Supporting Care and Compassion at End of Life in Nursing Homes
A continuous learning programme

Caru is a new learning programme for nursing homes. The initiative has been developed by the Irish Hospice Foundation (IHF) in partnership with All Ireland Institute of Hospice and Palliative Care (AIIHPC) and the HSE.

This five-year programme is offered free of charge to every Nursing Home in Ireland, numbering approximately 580.  Its aim is to improve the delivery to residents of compassionate and person-centred palliative, end-of-life, and bereavement care. This will be achieved through a multi-strand, integrated programme which will enable all nursing homes to engage at a level appropriate to them.

Project ECHO

Project ECHO (Extension for Community Healthcare Outcomes) is a pioneering tele mentoring programme which was developed in the School of Medicine at the University of New Mexico. Since launching in 2003, Project ECHO has become a global learning and change movement and framework. Its work has been evaluated among the world’s most prestigious medical journals, including British Medical Journal (BMJ), The Lancet, The Journal of American Medical Association, and dozens more.

The ECHO model™ does not provide care to individual patients. Instead, it increases access to specialty treatment in rural and underserved areas by providing front-line healthcare professionals with the knowledge and support they need to manage patients with complex conditions. It does this by engaging healthcare professionals in a continuous learning system and partnering them with specialist mentors at a hub.

Project ECHO leverages videoconferencing technology to share knowledge and expertise to increase the capacity of local resources.  Its distance learning methodology breaks down hierarchies of specialist knowledge by creating virtual knowledge sharing networks.

Project ECHO uses a ‘learning loop’ approach; specialist teams and local providers learn from each other by collaboratively problem-solving real-time experiences and sharing best practice via videoconferencing. This method of knowledge sharing overcomes the geographical and financial constraints of traditional hierarchical methods of education.

ECHO’s aim is to enhance decision making and transform service delivery.

Caru AIIHPC Project ECHO Nursing Home Knowledge Networks

As a Caru partner, AIIHPC will establish a Project ECHO Nursing Home Knowledge Network in each CHO area.  Participation in these networks is free to nursing homes and open to all staff. This aim of these virtual networks is to develop the knowledge, skills, confidence, and resilience of nursing home staff in caring for residents with life-limiting conditions.

Project ECHO uses a ‘hub and spokes’ model. Our Caru Project ECHO nursing home learning networks will connect groups of learners from local nursing home settings (the spokes) with local experts in the areas of palliative and older persons care (the hub), through interactive video technology (currently Zoom) for regular educational support sessions.

Project ECHO is intended to build relationships and communities of learning, and to provide a safe environment that facilitates open discussion between participants.  The network fosters a spirit of collaborative learning in a safe and inclusive environment. It is explicitly non-hierarchical and participatory in nature.   In the inclusive ECHO educational model, everyone is a teacher, and everyone is a learner. Network participants are involved in curriculum setting, case presentations, discussion, and evaluation.

How Caru AIIHPC Networks Will Operate

Each CHO Project ECHO programme will run initially for 10 sessions, usually at fortnightly intervals.  Thereafter the network will decide for itself, with the support of AIIIHPC, how it would like to continue and develop.

Nursing home staff can join the sessions online using their computer, tablet or mobile phone from wherever they are.  All nursing home staff who are free to attend a session are welcome to sit in.

A typical ECHO session is 60-90 minutes long.  A topic expert delivers a 20-minute teaching session. This is followed by anonymised case presentations or breakout workshops where the topic is explored under a local lens. The participants then discuss together the current issues or experiences they face and explore the best course of action or outcomes.

Examples of Project ECHO curriculum topics

The network members will be involved in deciding what topics will be covered during the ten learning sessions.  Potential topics could include:

  • Assessing palliative care needs for nursing home residents
  • Advance care planning
  • Accessing services
  • Polypharmacy
  • Infection control
  • Nutrition and hydration
  • Managing symptoms
  • Managing co-morbidity
  • Self-care and resilience

Project ECHO Information Meetings

As the establishment of Caru AIIIHPC Project ECHO networks rolls out, staff in nursing homes in each Community Health Area (CH0) will be invited to attend our Project ECHO briefings.  Here they will learn:

  • How ECHO is different to a webinar or telemedicine
  • What the benefits of ECHO are to nursing home residents, staff and management
  • How the Caru AIIHPC nursing home knowledge networks will operate
  • How a nursing home can participate in this ECHO network

For further information on the Caru Programme, Caru Webinars or Caru AIIHPC Project Echo Nursing Home Knowledge Networks please contact:

Miriam Ahern, Project Manager for Nursing Home Education      e:     t: 087 096 4468