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Review

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October 2011

Tauranga House of Travel wins Hospice Embrace Award A mix of classic fundraising events and innovative new efforts for Waipuna Hospice earned Tauranga House of Travel this year’s Embrace award. In recognition of the ongoing corporate partnership between House of Travel and hospice, the Embrace award is given to the House of Travel outlet that has integrated their local hospice into every aspect of the business. House of Travel has been a national partner of all hospices throughout the country since 2005 – this partnership is based on raising awareness, giving support and

increasing knowledge of hospice in the local community. Shane Kennedy, owner of Tauranga House of Travel, said his staff were thrilled to receive the award at the House of Travel national conference in June. “It was also nice to have an award that was not sales related, to acknowledge that we do give back.”

In This Issue: Standards for people approaching the end of life............................. 3 Fundamentals of Palliative Care training launched........ 5 Assessment shows increased need for palliative care...................... 7 Around & about................... 9


Tauranga House of Travel started cruise ship tours as a fundraising activity for their local hospice, Waipuna, in 2007. The idea that has since been taken up by House of Travel outlets in other port cities. Over the last four years, the Tauranga team have raised $33,365 for Waipuna Hospice from the cruise ship tours alone. In recent years the cruise ships have limited the number of tours they have been able to hold, so this year the team organised a new fundraising activity - a dance party for over 30’s. Over 270 people attended the High Flyers Dance Party, held in an aircraft hangar.

Photography awards for photographs in the last two Waipuna Hospice calendars. Shane said the partnership with Waipuna Hospice gave the staff some balance. “For me it’s about keeping life real. It’s important to have a reminder that there’s another purpose to working hard.” “I say to them, if you think you’ve had a hard day, think about the families sitting around a bed at the hospice because it’s harder there.” Waipuna Hospice CEO Richard Thurlow said the House of Travel team were good advocates of hospice and Shane took every opportunity to mention their partnership.

Trish Rae, fundraising manager for Waipuna Hospice, said the party raised $9500 and was a fantastic “For me it’s about keeping life way to raise awareness with a section of the community that may not have real. It’s important to have a had a lot of exposure to hospice.

reminder that there’s another working hard.”

“The amount of time, energy and purpose to attention to detail that the House of Travel staff put in to ensure a successful event cannot be underestimated. While the Tauranga office is extremely busy, Shane and his team are committed to the partnership with Hospice and are always looking for opportunities to extend their support of Waipuna,” she said.

They display newsletters and information about Waipuna Hospice and sell cards, calendars and tickets to events on the Hospice’s behalf. One of the Tauranga House of Travel staff, Alana Dresner, is also a professional photographer. She volunteers her time to photograph for Waipuna’s annual fundraising calendar and promotional material. She has won New Zealand Institute of

A unique piece of art is created each year for Embrace award prize. This year, the award was a painting created by an art therapy group at West Auckland Hospice representing the departure of the Godwit from New Zealand to Alaska.

“The group felt a bird was fitting with the stage they are at in their journey - one of leaving to take flight and the idea that these little birds battle to get where they are going, and with ‘journeys’ being the business of the House of Travel. What a wonderful synergy and beautiful piece of art,” said Jo Seagar, Hospice New Zealand ambassador when awarding the prize. The painting now sits proudly on an easel at the front of the House of Travel Tauranga store. The Embrace award is judged by Hospice NZ CEO Mary Schumacher. Nominations open for the 2012 award in February.

Previous winners of the Embrace Award include: 2006 - Dennis Payne and the team at HOT Orewa nominated by Hibiscus Coast Hospice 2007 - Stephen Gillingham and the team at Stephen Gillingham HOT nominated by North Haven Hospice 2008 - Tony Laker and the team at Laker House of Travel nominated by Hospice Southland. 2009 – Pam Turner and the team at Rotorua House of Travel nominated by Hospice Rotorua 2010 – House of Travel Dunedin nominated by Otago Community Hospice

