Issue Date: December 2015 / Issue No 4
Page 3 of 3
END OF LIFE CARE POLICY
As far as possible everything should be done to meet the wishes of dying residents and their relatives. They should be able to die with dignity and composure.
It is important to meet the holistic/whole care needs of residents and this should take into consideration their physical, religious, spiritual, psychological, social and cultural needs. This means looking at them as a whole person and not just focussing on their medical condition.
Our policy follows the guidance developed by Skills for Care based on the National End of Life Care Programme 2012, SCIE briefing on End of life care for people with dementia living in a care home 2012, the DoH End of Life Care Strategy 2008 and The DoH guidance on Advanced Care Planning 2007.
Gold Standard Framework
Our GP practice follows the Gold Standard Framework for End of Life Care. As such they would advise us on when an end of life care pathway needs to be implemented.
Common Core Principals for End of Life Care:
Choices and priorities of the resident are at the centre of planning and delivery. We therefore following the NHS End of Life Care Pathway which identifies 6 steps:
1. Discussions as end of life approaches
Effective, straightforward, sensitive and open communication between residents, family and staff underpins all planning and activity. Communication reflects an understanding of the significance of each individual’s beliefs and needs.
Residents and family are well informed about the range of options and resources available to them to be involved with care planning.
2. Assessment, care planning and review
Agreed care plan and regular review of needs and preferences
Assessing needs of carers
3. Co-ordination of care
Strategic coordination, close multidisciplinary and inter-agency working.
Coordination of individual patient care
Rapid response services
4. Delivery of high quality services
High quality care provision in all settings
Care is delivered in a sensitive, person centred way, taking into account of circumstances, wishes and priorities of the resident and family.
Care and support are available to anyone affected by the end of life and death of the resident.
Staff are supported to develop knowledge, skills and attitudes, and will take responsibility for and recognise the importance of their continuing professional development.
Close liaison between the resident, family, GP and Nurses in charge is essential, and priority must be given to the question of pain relief and comfort.
5. Care in the last days of life
Identification of the dying phase (please see below)
Review of needs and preferences for place of death, i.e. would the individual prefer to stay in the home or transfer to hospital.
Support for person and their relatives and friends
Recognition of wishes regarding resuscitation and organ donation
6. Care after death
Recognition that end of life care does not stop at the point of death.
Timely verification and certification of death or referral to coroner
Care and support family and carers, including emotional and practical bereavement support.
Assessment
On admission to the home, every effort is made to gather as much information as possible as to the resident’s wishes on all aspects of dying. We use the Preferred Priorities for Care document to record preferences and wishes for the future.
Mental Capacity Act:
The Mental Capacity Act (MCA) 2005 provides a framework for decision making on behalf of adults who lack capacity. All decisions taken on behalf of someone who lack capacity must be taken in his or her best interests. Under MCA individuals can continue to anticipate future decision making about their care or treatment should they lack capacity.
Lasting Power of Attorney:
A Lasting Power of Attorney (LPA) is a statutory form of power of attorney created by the MCA 2005. Anyone who has the capacity to do so may choose a person (an attorney) to take decisions on their behalf if they subsequently lost capacity. These take two forms LPA for property and finances and LPA for health care decisions.
“Do Not Attempt Resuscitation” (DNAR)
There may have been earlier discussions with the resident about their general care and treatment aims which may have addressed the issue of Cardio Pulmonary Resuscitation. A wish for DNAR will be supported by appropriate documentation.
Staff Training:
All staff undertake annual palliative care training provided in the home. Registered Nurses attend palliative care seminars at the local hospice. Any further training would be gained via the Palliative Care Team at “The Hospice in the Weald”, Pembury.
Identification of the dying phase
SCIE briefing on End of life care for people with dementia living in a care home 2012, states:
Identifying this stage is important to the provision of good palliative care.
In the final months of their lives, people with advanced dementia may experience symptoms such as pain, depression, incontinence, constipation, appetite disturbance, breathlessness, difficulty swallowing, weight loss, dehydration and pressure sores.
Initial Actions
Nurses and team leaders monitor people on a day to day basis and where changes such as:
Loss of mobility
Increased dependency
Loss of meaningful communication
Weight loss
Signs of dehydration
Recurrent infections
Developing pressures wounds
People with such symptoms are referred to the GP who, in discussion with the RN or Team leader, will determine the need for palliative care and the introduction of the care pathway in line with the Gold Standard Framework they follow.