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End-of-life care

Nurses Caroline and Jane from Garden House Hospice

Hospice nurses with extensive experience in caring for terminally ill people are helping care home staff come to terms with the matter of death.

Caroline Smith and Jane Landon have worked in hospitals and hospices, but now they are training care home staff on how to help elderly, frail residents – and their families -  come to terms with dying and death.

One of the biggest challenges they’ve discovered when talking to staff from care homes across Hertfordshire is the barriers to conversations about death.

Families often don’t want to have these conversations

“Families often don’t want to have these conversations,” said Caroline, “and staff can be uncomfortable about discussing death with them and their loved ones. But often elderly people want to talk and we need to be better at reading the signs, and helping them to discuss their needs and wishes.”

New guidelines to improving the care of people at the end of their life were published by NICE in 2015 and the training Caroline and Jane are providing is a key part of the Care Homes Vanguard Programme – which supports care home staff to better care for their elderly, sick residents.

Training covers things like communication - to help staff pick up subtle signs that a patient wants to discuss their death -  pain management, documentation and record keeping, as well as instilling confidence in carers to deal with the many issues around death.

“Often end of life care planning is left until the last weeks or days of a resident’s life, but it should be something that is done well in advance of this, when the resident and their family is more able to talk about it  and make their wishes and preferences known,” said Caroline.

All of the feedback on the courses has been positive with some homes really embracing the concepts of ‘good death’.

“We must strive to address the concept that ‘death is not a failure’ because there is still a huge stigma attached to conversations around it,” said Jane. 

She cited one of the homes she has worked with as an excellent example of dealing with issues around death. St Catherine’s Nursing Home, Letchworth has taken on board the importance of establishing care plans for elderly residents before their health deteriorates seriously. 

Staff feel confident in having difficult conversations with residents and their families around death and dying. They have also introduced practices to build awareness and show that death is not a subject to be shied away from.

For instance when a resident is dying staff hang a wicker heart with a dove on the bedroom door to remind other staff to be quiet and mindful that a residents is dying and that their family may need support. They have also established a memorial shelf for those who have died and at Christmas they hang stars on the home’s Christmas tree, dedicated to the residents who have passed away during the year and they encourage fellow residents and family members to remember them.

“We need to be encouraging people to have the conversations about dying earlier so that our loved ones have choice, dignity and respect when it comes to their final days,” said Caroline.