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Standards for people approaching the end of life – a commitment to continuous quality improvement. Ensuring anyone approaching the end of life receives a high standard of care, regardless of where they live, may sound like a lofty goal, but that is precisely the motivator behind the Hospice NZ project dedicated to developing a national set of standards for end of life care. The Standards have been developed to enable hospices to improve the quality of their care. The Ministry of Health funded Hospice New Zealand to develop the Standards and an associated quality assessment programme following the national stock-take into palliative care service provision in 2009. “It is critical that hospices demonstrate continuous quality improvement and we need a standardised tool and approach across the sector,” said Maree Meehan-Berge, Project Manager for Hospice NZ. Karen Talbot, Director of Clinical Services at West Auckland Hospice and pilot participant said she sees the development of The Standards as a step forward. “It will be good to see it come to fruition so it becomes an effective tool.” Suzie Kuper, Clinical Team Leader at Lake Taupo Hospice, said the

Hospice New Zealand Standards were more helpful in assessing the care they provide compared to a DHB audit they had recently undergone. “We were able to capture in more detail what we do. It gave us a really clear snapshot of what we want to achieve and, as a small hospice, who we might need to collaborate with to ensure we are in line with best practice.” The 14 standards were based on the Palliative Care Australia standards, adapted to suit New Zealand. To assess how well they are achieving the standards, a hospice assembles a team with representatives from all service and professional areas (and ideally including and consumer and volunteer representation) and discusses the quality of care they are providing. Each of the 14 standards is broken into quality elements for the hospice team to rate the frequency which the

An overview of the Hospice NZ Standards Standard 1 – Values based care A competent and compassionate palliative care service provider reflects the philosophy, values, organisational culture, structure and environment in keeping with the core values of quality end of life care. Standard 2 – Ensuring equitable access Access to end of life care is available for all people based on need and is independent of current health status, diagnosis, age, cultural background or geography. Standard 3 – Coordinating care Care is coordinated to minimise the burden on patient and their family/whanau. Standard 4 – Providing holistic care The holistic needs of the patient and their family/whanau are acknowledged in the assessment and care planning process. Standard 5 – Meeting the cultural needs of patients and their family/whanau The unique cultural needs of the patient and their family/ whanau are acknowledged Standard 6 – Providing people centred care Decision making and care planning is based on a respect for the uniqueness of the patient and their family/whanau. Standard 7 – Ensuring ongoing assessment and planning Ongoing and comprehensive assessment and care planning are undertaken to meet the needs and wishes of the patient and their family/whanau.

Standard 8 – Caring for patients who are dying The unique needs of dying patients their family/whanau are considered, their comfort maximised and their dignity preserved. Standard 9 – Caring for the carer/s The primary carer/s is provided with information, support and guidance about their role according to their needs and wishes. Standard 10 – Providing bereavement care Formal mechanisms are in place to ensure that the patient and their family/whanau have access to bereavement care, information and support services. Standard 11 – Building community capacity Community capacity to respond to the needs of people who are approaching the end of their life and their family/whanau is built through effective collaboration and partnerships. Standard 12 – Quality and research The service is committed to quality improvement and research in clinical and management practices Standard 13 – Professional development Staff and volunteers are appropriately qualified for the level of service offered and demonstrate ongoing participation in continuing professional development. Standard 14 – Reflective practice and self care Staff and volunteers reflect on their practice and initiate and maintain effective self care strategies.

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hospice is able to achieve that element of care - never, rarely, sometimes, often or always. The assessment team then prioritise areas of improvement and target those quality elements in their action plans. Hospices will be able to get a summarised analysis of their results compared with all other hospices’ results. A thematic analysis of the improvement actions generated through the assessment process will be produced for participating hospices and Hospice New Zealand. It is proposed hospices will undertake self assessment every two years once the standards are launched, with peer review input and support on the alternating years. Hospice New Zealand consulted widely when developing the standards and assessment framework. Over 140 people within the palliative care sector attended stakeholder meetings in seven regions. A special hui was held in Auckland in September 2010 to seek advice and input from Maori hospice and health workers. The Palliative Care Council, Palliative Care Nurses New Zealand, Palliative

