Improving end of life care in care homes

1. Improving end of life care in care homes By Gaynor Pitman

2. With the introduction of the end of life care strategy came emphasis upon the provision of high quality care available wherever an individual may be, including care homes The work undertaken to develop the strategy highlighted the fact that in March 2007 there were a total of the of 18,577 registered adult care homes in England offering a total of 4441,958 places

3. It has been found that most deaths occur in people over 65 years and amongst those experiencing a period of chronic illness related to conditions such as heart disease, liver disease, renal disease, diabetes, cancer, stroke, chronic respiratory disease, neurological disorders and dementia Many individuals living in residential care settings can become susceptible to such conditions as a result of the ageing process Care home death rates are highest in people over 85 years

4. Within the strategy the evidence indicates that some people are experiencing excellent care in residential care homes but the reality is that many are not Therefore, how can we, as a care home sector, ensure that such experiences are not repeated ‘ How we care for the dying is an indicator of how we care for all sick and vulnerable people’ End of life care strategy, DOH.2008 ‘ How people die remains in the memory of those who live on’ Dame Cicley Saunders, Founder of the Modern Hospice Movement

5. For those working in the care home sector ‘it is paramount that care of the dying is recognised as a core activity with the same rigorous measures and outcomes applied as to other areas of health and social care’ But how can we as care providers achieve this?

6. A cultural shift in both attitude and behaviour towards end of life care is required • Close working relationships with GP’s who, it has been shown, play a pivotal role in the provision of end of life care and care of the bereaved • Co ordination between the care home team and members of the specialist palliative care teams • Advanced care planning • Adequate and appropriate training of staff • Appropriate modification and implementation of the Liverpool Care Pathway

7. Promoting a Cultural shift • Assisting the care home team to recognise the importance of communication with individuals around the issue of end of life care to allow for holistic assessment of needs and preferences • Dispelling the perception that care staff have of the home being viewed in a negative manner should too many residents die whilst in their care • Discussing the concerns that carers may have regarding the impact on other residents of people dying within the care home

8. Interprofessional working • Promotes adequate access to the services required to ensure that staff in residential care settings are given the support and resources required to provide optimal end of life care • Improves information exchange about those requiring end of life care • Enables staff to offer a better standard of after death and bereavement care

9. Advanced care planning • Enables staff to ensure that the wishes, needs and preferences of individuals are met • Ensures that the individuals physical, psychological, social, spiritual, cultural and environmental needs are considered • Enables staff to develop traditional care plans which will be flexible to link up with an end of life care plan • Promotes well co ordinated care and access to information relating to an individuals choices and preferences by the multi disciplinary team on a need to know basis

10. Staff training • Inclusion of end of life care in the induction programme which covers basic and intermediate communication skills training as well as an understanding of care planning • Ensures that all staff have the necessary knowledge, skills and attitudes to manage quality end of life care effectively • The staff will be enabled to know when to refer or seek expert advice or information • Enables employers to identify the most effective support system for their staff team • Recognition of the importance of incorporating end of life care in continuing professional development plans

11. The Liverpool care pathway • Assists staff to have open and honest communication as end of life approaches • Helps staff to recognise the dying phase • Promotes the development of care plans based on individual need and preference • Encourages co ordination of care • Assists staff to understand that end of life care does not stop at point of death

12. By adopting the ethos of the End of Life Care Strategy, care home providers and their staff teams will ensure that the high quality end of life care for which we are all striving is achieved by a well educated, focused, co ordinated and dedicated workforce in the community providing choice, dignity and respect to those for whom they care