End of life care in a care home
Most care home residents are over 85 years old, with an average life expectancy of less than two and a half years. This means, of course, that caring for people approaching the end of their lives must be a large part of what care homes, with or without specialist nursing care, must provide.
Almost a half of all deaths in England take place in hospital, although many of these people might have preferred to die ‘at home’. In 2016, the government’s response to the Review of Choice in End of Life Care declared a commitment to improving end of life care in all settings. The Review found that people want to make choices about their own care even at the end of life; and they want these choices to be real – based on available, varied, high-quality services.
Checklist for owners and managers
Care homes currently vary in the extent to which they provide end-of-life care. Some have specialist teams on site; others draw on community-based resources, primary palliative care or hospice outreach teams to support residents. A full service may involve:
- effective pain and other symptom control
- support for carers
- 24-hour nursing care
- night sitters
- access to equipment
- out-of-hours support.
Every care home, whatever their resources, should have a strategy in place which supports a personalised approach to people who are dying. It should draw on NICE guidance, and collaboration with partners to ensure that:
- access to care is fair, personalised and coordinated
- trained staff have enabled the person to express their preferences
- a person stays for as long as possible where they want to stay
- emergency admissions to hospital are avoided
- quality of life is maximised, and pain and other distressing symptoms controlled
- carers are informed and supported
- requirements relating to their religion or ethnicity are fully respected.
In 2015, CQC developed with other organisations a new set of principles to ensure consistent care in care homes and other settings: ‘Ambitions for Palliative and End of Life Care’. Care homes are not given a rating for quality of end-of-life care, but CQC inspectors always ask a question about it.
My Home Life has developed a step-by-step guide to good practice in end-of-life-care