It is proposed hospices will undertake self assessment every two years once the standards are launched, with peer review input and support on the alternating years. Care Advisory Group, Australia New Zealand Specialist Palliative Medicine and Hospital Palliative Care New Zealand were also consulted. Representatives from hospices, audit providers, DHBs, primary care and aged-care providers across New Zealand made up the Governance and Working Groups for the Standards project. Throughout the consultation, many palliative health care workers expressed their concerns that the new standards and assessment would further burden hospices when they are already required to undertake many audits for quality assurance. Initially it was thought these concerns would be addressed by shifting the document to be a quality assurance tool to supplement other audit tools, however as the project progressed it was decided that the intent was significantly different. “The Standards project was intended to improve quality, not only measure quality, and a national self assessment programme is the only convincing way to achieve this,� says Mary Schumacher, CEO of Hospice NZ. Hospice New Zealand has discussed streamlining the quality assurance processes hospices are currently required to undertake with the Ministry of Health and will form an audit related project around this issue in the future. Depending on the scope of the changes suggested by pilot participants, the standards are due to be finalised in February 2012. Hospice NZ will then begin rolling out the standards and assessment programme to all member hospices. The hospices that have been part of the standards pilot will trial peerreview assessment in 2012. Maree says Hospice New Zealand hoped all hospices will be using the standards within two years.

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Fundamentals of Palliative Care training launched People working in aged residential care facilities across New Zealand will be given the opportunity to participate in palliative care training from October, when the Hospice New Zealand Fundamentals of Palliative Care education resource is launched. “We recognise the importance of working in partnership with our colleagues who are providers of palliative care which is why we have developed, with funding from the Ministry of Health, The Fundamentals of palliative care training resource. The series of

showed a need for consistent education programmes for generalist providers across the country. Nine packages have been developed by Hospice New Zealand, with input from aged residential care facilities. The packages

Each learning package has a self-learning component to be completed prior to the formal training sessions and a post learning evaluation to encourage reflection. 9 learning packages provides a range of tools and information to enable healthcare professionals in a range of settings – aged residential care, district nursing, GP’s, to confidently provide the very best care to people approaching the end of their lives.” Said Mary Schumacher, CEO, Hospice NZ. Educators from local hospices will run the courses in the same way they run the Hospice New Zealand Syringe Driver and Care Assistant education courses, but will co-facilitate some packages with expert aged care and gerontology educators where possible. The Ministry of Health funded the development of the courses after their national stock-take of palliative care provision in 2009

provide a range of tools and information to enable rest home staff to confidently provide appropriate care to residents who are approaching the end of their lives. Each learning package has a self-learning component to be completed prior to the formal training sessions and a post learning evaluation to encourage reflection. Pilot courses were run from May until July at North Haven Hospice - Whangarei, Arohanui Hospice – Palmerston North, Mary Potter Hospice – Wellington, Otago Community Hospice – Dunedin and Hospice Wanganui.

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An educator from each hospice worked with two to four aged care facilities in their region. The hospice educator led the training sessions, drawing in other experts in various subject areas as appropriate. For example, the educator at Hospice Wanganui asked a psychiatrist and registered nurse to co-present the dementia package with her. Hospice New Zealand Education Project Manager Maree MeehanBerge said the feedback from the pilot courses was very positive and only minor modifications to the learning materials were required.

Fundamentals of Palliative Care Learning Packages 1. Essence of palliative care This package defines palliative care and end of life care and discusses the palliative approach that is the underpinning philosophy of care for residents with life limiting illness 2. Ethical issues in palliative care

Following the training, a registered nurse from Dannevirke commented; “I feel I will be more aware of the uniqueness/individuality of each person and their specific problem and pain process. I will ask myself what type of pain is this person suffering - physical, psychological, spiritual?” A range of aged care staff attended the pilot courses. The majority were health care assistants and registered nurses, but there were cooks, recreation therapists and managers too. “Some facilities did see that all staff would gain from attending, that it’s a whole team opportunity and experience,” said Maree. During September, ‘train the trainer’ workshops were run in eight regions. Hospice educators who attended these sessions will now roll-out the courses to facilities in their area. The hospice educators will work with their aged care colleagues to establish the best format for the courses. For example, in the Whangarei region pilot, care assistants from six different facilities attended a one-day seminar whereas others chose to have weekly one-hour sessions. Over the next two years Hospice New Zealand will work with other health care professionals to modify the resource to ensure the suitability for provision in other settings such as hospitals and general practices.

