Virginia nursing home transforming end-of-life care

Staff in Virginia Community Health Centre in Cavan have transformed the way they deliver end-of-life care.

Staff in the centre have taken part in two Irish Hospice Foundation programmes -  'What Matters to Me' and Journey of Change. Since then when a resident dies in the centre, they are waked in their own room rather than the unit’s mortuary.

Their coffin leaves through the front door of the centre – with staff and residents forming a guard of honour to say their final farewell.
These are two of the many changes the unit has made and continues to make as they strive to improve end-of-life care for residents, families and staff.

Person in charge, Bernardine Lynch said: “Many of our residents have single rooms, therefore if a resident becomes ill and dies they are no longer removed to the mortuary unless that was their specific wish.
“A resident who has died remains in their room until the removal of their remains. Their family, neighbours and friends are welcome to come to pay their final respects to the resident and sympathise with relatives. Other residents can have quiet time with them too. This is very important for other residents, because they have become friends and they have become like family. They have the opportunity to say goodbye which is very important for their healing.

Bernardine added: “We have had residents requesting that we do the same for them when they die. These changes mean so much for the staff also as they become close to the residents. They build relationships and close bonds with the residents and their families, whether it be for six months, six years or twenty years. They become extremely attached to them.
“It’s not like being in an acute hospital. It really is like an extension of your own family.
“We have lovely white linen and sheets specifically for death, dying and bereavement. We put the End-of Life symbol outside the deceased resident’s room door with the story behind it. We lay a table with specific symbols like a candle, cross, holy-water, bible etc reflecting their religion. The majority of our current residents are Roman Catholic.”

Bernardine said when visitors attend the unit they are alerted that a resident has died as the End of Life Symbol is displayed at the entrance to the ward where the deceased resident is reposing.
There is also a large End of Life sign and story painted on the wall at the entrance to the Centre to show that the unit has embraced the Journey of Change programme to strive for the best end of life care.
She said: “When a resident is being removed from the centre, they no longer leave through the mortuary door. They are removed through the front door and the staff on duty and any resident who wishes to participate form a guard of honour from the building to the road.

“We had one resident and his absolute favourite hymn was Amazing Grace. At his removal from the centre we formed our own little choir and sang the hymn for him.”
“We have had undertakers come back and compliment us on our practice, saying they had never seen it done before. We often have family come back and say thank you. It means an awful lot.'
Bernardine said that providing best end- of- life care for residents was always a priority for the centre but the two Irish Hospice Foundation programmes have made a real difference.
She said: “We have always felt that end-of- life care was something we did do well. I always felt it was an honour to look after a person in their last minutes, weeks, days or months of life. It’s something that was always very important to us in this unit.

We participated in the 'What Matters to Me Programme' initially facilitated by HSE Training Specialist Thelma Pentony and this got us re-focused and rethinking.

Bernardine said: “Thelma was such a pleasure to work with,such an inspiration to us all. She brought out the best in everybody. Everyone including nurses, healthcare assistants, catering, cleaning staff and the management teams participated in the training.
“When a resident dies you really only have one chance to get things right. We all thought about what would matter to us personally at end-of-life.
“Quietness, soft music and family and having the people they loved around us were the most common things.“

Following on from this programme, they took part in the Journey of Change Programme and set up a CEOL Group which is the Compassionate End of Life Review Process.
These meetings take place after the death of a resident to reflect on the end-of-life care.
Bernardine said: “Everybody talks and gives their opinion on what we did well and what we could do better the next time. So we are trying to reinforce what was good and do things better and better all of the time.
Currently there are 29 residents at the Virginia Health Care Centre. The nursing home is one of more than 100 across the country that has taken part in the IHF’s Journey of Change Programme.

Marie Lynch, head of Irish Hospice Foundation’s Healthcare Programmes said: “Journey of Change was developed to support staff to continuously review and enhance the culture of person-centred end-of-life care in their residential care centre.”

It begins with What Matters to Me workshop where staff have the opportunity to explore end-of-life care from different perspectives and enhance communication skills with residents and their families.
The CEOL – Compassionate end of life Review process workshop gives staff skills to facilitate CEOL review after the death of a resident to review and reflect on the care provided. The second part of this process involves getting feedback from bereaved relatives and friends three months after the death of a resident.

It means their feedback can be incorporated to quality improvements in end of life care in the residential care setting.
For further enquiries on the Journey of Change Programme contact: ajourneyofchange@hospicefoundation.ie