Improving inpatient hospice environments for older people in England:a documentary analysis

Objective: To assess the extent to which a grants programme to fund improvements to English inpatient hospice buildings achieved its goals of involving and directly benefiting older people. Method: Qualitative content analysis was undertaken of all grant application forms which (a) resulted in funding, and (b) proposed to refurbish or replace inpatient hospice buildings. Data were extracted, and themes identified, on the nature and extent of the benefits envisaged for older people, and how older people were involved in the proposed building projects. Results: Of 227 grant applications, 139 (from 111 hospices) met the inclusion criteria. Four categories of building improvement were identified: interior decoration or equipment (n = 386, or 36% of the total); public spaces (n= 291, or 27%), private spaces (n = 283, or 26%), and health and safety (n= 116, or 11%). These improvements, while generally beneficial, were rarely targeted at older people. Most grant applicants stated that they had consulted service users, but only 13 specified that they consulted older people. Limited information was supplied about the methods or findings of these consultations. In 15 grant applications, older people were not mentioned at all. Conclusions: Older hospice inpatients, their relatives and advocacy groups should be involved more fully in decisions relating to the physical environment of care. Staff who prepare funding bids should receive training in conducting consultations with service users, and identifying and evaluating other relevant evidence. To ensure a consistently high standard of environmental provision for older people in hospices, evidence based assessment tools and guidelines should be developed.