End of life care and the end of life care plan
End of life care refers to the care and support people receive in the last days months or years of their life. The NHS considers people to be at the end of life when they have 12 or fewer months left to live. However, making such a prediction isn’t always possible.
Palliative care is often included as part of end of life care. Palliative care is given to people with incurable illnesses in order to make people as comfortable as possible. It encompasses managing pain, psychological, spiritual and social support, not only for the person at the end of life, but their family and carers too.
Palliative care is said to be a ‘holistic approach’, caring for someone as a whole person not just treating or managing their illness or symptoms.
End of life care can be delivered in a variety of settings, including care homes, nursing homes, hospices, hospitals and in people’s own homes. Where end of life care will take place depends on a person’s preferences and their conditions.
What is a good death?
Regardless of where and how people die, all are entitled to receive person centred care, at a high quality. People often see the aim of end of life care as ensuring people’s comfort and that they have a ‘good death.’
A good death typically means the dying person was treated with compassion, dignity and respect, was kept clean, comfortable and in familiar surroundings with people important to them close by.
Essential to ensuring people have a good death, and experience as little distress and pain, as much comfort and joy as possible in their last months, days or years, is developing and documenting an end of life care plan.
End of life care plan
Person centred care planning is as important in end of life care as in any other form of health and care delivery. End of life care plans are not easy to create, difficult conversations will need to be had about difficult choices.
In addition to the common areas included in a care plan, an end of life care plan will often include additional areas such as their preferred care setting should their condition worsen, preferences for symptom management and care after death. Opportunities for discussion should continue so the plan can reflect changes in a person’s wishes or needs in their final days.
Some people will already have what is called an advance care plan, which typically include:
- priorities and preferences for care and treatment
- decisions about resuscitation
- views about how and where they would like to be looked
- after in their last days of life
- who they would like to have with them
- any spiritual or religious beliefs they would like to be considered
- who they would like to make decisions for them if they become unable to make them for themselves
Creating a good end of life care plan
A study by Nursing Times developed a highly effective Personalised Care Plan for the Last Days of Life, based on five priorities developed by the Leadership Alliance for Care of Dying People. These Five Priorities of Care of the Dying Person, can help shape your end of life care plan approach:
- Recognise The possibility that a person may die within the coming days and hours is recognised and communicated clearly, decisions about care are made in accordance with the person’s needs and wishes, and these are reviewed and revised regularly
- Communicate Sensitive communication takes place between staff and the person who is dying and those important to them.
- Involve The dying person, and those identified as important to them, are involved in decisions about treatment and care
- Support The people important to the dying person are listened to and their needs are respected
- Plan and do Care is tailored to the individual and delivered with compassion – with an individual care plan in place
Meanwhile the Social Care Institute for Excellence identified the holistic assessment, as we’ve already discussed, as being essential to delivering the best end of life care, as this video details:
More guidance on end of life care for adults is available via NICE, the NHS and the Royal College of Nursing
Software can help
Care planning software can make the process of assessing for, creating, updating and using end of life care plans much easier and more efficient. Care homes, nursing homes, hospices and other providers of end of life care across the UK are using this software to enable them to spend less time on admin and more time with people they are caring for.