Ethical issues occur in end of life care but with the right skills and decision making processes staff will be enabled to assist residents and families in the best way possible. 3. Pain and symptom management Residents with advanced disease may experience symptoms which will have significant impact on their quality of life. In this session, discussion is around assessment of symptoms, careful planning and management of care and on-going evaluation. 4. Palliative care for people with chronic illness This session looks at the challenges for people with chronic illness and ways to improve their quality of life. 5. Palliative care for people with dementia Staff will learn skills in the holistic assessment of pain and symptoms in end stage dementia, how to minimise the burden and strain experienced by family/carers, and decision making skills in end of life care. 6. Communication skills In this session we will explore how we communicate and what can cause challenges as we communicate with residents, their families and our team members. 7. Last days of life Inevitably residents will die and care provided during the last days and hours of life has profound effects on the resident, the family and on the care team. There is only one opportunity to get it right and this session will assist staff in developing the skills to make those last hours positive memories for family. 8. Loss and grief The importance of the care we give at the end of life and after death will be explored during this session. We also look at our own grief and the importance of self care. 9. Caring for ourselves Those in the caring professions are compassionate and caring individuals working with people who are suffering and are therefore at risk of stress and burnout. This session is therefore designed to provide staff with time to reflect on their wellness and look at ways to maintain it.

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Assessment shows increased need for palliative care The first comprehensive needs assessment of palliative care in New Zealand has shown that there will be significant increase in those likely to need palliative care in the next 15 years. Phase 1 of the National Health Needs Assessment for Palliative Care was released by the Palliative Care Council of New Zealand in June 2011. The report determined the number and characteristics of people that would benefit from palliative care now, and in 15 years, to help health care providers and District Health Boards plan. Dr Kate Grundy, Chair of the Palliative Care Council, said Phase 1 of the report indicated that there was a large number of noncancer patients that could benefit from palliative care. “This remains poorly understood in many sectors of health and is a challenge with regard to communication and education. We anticipate that Phase 2 will illustrate the urgent need for ALL providers of palliative care, particularly primary care (including

“This will need to be taken into consideration when evaluating and developing the cultural responsiveness of palliative care services,” said Wayne. “If you were in a region with a large Maori and Pacific Island population you would take into account factors such as they tend to die at a younger age, more commonly at home rather than in a hospital or residential care, so more community care might be needed.” The report found Maori and Pacific Islanders tended to die at a younger age than other ethnic groups. More died between 40 and 50 years than over 65 years. On a national basis, most deaths occurred in a hospital setting (34%), followed by residential care (31%) and private residence

The report showed that in the next 15 years, the New Zealand population is expected to increase by 19%, with significant increase in the older age groups. district nursing) and aged residential care as well as the acute care environment, to be resourced and supported adequately to provide quality palliative and end of life care to all who need it. This will be vital if this increasing demand is to be met and can only be achieved in an environment of partnership with specialist palliative care services,” said Kate. The report showed that in the next 15 years, the New Zealand population is expected to increase by 19%, with significant increase in the older age groups. Based on population growth, the number of adults that might benefit from palliative care would increase by 23.5% over the next 15 years. For children and young people (under 20 years) the estimated increase was only 5%. The report said that one in 20 people aged over 65 lived in residential care and were likely to die there. Research showed the physical dependence of these people had increased significantly over the past 20 years. The Palliative Care Council’s Senior Analyst, Wayne Naylor, who conducted the needs assessment, said this had implications for the quality of care delivered at residential care facilities. “They will require adequate resources and appropriately trained staff, as well as access to specialist support, to deliver high-quality palliative care,” said Wayne. The report showed the ethnic makeup of the DHB regions was quite different. Some regions were predominately European, especially in the South Island, and some, like Auckland had a very diverse ethnic mix.

