ByGaynor Pitman

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

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 processCare home death rates are highest in people

over 85 years

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

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?

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

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

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

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

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

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

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