Hospice at Home

Hospice at Home Referral Form

Service description

The Hospice at Home services for last days of life and respite care offers care and support to enable patients to stay in their usual place of residence. The service is for patients and families with a high level of need which cannot be fully met by other care providers. The service provided includes full night shifts, and days from 3-8 hours in duration and can provide up to 24-hour cover for last days of life. Care needs are reviewed daily and service allocation is prioritised on a patient needs basis.

Referral criteria

  • Additional holistic needs of patient and/or that are not met by other agencies.
  • Patients and carers understand and agree to the service.
  • Adequate seating and comfort facilities available for use by Hospice staff.
  • Other care providers informed about Hospice at Home input.
  • Appropriate equipment in place/on order for staff and patient safety.

Referrer confirms or requests the following updated documents:

  • Lone working hazards identified and risk assessment completed, as indicated.
  • Care plan
  • SSKIN bundle
  • Mobility assessment

NB Existing package of care must remain in place as care from Hospice at Home is a short term service.

Referral criteria –Last Days of Life

  • Prognosis ≤ 2 weeks.

Referrer confirms or requests the following updated documents:

  • DNACPR decision and form
  • Just in Case medication, prescription chart and syringe pump equipment