(22%). A small number of deaths were in a hospice inpatient unit. In the group highlighted as the people who would benefit most from palliative care, more died in hospitals - 47% of adults and 77.6% of children and young people. Almost 70% of all deaths in children and young people in the study were due to perinatal conditions and congenital abnormalities, mostly in the under 1 age group. Given the population size, many more Maori children died before they turned 1 than in other ethnic groups. Wayne said these figures may give rise to more specialist palliative care services being established to address the needs of the families whose babies die. For adults, cancer was the single biggest cause of death (43%), followed by circulatory and respiratory diseases. Among the adults who died from cancer, the four most prevalent symptoms/problems were likely to be pain, loss of appetite, vomiting or feeling sick and sleeplessness. For those who died of non-cancer causes, the four most common symptoms/problems were likely to be pain, trouble with breathing, mental confusion and loss of appetite. Nearly one third of people in New Zealand stated they had no religion, a much higher proportion of the population than in the UK or Australia. This figure did not vary greatly across New Zealand regions. “This has interesting implications when looking at spiritual care at the end of life,” said Wayne.

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The report also looked at deprivation. “Research has shown that people who have a high level of deprivation have a need for more palliative care resources,” said Wayne. “Some DHBs have relatively high levels of deprivation and this must be taken into account when allocating resources.” Mary Schumacher, CEO of Hospice NZ, was chair of the advisory group for the Needs Assessment, said the report would be of great assistance to hospices in their planning. Phase 2 of the National Health Needs Assessment for Palliative Care will establish the palliative care services available in New Zealand. Wayne is currently surveying hospices and hospitals with palliative care teams. He will also measure generalist palliative care by collecting data on rest homes that have contracts to provide palliative care, the number of health workers in palliative care education programmes, the number of GPs accredited with the palliative care component of the Cornerstone programme and uptake of the Liverpool Pathway. When Phase 2 is complete (probably December 2011) the Council will look at where services are not meeting the palliative care needs set out in Phase 1 and consult with palliative care services.

For adults, cancer was the single biggest cause of death (43%), followed by circulatory and respiratory diseases. “We’ll be asking what we should do to address those gaps and what our priorities should be,” said Wayne. The Council will then form recommendations for the Ministry of Health. Wayne said he has also been working with other organisations doing research work around palliative care to ensure the projects were aligned. “People have been talking about doing a needs assessment for years but no one has had the time to do it. Feedback from Phase 1 has been really positive. People have said the report was easy to read, they’ve found the information enlightening and helpful for planning,” said Wayne. To view the full report go to: http://cancercontrolnz.govt.nz/about-us/publications

What is the Palliative Care Council? Established in 2008 by Cancer Control New Zealand to provide independent and expert advice to the Minister of Health, and to report on New Zealand’s performance in providing palliative and end-of-life care.

Members (meet bi-monthly): Dr Kate Grundy Consultant Physician Palliative Medicine at Christchurch Hospital) Dr Carol McAllum palliative medicine specialist working at Hawkes Bay Hospital and Cranford Hospice Karen Bycroft Nurse Specialist in Paediatric Palliative Care at Starship Hospital Mary Schumacher CEO, Hospice New Zealand Dr David Wilson Rural GP in Whitianga

Kate Gibb Registered Nurse and Facility Manager at George Manning House, Christchurch Bob Fox Consumer representative, formerly Communications Manager Royal New Zealand College of General Practitioners Ranei Wineera Ngati Toa, Nga Puhi, General Manager Primary Care Wellington and Wairarapa at Compass Health Taku Parai Ngati Toa, Ngati Raukawa, Maori – Service Development Manager at Compass Health

cancercontrolnz.govt.nz/palliative-care

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Around & About This popular column allows the extended hospice family to get to know one another a little better. Each edition we select people in a range of roles and locations and ask them a set of questions about their work and them personally. Thank you to Belinda Donaldson, Nurse Maude & Vanessa Brown, Cranford Hospice for taking the time to share with us.

Belinda Donaldson

Vanessa Brown

Volunteer Coordinator, Nurse Maude

Cranford Hospice, Specialist Palliative Care Pharmacist

Brief background to your professional career – and your current role with hospice, what led you here?

Brief background to your professional career – and your current role with hospice, what led you here?

