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Difficulties experienced with hospice providing palliative care at home (00HDC11970)

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(00HDC11970, 8 December 2002)

District nurse ~ Hospice ~ Palliative care ~ Continuity of care ~ Co-ordination of providers ~ Right 4(1)

A woman complained on behalf of her family about the services provided to her father at home by a hospice and a principal nurse. The complaint was that the hospice: (1) provided inadequate pain relief; (2) provided inappropriate nursing care as (a) the patient's dehydration was not addressed, (b) the patient's mouth was in poor condition, (c) napkins were not supplied, and the patient's sheets needed changing regularly, (d) the patient was not provided with liquid foods, cream for bed sores, or nursing care on a daily basis, and (e) the nursing care at night was inadequate; and (3) there was not proper liaison between and co-ordination of health care providers.

The complaint also alleged that the principal nurse did not provide the necessary care when the patient required it.
The Commissioner reasoned that:

1 although the nursing care provided to the patient was generally appropriate and of a high standard, there were concerns that the communication, liaison and provision of care between the people and organisations responsible for providing care was not smooth;
2 the delay in the provision of services was not optimal given that there were only 15 days between the patient's referral to the hospice and his death;
3  the involvement of the patient's family could have been more effective with regard to the provision of mouth cares and management of faecal incontinence; and
4  the reference to a "24-hour service" meant that the service was available throughout the day, but did not mean the patient would be provided with constant hospice care.
It was held that the hospice and the principal nurse did not breach Right 4(1) with regard to any aspect of the complaint, but that the reference in the hospice's brochures to a "24-hour service" should be clarified.