NHS funded Live-in Nursing Case Studies

1. Mr. J.K.

JK is a 65 year old man living at home in a Northern Home Counties PCT area. He has motor neurone disease and has had a tracheostomy. He uses a bi-pap ventilator 20 hours daily and overnight PEG feeds. Mr. K. remains alert and is very strong willed.

JK walks resting his hand on the nurse's shoulder as she walks in front of him. He sometimes goes out for short periods on his motorised scooter. The nurse helps manage his daily affairs and gives assistance with money and paying bills. She accompanies him to the bank and Post Office. Mr. K. uses a light writer to communicate.

Mr. K. is able to live at home with the help of his partner, close friends and District Nurse. A stay in a nursing home had proven very unsatisfactory and distressing to the client so Consultus was engaged in December 2005 to provide professional respite nursing within the home, for occasional two-week periods.

It was subsequently noted that Mr. K. insists that his carers dismantle and clean his blocked gastrostomy tube. He also puts unreasonable pressure on non-qualified staff to do the same. This is against health authority rules and Codes of Conduct. A case conference held in September 2006 noted the demands of the role and recommended:

An appropriate nurse should henceforth always be on hand
Live-in Nurse rota should ideally comprise 2-weeks on, 2-weeks off with built-in handover time.

Consultus Live-in Nursing Service (CLINS) was commissioned to provide a live-in nurse at all times. Nurses work a standard 10 hours of nursing per day (daytime), seven days a week, at a cost to the trust of £1,103. In addition, the PCT meets the cost of any necessary night-time overtime, presently averaging £200 per week. Other costs to the client include a two-hour visit by a local (third party) agency care assistant which enables the nurse to take a break. The family meet the cost of nurses' meals and accommodation within the home.

We deal mostly through a Senior District Nurse sister at a local health centre who organises JK's Continuing Care package. Next of kin lives in Manchester.

CLINS has since been asked to provide a quotation for supplying two live-in nurses at once (a 'day nurse' and 'night nurse'). Sufficient private bedrooms exist at the property to facilitate two nurses' accommodation. We await the PCT's decision.

2. Mr. L.B.

LB is a 71 year old male from Mid-Wales. He lives at home with his wife thanks to the support of the Local Health Board, which funds his Continuing Care. He receives regular help from a District Nurse, Respiratory Nurse and domestic assistance from the local authority.

One year ago Mr. B. was healthy and had just obtained his pilot's licence. Today he suffers from pulmonary fibrosis, asthma, skin cancer, cervical spondylosis, tinnitus, depression and short term memory loss. He receives oxygen continuously via nasal prongs and uses two concentrators and a humidifier. He can walk unaided for short distances but uses a back-up oxygen cylinder and mask for trips to the toilet.

Mr. B's wife keeps a chart and likes to go through medication with the nurse personally.

Consultus was approached in June 2006 by LB's Continuing Care Manager and subsequently we were engaged to provide regular live-in respite care. We have provided a live-in nurse for one week each month since, at a cost to the Health Board of about £1,200 per month. This has allowed LB to remain at home where he and his wife most want him to be.

3. Mrs. K.H.

We were approached in August 2006 by a Nurse Assessor attached to a Social Services Dept in another part of Mid-Wales, who had been referred to us by Mr. B's Continuing Care Manager.

KH was a 57-year old woman living at home with her son, daughter-in-law and their new baby. She was suffering from end stage motor neurone disease, was immobile with a syringe driver in situ. She was prone to panicking and choking; it took 3 people to move her and night calls were increasingly necessary. Three local agency nurses called during the day but most of the time she was left alone with her family. A glide sheet, profiling bed and hoist had been fitted by OT.

Latterly, Mrs. H had become very anxious and demanding. It was felt her condition was exacerbated by seeing many different faces in the course of a week and that intermittent attention was insufficient. A stay in a nursing home had proved disastrous to her well-being as KH valued her privacy, dignity and family environment above all else.

After discussions and exchanges of notes and the care plan, Consultus agreed to provide KH with live-in nursing. After one week, local healthcare professionals reported fantastic progress and Mrs. H's panic attacks had subsided.

In the second week, the second phase of the plan was put into action and we began providing full time waking assistance via two live-in nurses, one working days, the other nights. The second nurse lived off-site in a nearby relative's home and was driven in each day by a relative or minicab.

The total cost of this dual nurse package was £2,860 per week. Overtime was very minimal because at least one nurse was always on duty. We understand social services met the cost of the nurses' accommodation through an arrangement with the LHB.

Sadly Mrs H passed away six weeks later. Her family reported that they were immensely grateful for the difference we had made to KH's quality of life and inner peace during her last few weeks. One of our nurses was invited to a meeting at the LHB where she and Consultus were roundly praised for their care and management of the case.

4. Mrs. D.B.

DB is aged 90 and lives on her own in a West Midlands shire county. Mrs. B. suffers poor circulation and an enlarged heart; she had a CVA four years ago. She has shortness of breath and has an oxygen cylinder/mask at home. She can walk with a Zimmer frame and transfers with help. Pain is adequately managed with medication. Condition is terminal.

Mrs. B. is very independent and has made it clear that she wants to remain at home near her church and friends.

While funding was being agreed, DB arranged a private service from Consultus and our live-in nurse met her at hospital on the day of discharge. The nurse received a hand-over from hospital staff and accompanied DB home, where she administers oxygen, medication and personal care as required. She also helps around the home, cleaning, cooking etc.

The PCT ultimately decided to part-fund the live-in nursing service: 6.5 hours of daily nursing would be provided by the trust, including 1.5 scheduled hours of care after 8pm, at our night rate. Such for a combined weekly cost of £791.00. Consultus invoices the family separately for the remaining 3.5 hours of daily nursing and any overtime. The nurse's accommodation costs are met by Mrs. B.