Author: Rosee Swift, Registered Nurse, Wellbeing at Home Coordinator
Date: October 2023
The Wellbeing at Home Service brings our range of bespoke and personalised wellbeing care and support into your own home.
Monday
At the start of each day, I check that the Wellbeing at Home nurses and Health Care Assistants (HCAs) are all available for work with a text “Morning from the Mothership”. I check that everyone is okay emotionally and physically to start their day.
I also check planned visits are still going ahead. Our Hospice at Home Team let us know if a patient’s health has declined and if they are needing more symptom support. Or sometimes a family asks for extra support during the day because they are exhausted emotionally and physically. Today, a visit has been cancelled because the patient is too unwell, and family are now visiting.
Ensuring patients have continuity of care
If I have been On Call on an evening or weekend, I can also identify patients or families in need of some extra support. This can be a shared patient already known to us, or it may be a new referral. We then work with the Hospice at Home team to maximize support. I enjoy planning this continuity of care delivery.
I take a phone call from a patient’s wife wanting some reassurance. She is feeling guilty about how she feels about her husband’s diagnosis. At the end of the call she is brighter, and I have signposted her to counselling. I also suggest she comes to our drop-in Wellbeing Café on a Thursday.
There’s a call from a patient’s daughter to ask if we can arrange a Wellbeing at Home visit for her dad. This is so that she can take her Mum out to lunch and have a much-needed break from caring.
The importance of staff wellbeing
I monitor the Wellbeing at Home mobile phone throughout the day to ensure all staff have safely arrived and departed after their home visits. We also remind the team they can call or message us if they are in need of a debrief.
The nursing team let us know if they have concerns about the person they have visited and have requests for District Nurses or GPs to do follow-up visits. Or we refer to other Treetops teams for care and support.
We’ve had three new referrals during the day, and I begin to review our patient waiting list. I end the day by provisionally booking visits for the next few weeks. I try to make sure nurses or HCAs visit the same patients and families, to ensure consistency and continuity wherever possible.
Tuesday
We put our heads together about planning patient visits. This includes looking at each patient’s needs, their carer’s health and age, and mileage between visits.
It's the part of the job when I imagine we should have little cars on sticks and move them around the map, plotting out the most effective route for patients, staff members and the service. Like the RAF flight planners in an old black & white film!
I make a referral to our Complementary Therapy team and take calls from three families to confirm visits.
Each carer I speak to has a small ‘off-load’. I know carers find it helpful to speak to someone who treats them as a person and not just a carer, and someone who really listens.
Support for carers
Carers can easily get stressed and exhausted and then can’t continue to support their loved one. This is especially the case if a patient has dementia. A carer’s world can become very silent and isolated as their loved one may not be able to communicate or even have a conversation. We are there for them emotionally and physically.
I email a patient’s daughter who lives in Australia to try and arrange a Zoom call. The patient has a non-malignant brain tumour. As a result she has short-term memory problems and sometimes struggles to make decisions. Her daughter has lived in Australia for 25 years and telephones her Mum every Sunday. She also sends regular photos. During a Wellbeing at Home visit, the patient shared that she thought she would never see her daughter again so, we discussed arranging a Zoom call.
We receive a referral to cover a funeral. A patient’s husband died suddenly, and he had been her main carer. I have a 40-minute conversation with their daughter. We’re able to provide support for the funeral and agree that the family would benefit from some Wellbeing at Home visits before and after the funeral.
Helping patients to share memories with loved ones
A Wellbeing at Home HCAs drops into the hospice to collect items for some legacy work. She is helping two patients complete memory books. One lady wants to write letters to her husband and children. She also wants to write down special memories, and as she is now unable to write herself, she dictates and the HCA writes.
The second book is for a lady who cannot read or write. She wants to leave photos, memories, and letters for her grandchildren. I am concerned that it may be emotionally draining for the HCA and encourage everyone to attend supervision sessions.
At the end of the day, I make a referral to the benefits advice service and once again, review our patient waiting list.
Wednesday
I take a phone call from a daughter who is angry and upset about what’s happening to her dad. She feels everything is very unfair. I listen and try to give reassurance. She shares with me that she found it easy to talk to me because she doesn’t ‘care’ about me. I know exactly what she means.
I cover a Wellbeing at Home visit so a carer can attend our Wellbeing Café to offload, speak to someone about benefits they may be able to apply for, and have some time out.
Over a cup of tea, we have a discussion with the Treetops Occupational Therapists about a Wellbeing at Home patient who has no equipment around the home and would benefit from an assessment. Our Occupational Therapist agrees to liaise with the family and community team.
Thursday
We receive chocolates and thank you cards when a family call into the Wellbeing Café to say hello! I have spoken to and emailed this family for the last 10 months. Dad died and they came in for a hug and to say thank you. Their visit is made more poignant because I have spoken to this family at their most frightened and vulnerable but never seen them face to face.
I’m asked to go into the Wellbeing Café to speak to a gentleman and his wife. She has a life-limiting condition, and he is unable to leave her on her own. He is deaf but can lipread really well. We complete a referral and agree to email to arrange visits, instead of telephoning.
Bespoke care for patients and carers
There’s another referral via the Wellbeing Café. A gentleman who is 94 and caring for his wife who is 90 and living with Alzheimer’s Disease. He shares with me that he is worried about having people in their home “because you hear about such terrible things happening”. I reassure him that our Wellbeing at Home staff are in Treetops uniform with a logo, and that they have identification on them.
He says that he would like to go out, maybe to the barbers, but is not sure. I reassure him that I understand his anxieties. We don’t have strict criteria about him leaving the house. He can go for a nap, go out in the garden, or stay for a chat.
He goes on to tell me that he and his wife have been married for 65 years and he feels it is his responsibility to look after her. But he feels really guilty as he’s feeling resentful because they are unable to do things. We share a joke about not getting any younger and I stress the importance of looking after himself to care for her. He ends our call by telling me I must be an angel. I assure him he doesn’t know me!
We continue to get several referrals in the afternoon from District Nurses and make another referral to our Complementary Therapy team.
Friday
A lovely box of tea bags, a jar of coffee and some biscuits are delivered to the hospice as a thank you. It’s time to have a chat with the volunteers on reception and make them a cup of tea.
I refer a patient who’s approaching end of life to our Hospice at Home team as his family are asking for extra support at night.
Liaison with other local services
It's a busy day on the phone. A District Nurse gets in touch asking us if we can visit a patient and help get them washed and dressed every morning. I explain that we are not a care service, but if one our members of staff is visiting and a patient needs support with activities of daily living, we will help them.
I’m asked to speak to a member of the Tears to Laughter bereavement support group. She has an elderly relative with a life-limiting condition and feels they would benefit from the Wellbeing at Home support and befriending support.
A daughter of a patient calls to ask if we can visit every day because she is concerned about her mum who is looking after her dad.
We end the week with all visits finished and everyone looking forward to the weekend.