from service provision to community...
TRANSCRIPT
FROM SERVICE PROVISION TO COMMUNITY ENABLEMENTCompassionate Communities – The Milford Model
“Once upon a time…”
28,000 people die
1 in 4 die at home
IT MAKES SENSE
Death, dying, loss and care affect everybody and are not just issues relevant to health and social care professionals.
The experiences of death, dying, loss and care bring with them additional personal, health and social costs which are preventable and/or relievable if the right supports are available in the right place at the right time.
The majority of people living and eventually dying from advanced life limiting illnesses spend the greater part of their time at home being cared for and supported by family members, friends and neighbours.
Specialist Palliative Care Services developed historically in response to the care needs of those affected by and dying from cancer. Between 80% and 90% of patients cared for by these services have a cancer diagnosis. But the majority of people in Ireland do not die from cancer and many have limited access to Specialist Palliative Care Services.
Many people feel unprepared when faced with the experiences of advanced, life-limiting illnesses, death and bereavement and are uncertain as how to offer support and assistance.
Specialist Palliative Care Services have accumulated a wide range of skills, knowledge, expertise and information which are transferable to non-specialist settings, including the community and general public.
What is it like for people like Bill living with
an advanced illness and facing death, who
spend most of their last year of life at home,
in their community with family and friends?
–Carroll, 2010, Forum on End of Life
“I think we must look at the social context of
dying in Ireland today. In Ireland death has
been sanitised, put in the closet, so to speak.
Until lately, speaking about death had almost
become a taboo subject, resulting in a similar
denial and fear of death that is prevalent
throughout the Western World”.
SO WHAT DOES THAT MEAN FOR MILFORD?
The difficulty in talking about death, dying and bereavement (particularly to children).
The experience that the emotional impact of loss is often unacknowledged.
The cumulative and intense nature of the loss experienced by local communities particularly as a result of the number of young people who had died in tragic circumstances..
“She went up to the cemetery; she said every second grave at least was a young person. I suppose it’s only when you look at the bigger picture because in some ways bereavement is a personal thing because it’s just what happens around your circle. When you see all the circles and you see them together, it’s shocking”.
The recognition of death as profound and mysterious and the comfort and support found . in religious faith and belief in an afterlife.
Irish society was regarded as generally supportive of recently bereaved people. Ritual and remembrance of the dead were seen as important and as expressions of community solidarity for the bereaved.
Concern that bereaved people are not always allowed sufficient time and space to grieve, and that sometimes social and practical support are withdrawn too soon.
“Often around death there is a huge fuss at the time and there is quiet an intense kind of thing that goes on maybe for a few days or a week, but it is shocking then how much that is replaced by absolutely no intervention … there was a massive fuss. But then that just absolutely evaporated and then there was nothing”.
Immediate family and friends were seen as the most important sources of support for people living with a life limiting illness.
But sometimes people don’t know what to say or what to do.
McLoughlin, Rhatigan, Richardson 2011
‘How do we use the experience and knowledge of the
Specialist Palliative Care Service to support
communities, groups and individuals to enhance the
social, emotional and practical support available to
those living with a life-threatening illness, those facing
loss and those experiencing bereavement?’
THE COMPASSIONATE COMMUNITIES PROJECT
• An initiative of Milford Care Centre
• We are here to support people in the Mid-West to think a
little differently about death, to encourage people to plan
ahead, talk with others and offer practical support within the
community to those facing the end of life.
• A small change in our attitude toward death can make a big
difference to how we live.
BUT HOW ARE YOU GOING TO MEASURE IT?
54 5141
0
25
50
75
100
Nationally Mid-West Familiar with CCP
% of people who had taken NO action regarding
issues associated with death, dying, loss and care
e.g. Drawing up a will, thinking about who will attend
their funeral, considered organ donation etc
IHF 2014, Weafer Study.
P<0.00
4P<0.000
P<0.00
0Not sig.
