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Step 2: assessment, care planning and review






Step 2 Workshop

Time: Half day

Aim: The domiciliary care organisation representative will understand holistic assessment and its relevance to advance care planning.   They will explore systems to discuss, record, review and share assessments appropriately.

Objectives: By the end of the session the end of life domicilary care oganisation representative will be able to:

  • Recognise the importance of holistic care assessment and planning
  • Demonstrate an awareness of assessing an individual's mental capacity
  • Produce an action plan to implement a system to support advance care planning
  • Develop further the domiciliary care organisation's End of Life Care Policy


Attendance register - Register.

Route to Success in Domiciliary Care - The progamme is based on Route to Success and guides each workshop.

Presentation - provides an overview of holistic assessment.

Holistic Common Assessment Guide - provides guidance for holistic common assessment for the supportive and palliative care needs of adults requiring end of life care.

Support Sheet 16 - provides information on holistic assessment.

LGBT Route to Success - The Route to Success in end of life care for lesbian, gay, bisexual and transgender people.

BAME report June 2013 - information on palliative and end of life for black, asian and minority groups.

Case Study Part A - learning aid providing the first part (A) of a case study around a patient with heart failure.

Case study Part A care plan templates - to be used alongside case study part A.

Mental Capacity Act:Two stage test guidance - produced by the Care Quality Commission containing information about the mental capacity act and the two stage test of capacity.

Best interests at end of life - practical guidance for best interests decision making and care planning at end of life.

Preferred Priorities for Care (PPC) document - to use in advance care planning to document the patient's preferred priorities for care.

Guide to Preferred Priorities for Care - guidance on how to use the PPC document.

Support Sheet 4 - guidance on advance decision to refuse treatment (ADRT).

Support Sheet 12 - provides information on mental capacity act.

Support Sheet 13 - provides information on best interests decisions.

Support Sheet 18 - provides information on PPC.

Supportive Care Record - useful template to record and monitor individuals who require end of life care.

Support Sheet 3 - provides information on advance care planning.

Capacity, Care and Advance Care Planning: A guide for Health and Social Care Staff - guidance around advance care planning for health and social care staff.

Case Study Part B - second part (B) of case study around the patient with heart faillure.

To Do List - Checklist of actions to be completed before the next workshop.

Evaluation - to allow delegates to provide feedback, which facilicators can use to further improve workshops.