independence and quality of life for patients and their carers. The multidisciplinary day care team includes:

• nursing

• occupational therapy

• physiotherapy

• complementary, artistic and supportive therapy (CAST)

• secretarial support

• volunteers

Medical Clinics are also held in the Day Hospice. The service is open five days a week. Patients may attend for individual appointments with Occupational Therapy, Physiotherapy or CAST from Monday to Friday. Patients may attend for a full day (10.45 a.m. to 3.00 p.m.) on a Tuesday, Wednesday or Thursday when the nursing team is available. Each patient has an individual programme of care created to meet their needs.

St Francis Hospice, Raheny

The day care service at St Francis Hospice was expanded in 2004 to include complementary therapy services. Patients can avail of the following range of services:

• nursing and medical assessment

• nursing care

• complementary therapies e.g. aromatherapy, reflexology

• hairdressing/beauty therapy

• social activities

• refreshments and a midday meal

• pastoral care

• recreational art

• outings and day trips.

The service operates for four days each week, accommodating 16 attendees per day.

Galway Hospice Foundation, Renmore

The service at Galway Hospice offers:

• medical review/treatments

• nursing care

• creative arts therapies

• complementary therapies

• physiotherapy

• dietetics.

The service operates for two days each week, accommodating seven attendees per day. Pastoral care, chaplaincy and social work services are also available as required. Patients can avail of chiropody, hair care, assisted bathing, jacuzzi, group and individual games.

Milford Care Centre, Limerick

The range of services available at Milford’s day care facility include:

• nursing assessment and care

• physiotherapy

• occupational therapy

• complementary therapies

• hairdressing/beauty therapy

• social activities

• art and music therapy

• pastoral care

• personal care

• recreational art

• horticulture therapy.

The complementary therapies include aromatherapy, Reiki and reflexology. The service operates two days each week, accommodating 12 attendees per day.

Marymount Hospice, Cork

Marymount Hospice offers a five-day (Monday to Friday) service with eight places available each day. Transport is provided. The service includes access to:

• medical assessment and interventions

• nursing care, physiotherapy

• pastoral care

• social work support

• chiropody

• hairdressing

61

1 This figure does not include data on activity in the NEHB and the SEHB and therefore underestimates the level of activity over 2004.

5.2.2 Future day care service development plans

The NACPC report recommended that all specialist palliative care inpatient units should provide day care to patients and families. A specialist palliative care day care service is currently being developed in Blackrock Hospice and is expected to be operational before the end of 2005. The Northwest Hospice, Sligo, has access to medical assessment and interventions, nursing care and physiotherapy for only a small number of cases. The hospice has noted that the formal introduction of day care will involve employment of new staff and a capital programme: their service agreement has a clause agreeing to discuss the development of day care services within the coming three years. There are plans at Kerry General Hospital for the development of a specialist palliative care day care service to start in 2006. This will precede the development of a planned specialist inpatient unit in the same location. In the former South-Eastern Health Board area, where no inpatient unit currently exists, there are advanced plans to commence a day care service in St Luke’s Hospital, Kilkenny by the end of 2005.