SCIE opinion - 31 July 2013

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Photograph of Pamela Holmes

Why 'dying well at home' is a health and social care issue

From Pamela Holmes, SCIE Practice Development Manager

We all talk about the importance of integrating health and social care. But in no area of care it is more essential than in end of life care. It’s only when health and social care practitioners work seamlessly together to meet the physical, social, psychological and spiritual needs of a person who is dying that dignified and respectful high quality care can be delivered.

This message was highlighted in the recent review led by Baroness Julia Neuberger which recognises that end of life care is as much a social as a medical issue. The  news that the Liverpool Care Pathway will be phased out over the next year has hit the headlines. Her report includes many recommendations, such as taking a system-wide approach to improvements so that all the agencies are involved and the issue isn’t just seen as a medical problem.

As SCIE’s Chief Executive, Andrea Sutcliffe, says:

It is sad that the good intentions of the Liverpool Care Pathway were undermined by its implementation in some places. But let’s use this as an opportunity to improve the care we provide at this most difficult time in people’s lives.

Integration is one of the main recommendations of a recent SCIE digital guide Dying Well at Home. This brings together the latest evidence for what needs to be in place to ensure that people and their carers receive quality care at the end of life. The guide draws on a variety of sources including what people at the end of life and their carers tell us about the barriers and gaps. They said that coordination of key staff was vital and that the provision of twenty-four hour access to advice and support was essential. Our guide has a special section addressing just this.

This quote comes from a carer who received the support that enabled her to support her relative to die at home: “You could feel it in her and it was the remarkable increase, again, in her spirits and that’s all I can say. So, no, I had no hesitancy in ... saying: “Yeah, you can come home.” And, as it turned out, it was a wonderful development.’

A ‘good death’ at home may not be feasible, or desirable for everyone but if high quality services and approaches are in place, it could become a reality for many more. Currently, 59% of all deaths are in hospitals, while 17% happen in care homes and 18% in the person's own home.

Carer exhaustion and isolation is often a trigger to admission to hospital.  At St. Catherine's Hospice in Central Lancashire, a free carer befriending service, developed by hospice social workers, encourages trained volunteers to sit with a cared-for person, for a few hours a week, so the family carer can have a break. We’ve highlighted this example of integrated practice in our guide because by sharing the knowledge of what works, we can help make people's dying wishes a reality.

See also

Social Care Online

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