I’ve been in the role of Volunteer Coordinator since July this year. I find it a little awkward to explain where I’ve come from before this, although I shouldn’t, because it would be pretty typical of the modern working mum. I did all the usual things like university, Big OE, establish a career - in my case this was in the education sector with writing assessments and coordinating students through assessment processes. For the past six years I’ve been at home full time with my three children, and my focus was on family. During that period I was very involved in my local kindergarten and school, gathering up steam until I was leading groups of volunteers in event fundraising. Which was fortunate for me, because that informal work experience, awareness of volunteering and skills and experience gained in my previous career has led me to being a part of the Volunteer Services team. Now I’m responsible for orientating all new volunteers to Nurse Maude, and coordinating volunteers in clinical areas such as in our 40 bed hospital and 11 bed hospice.

I completed a BPharm at Otago University and then an Internship year at Hastings Hospital. I then spent a year working in community pharmacy before heading to the UK. In the UK on went on to specialise in Oncology & Haematology before being asked to join the MacMillian Team (palliative care team) at Northwick Park NHS.

Current challenges facing your hospice service? As a hospice in Christchurch, the past year has obviously been extremely difficult and stressful. We’ve seen an increased demand for our services as a result of the earthquakes at the same time as sustaining damage to our buildings. On the positive side, I’m coming in at a time where I get to be a part of change and growth as Nurse Maude faces these challenges. Highlight of the past six months/twelve months for hospice/your role with hospice The highlight for me is not attached to career achievements or goals, but observing the way my colleagues band together in the aftermath of earthquakes and record setting snow-falls to continue to provide the best possible service. I am so proud of the work we do, of the volunteers that still commit to their shifts despite what may be happening in their personal lives and around the city.

I then moved on to complete a year as a paediatric palliative care pharmacist at the Royal Brompton. On return to NZ I was lucky enough to be employed by Cranford Hospice as a Clinical Pharmacist. I completed a post-grad cert in Palliative Care from Flinders University, Adelaide in 2006. My current role is based around advising and educating. Both within the Hospice MDT supporting my colleagues, educating patients and families and other Health Professionals with respect to Palliative care clinical pharmacy queries. I also sit on the Palliative Care medication working group (PCMWG), which is a sub-group of the Palliative Care advisory group. This group aims to improve access to medications for palliative care patients as well as addressing appropriate and effective prescribing of medications used in palliative care. Current challenges? The greatest challenge for me is probably more national than local and that would be trying to avoid Specialist Palliative Care Pharmacists becoming extinct. I constantly try to promote the benefits of having a Specialist palliative care pharmacist as part of your permanent team. I am currently trying to set up a Palliative care pharmacy special interest group and would love to hear from anyone that would be interested. Highlight My highlight would be being appointed to the PCMWG and as part of this group publishing a Palliative care article in the NZ Doctor journal each month.

What do you do to relax?

What do you do to relax?

I find waking up my 10 year old daughter in the morning highly amusing!

To relax I love to mountain bike and dance and spend time with my 2 beautiful daughters.

What would we always find in your fridge?

What would we always find in your fridge?

This question should be first because it’s the easiest! A chilled bottle of Marlborough Sauvignon Blanc. Opened and partially consumed.

You would always find cheese in my fridge!

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Thanks to our supporters Thank you to all the individuals, companies and grant makers who have made donations to support our work. We really couldn’t do it without you!

National Partners;

Our long term supporter;

And our friends at;

Buzz Channel | Blanchard | Waipawa Motorcycle Club VMD Collier Charitable Trust | Phoenix Trading

www.hospice.org.nz Go online and find out how you can create and send your very own special moment to make someone smile.

Often little gestures and knowing that someone is thinking of you can make your day. This is your opportunity to make someone smile by emailing them a moment, created by you, just for them. You can send as many moments as you like, for free, the idea being that the people you have sent them to will send them to others and so on and so on – we want as many people as possible to experience how good sharing a simple moment can make those involved feel. By sending a moment or passing this link onto friends you will be helping others to understand the philosophy and heart of hospice, enabling people to live every moment.

Hospice is a philosophy of care not a building. Our goal is to support people to live every moment. Page 10 | October 11


The Review - Oct 2011