One Comment
I find this a very complicated subject. How do you consider the interplay between Lasting Power of Attorney and Preferred Place of Care will work in future? Will these work alongside each other or will one supercede the other?
There are particular challenges for social care services when considering Objective 12 : Improved end of life care for people with dementia. The extent of these challenges are considered within the Department of Health publication; End of Life Care Strategy, July 2008.
The social care sector will become increasingly aware of the need to consider end of life care within care home, sheltered and extra care housing facilities. In particular the statutory, private and voluntary sector will need to consider how they accommodate issues of end of life care within their assessment and subsequent advanced support plans. The strategy considers that many people now enter a care setting because they can no longer live independently at home and that the care home will become their normal place of residence and is probably going to be the place in which they reside until they die.
This has implications for all support staff and those who conduct assessments of older people, they will have to consider issues such as:
- Initial and subsequent assessments will need to consider the sensitive issue of asking about the type of advanced support plans individuals want in place regarding their care at the end of their life, for example where do they want to die; in the current care home? do they want to be returned to their previous family home? in hospital?
- Consiering the target population, i.e. those with dementia, the process of decision making will need to be addressed, particularly for those who lack the mental capacity to make such important decision in their lives. In turn this will raise issues of the recognition of advanced decisions including Lasting Power of Attorney related to the person’s welfare. If they lack the mental capacity to make such decisions, then someone will need to be designated as the decision maker in each case and this will necessitate the initiation of the best interest process.
- When does end of life begin?
- Who should be involved in the assessment of need at end of life? a holistic approach is suggested, which will require a coordinated approach between services, including district nursing care, primary medical care, community palliative care teams and care home staff.
- Concerns in some care homes that if too many residents die in the care home, this may reflect badly on the care being delivered.
- Would there be a need to have a designated area in the care home for people to be given special care while they are dying? What might be the affect of this on other residents?
- Concerns about the impact on other residents of people dying within their care home, or in sheltered and extra care housing
- Inadequate training of staff at all levels within care home and sheltered and extra care housing sector. Within the EoLCS this is considered to be the single most important factor.
Some authorities are experimenting with various tools to introduce the concepts of end of life care, however these tend to be used with people who have a terminal illness where end of life care is a significant issue. An example of such a tool developed in Lancashire and south Cumbria is the Preferred Place of Care document. This is a patient held record designed to record and monitor patient and carer choices and services received by all terminally ill patients. It considers the patient and carers wishes about the care and treatment they would like at the end of their life. This can be amended at any time assuming mental capacity.Considering the Preferred Place of Care for those who receive support from social care services is potentially more tricky, but does highlight that assessments and subsequent support plans will need to address end of life care in the future.
Ian Crompton – Independent Social Worker