“How people die remains in the memory of those who live on.” Dame Cicely Saunders, Founder of the Modern Hospice Movement.
In Volume 1, Issue 1 of the Care Home Nursing Journal (CNJ) Dr Sarah Russell, Head of Research and Clinical Innovation Hospice UK, discusses care home ambitions for palliative care.
Sarah calls for care homes to define their goals for palliative care. Why? Because the environment we work in is changing. As we live longer, in changing socio economic circumstances, care homes have a significant part to play. According to Age UK’s “Later Life in the United Kingdom (December 2017)” factsheet there are now 11.8 million people aged 65 or over in the UK, and the number of people aged 65+ is projected to rise by over 40 per cent (40.77%) in the next 17 years to over 16 million. According to the latest Laing and Buisson survey, there are 421,100 people aged 65+ in residential care (including with nursing). With an aging population comes an expected increase in pressure and care homes need to define a strategy now in order to futureproof themselves.
What is palliative care?
Dr Sarah Russell highlights the confusion between the terms “end of life care” and “palliative care”, and how the term palliative care can apply weeks, months or years before the last days of life. As Dr Sarah Russell states: “It is important to have clarity about your individual and organisation understanding of palliative care so that you can plan, fund, deliver, monitor, measure and evaluate your care.”
The benefits of good palliative care in care homes
“How we care for the dying is an indicator of how we care for all sick and vulnerable people.” (National End of Life Care Strategy 2008)
As well as an indicator of the quality of care a care home provides, studies show that patients who receive hospice care have improved quality of life, with less depression and symptom burden; feel more in control; are able to avoid risks associated with hospitalisation; and have decreased costs with improved utilisation of health care resources (WHO, 2016).
Good palliative care in care homes has also been shown to reduce levels of distress in residents, families and care home staff. It improves staff-resident communication and adherence to residents’ wishes, and promotes greater openness about death and dying among staff. Statistics also indicate that good palliative care can reduce emergency hospital admissions. (Farrington, 2014; Goodman, 2014, Anstey 2016.)
How can we as health care professionals make a difference?
In 2015 the National Palliative and End of Life Care Partnership published a national framework of six ambitions for palliative care. Each of their six ambitions features a declaration to describe the ambition in practice, predominantly from the perspective of a person nearing the end of life.
“Although we have focused on the experience of the dying person, our concern is broader. Each statement should also be read as our ambition for carers, families, those important to the dying person, and where appropriate for people who have been bereaved.”
The Six Ambitions for Palliative Care:
- Each person is seen as an individual
- Each person gets fair access to care
- Maximising comfort and wellbeing
- Care is coordinated
- All staff are prepared to care
- Each community is prepared to help
These ambitions aim to empower staff to feel confident in the assessment and management of palliative care through on-going education and continuous development. They also help drive person-centred policies and procedures through robust and accessible systems to help communicate peoples’ wishes and promote ongoing conversations and advance care planning.
Dr Sarah Russell states for those we care for our ambitions should be this: “I can make the last stage of my life as good as possible because everyone works together confidently, honesty and consistently to help me and the people who are important to me, including my carer(s)” (National Voices and The National Council for Palliative Care and NHS England 2015).
By following these ambitions care homes will increasingly be seen as communities in themselves, as Dr Sarah Russell concludes, “As I see more and more care home and hospice and palliative care partnerships and initiatives, I am ambitious that together we can make a difference.”
For more information visit Hospice UK the national charity for hospice care, supporting over 200 hospices in the UK.
Read the National Palliative and End of Life Care Partnership publication, “Ambitions for Palliative and End of life Care” here.
End of Life Care Strategy: Promoting high quality care for all adults at the end of life (2008). Department of Health. Available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/136431/End_of_life_strategy.pdf [Accessed 15 Jan. 2018].
Lang and Buisson (2010) Care of Elderly People: UK Market Survey 2010-11. London: Laing and Buisson.
Later Life in the United Kingdom. (2017). [ebook] Age UK. Available at: https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/later_life_uk_factsheet.pdf [Accessed 15 Jan. 2018].
National Palliative and End of Life Care Partnership, 2015. Ambitions for Palliative and End of Life Care: A national framework for local action 2015-2020.
National Voices and The National Council for Palliative Care (NCPC) and NHS England (2015). Every Moment Counts: A narrative for person centred coordinated care for people near the end of life. London: National Voices.
World Health Organization. WHO definition of palliative care. http://www.who.int/cancer/palliative/definition/en. [Accessed November 20, 2017].