Keeping Care Close to Home

In Golden Bay, a team of four district nurses, along with two relievers, work in collaboration with Nelson Tasman Hospice to provide palliative care in the community. As Golden Bay is a rural area, community health care is provided by nurses that visit and care for patients in their homes, in association with the local General Practice. We met with Ruth Robson, Monika Schneider and Kitty Molloy at Golden Bay Community Health (GBCH) to talk about palliative care services in the area.

Ruth is the General Manager of the team at Golden Bay Community Health; she oversees the service that delivers palliative care in the community. Ruth said “We see specialist palliative care as a vitally important part of supporting whanau in Golden Bay. That is, being able to have care closer to home, and these wonderful nurses do an incredible job to meet that need. We also have a palliative care bed at the health centre, to support inpatient care.”

Ruth continues “District nurses are managing palliative care patients, as well as oncology patients, patients on ACC for specialist wound care, and all the other general nursing support that come through the district nursing service, so the rural teams have to be generalist experts. Palliative care on its own is a huge discipline which the nurses build up with experience, so we really do rely on the support that the Nelson Tasman Hospice team gives.”

Monika has been a District Nurse for about 15-16 years and has travelled to Christchurch to study palliative care and the hospice philosophy. Monika said “I really enjoy palliative care, which is a family and patient-focused service. It’s a holistic service and we have meaningful conversations with patients and their families.”

Monika continued “Such a small team, and such a big area we cover, it is often when symptoms are not controlled that we have the ability to bring the patient to the unit at Golden Bay Community Health, for 24 hours, to get the kind of support they need and hopefully manage their symptoms. Then they might be discharged again with a different plan and that’s when we can bring Hospice in for input into that plan, which is an asset to have.”

Kitty has been a District Nurse for a year and a half now. With Covid-19, the mandates reduced nursing staff and with the sudden need for more District Nurses providing in-home care, Kitty decided to pursue the role. Kitty said “I’m definitely enjoying working with many more experiences. It’s been really, really beneficial. But I can say that the Hospice, the palliative care part of my role, is by far my favourite. It’s so meaningful and you feel like you make a difference.”

Dr Juliet Fleming, Senior Medical Officer at Nelson Tasman Hospice, heads over the hill each month to support the team at Golden Bay Community Health. This includes making in-home visits to patients alongside the nurses and providing specialist care advice to the District Nursing team. Monika said “We take turns going out with Juliet to the patients. It’s amazing how she builds a relationship and trust with people. She is an amazing person to be around.”

Along with the regular in-person visits, clinical oversight includes weekly Zoom meetings with Dr Juliet Fleming or Medical Director and Palliative Medicine Consultant Dr Jodie Battley where they provide specialist oversight for palliative care patients in Golden Bay. The District Nurses, in-patient nurses and GPs at Golden Bay Community Health have 24/7 specialist support provided by Nelson Tasman Hospice via phone or video consultation.

In addition, Nelson Tasman Hospice offers palliative care education services to healthcare professionals. Kitty said, “Grace Lindsay comes out a lot, and she’s held education sessions for the HCA’s (healthcare assistants) and nurses in Golden Bay as well, which is great.” Grace is a Nurse Educator from Nelson Tasman Hospice working regularly with the District Nurses, the nurses in the Aged Care Facility and patients to upskill and support the team in providing excellent palliative care.

Nelson Tasman Hospice also provides education and professional development, including monthly breakfast sessions provided by the experienced Nurse Educators from the Nelson Tasman Hospice team as well as bi-annual Palliative Care for Rural District Nurses Workshops which bring together all rural District Nurses and provides an opportunity to explore challenges of palliative care in the rural context.

Golden Bay patients may also be admitted to the Specialist Palliative Care Unit at the Hospice in Nelson when required. Family/whānau can access the onsite accommodation unit Kōwhai House, which is available to whānau/families who have travelled to support a loved one staying in the inpatient unit.

Another service that is provided is the use of specialist equipment for people to use in their homes. This includes equipment such as specialist beds, syringe drivers and Multi-C-Air Chair pressure cushions.

All these services are provided to the community free of charge; however, it does cost to provide them. At present Nelson Tasman Hospice receives 45% of annual operating costs from Te Whatu Ora, Health New Zealand, Nelson Marlborough, the remaining 55% must be fundraised every year. The care service is an incredible thing in a rural setting, as no matter which stage you are in, you will have the same team of nurses to back you up. Monika adds “For example, if oncology patients become palliative, it’s a bit easier to have these conversations with them as we have an established relationship. It’s true continuity of care.”

The seamless transition, organised discharge planning and care plans for people from hospital to in-home care is something this team really benefits from. The details such as leaving the hospital with medication, so there is no pharmacy rush at the end of the week make the difference. Monika mentioned, “I’m never anxious if the Hospice team is involved.”

The team also pointed out the importance of the equipment provided by Nelson Tasman Hospice for use with palliative care patients in Golden Bay. Monika told us “The beauty of good symptom control with the syringe driver over 24 hours, the bed is amazing for us and of course the amazing air mattress.”

There is limited equipment available in the Bay, which is delivered by Hospice volunteer, John Campbell, to people’s homes. The GBCH nursing team has identified some equipment that is urgently required for patients on Hospice services, to supplement what is already available. This equipment includes a syringe driver (meaning that people can self-manage their pain medication, providing fast pain relief as required) and a medical transport bed (for in-home care). The cost for this equipment will be circa $7,000. Any additional funds raised will go back into supporting the funding shortfall we have for hospice services in the community.

There is currently a fundraising drive in Golden Bay to raise funds to purchase this equipment. This has been kickstarted by the ‘Kris Campbell Memorial Fund’, TradeZone, Waitapu Engineering and the Golden Bay Lions. A variety of local businesses have also come on board to support the fundraising for this equipment to help assist Nelson Tasman Hospice in supporting the local medical community to help Golden Bay locals live well until they leave well.

How you can donate:

– TradeZone & Waitapu Engineering will be holding a sausage sizzle at the Village Market on the 15th of April with all proceeds going to the cause, buy a sausage & leave a donation in the bucket

– Pop into one of the following businesses to leave your donation in one of the donation boxes when

NBS Takaka
Hammer Hardware
Tākaka Hospice Shop
Golden Bay Pharmacy
TradeZone
Tinky’s Tavern – Collingwood
The Pohara General Store
The Wholemeal Café
Molly B’s
Fresh Choice

– Donate online and reference “Golden Bay” when making your donation