Café Conversations (n=74)
4,53
3,16
2,1
3,06
4,76
4,18 4,18
2,88
0
1
2
3
4
5
Importance of Talking Understanding MCC Understanding CCP Difficulty talking
Pre
Post
Department of Psychology
BIL
L
Wife
Son
Sister
Best friend Pete
Work mates
Rugby pals
Neighbours
Parish
Community
organisation
s
Paid
services
I need someone
to cut the lawn
and tidy the
roses. I don’t
want to be
burden.
If only I knew
Bill needed
help...
Bill’s sick…but we
won’t intrude
Don’t
what to
say to
him.
Haven’t
spoken for
years
I am a
compassionate
communities
volunteer.
I find out what
the person
needs doing.
I mobilise the
person’s
network and ask
them to help.
I don’t do the jobs
myself…otherwise
I would burn out.
The people I
mobilise are the
Good
Neighbours
VOLUNTEERS
✓Maturity, common sense and the ability to be discrete and sensitive.
✓ A good understanding of ethical/confidentiality issues.
✓ The ability to confident and out-going, relate well to others and communicate effectively.
✓ A respectful and non-judgmental approach at all times.
✓ A good sense of humour.
✓ Good organisational skills and ability to complete paperwork.
✓ A good sense of personal boundaries and a clear understanding of purpose of the role.
7 WEEK TRAINING PROGRAMME
• Module 1 : Getting to know each other and the programme
• Module 2: Communication skills, confidentiality
• Module 3: Boundaries, understanding the Good Neighbour Partnership and making introductions
• Module 4: Assessing social and practical needs, identifying circles of community, developing and agreeing action plans
• Module 5: Understanding dementia.
• Module 6: Practice and rehearsal - professional actors
• Module 7: Safety, self-care, emergencies and endings .
BEANSTALK
✓ T – Talk to the
community
✓ A – Ask them to help
✓ L – Link people
together
✓ K – Keep an eye
✓ B – Breaks the Ice
✓ E – Explains the Good
Neighbour Partnership
✓ A – Assesses the
person’s social and practical
needs
✓ N – Network of
Community is determined
✓ S – Summarise and agree
the action plan
INSPIRE Study
Phase 0
Scoping studies
Systematic review
Interviews
Focus groups
Phase 1
Development of GNP
Recruitment, selection and training of volunteers
Brief Screening Tool
Pilot 3 patients
Phase 2
RCT
Department of Psychology
PRIMARY OBJECTIVES
To determine whether this new model of care can:
reduce unmet social and practical need;
reduce unplanned health service utilisation;
improve overall quality of life (including social connectedness and
psychosocial wellbeing);
increase the social networks and reduce isolation and loneliness;
alleviate caregiver burden.
FILM 2
COMPASSIONATE CITIES CHARTER (KELLEHEAR 2014)
“Through auspices of the Mayor’s office a compassionate city
will… develop and support 13 social changes to the cities key
institutions and activities”.
“A commitment by the city to embrace a view of health
and wellbeing that embraces community empathy,
directly supporting its inhabitants to address the negative
health impacts of social inequality and marginalization
attributable to dying, death and loss”.
“In other areas citizens have taken brilliant
initiatives such as the Compassionate Communities
project at Milford Care Centre in Limerick which
seeks to work in partnership with individuals,
groups and communities facing loss and those
experiencing bereavement.
The State must learn from these initiatives and
catch up with community-led creative solutions. We
need the panoply of State services to help us to
think, talk and tell about dying, death and loss and
enable us to support each other.”
Seanad 16th April 2014 Marie Louise O’Donnell
SOME THOUGHTS
It may take longer than you think – ground work is vital
People are compassionate, connect and want to be part of it
Despite your agenda, you will always attract bereaved people
In fact, this shouldn’t be about your agenda! But you still need a plan…
Staff need to be multi-talented
The team will need support and sources of renewal
Share what you develop – don’t be precious
Dare to be brave..and perhaps a little bit crazy.
FILM 3