Palliative care is ‘an approach that improves the quality of life of people facing problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.’ (World Health Organisation, WHO Definition of Palliative Care, 2015)
A palliative care approach is not just when the person is dying or at the end of their life; but at any time during a life-threatening illness. Most people living in care homes are frail and have life limiting illnesses therefore, care is delivered with a palliative care approach which considers the person’s needs and emphasises comfort and quality of life.
Quality palliative care is delivered in care homes every day. Care homes with onsite registered nurses have the knowledge and skills to support residents in the last weeks and days of life. Care homes without onsite nurses provide this care in collaboration with district nursing service or care home support teams. In some situations, care homes and health and social care services may require support and advice from specialist palliative care services. Specialist palliative support will always be provided in collaboration with care home and health and social care staff and care home support teams.
Anticipatory Care Planning for Residents
An important part of palliative care is understanding what is important to residents and their families and knowing their views about current and future care, especially speaking with them about their wishes and preferences about care at the end of their lives.
Further information is available on the Anticipatory Care Planning pages.
Regular Review and Assessment
It may be difficult to know why a resident is unwell or deteriorating so good physical, psychological, emotional or spiritual assessment is essential. As care home staff know their residents so well it can sometimes be a ‘gut feeling’ that helps recognise when someone is deteriorating. Regular assessment of pain is an essential part of care for frail older people.
Deterioration and Dying
Managing the uncertainty of deterioration and dying in frail older people can be a challenge. For some residents this may happen suddenly, but for the majority it is a gradual process. Good monitoring and assessment over months and weeks enables care home staff and families to recognise and anticipate the residents care needs when they are deteriorating or dying.
Final Act of Care
Good palliative care does not stop at the point of death. The final act of care (last offices) is part of a continuum of end of life care. Families may wish to be involved in this care. Most families and friends will need practical and emotional support around what to do after the death. Other residents and families may need support to grieve at this time.
Staff Wellbeing and Self Care
It’s normal for care staff to be affected by the death of someone they have cared for, especially when they have known them a long time or not experienced death before. Staff may need space and permission to grieve individually or with colleagues and other resident and families.
For more information please see the following webpages Wellbeing Resources for Everyone and Support Resources for Staff and Managers.
Training
Please see the education page for further details
Useful Resources
Scottish Palliative Care Guidelines provide information and resources (medicines and care approaches) on the management of a wide range of palliative care issues including pain management and end of life care.
- PAIN
- CARE IN LAST DAYS OF LIFE
Lothian Palliative Care Community Pharmacy Network
There are 22 community pharmacies across Edinburgh, Midlothian, East and West Lothian in this network. They allow timely access to palliative care medicines and can provide information regarding palliative care medicines to patients, carers and other health care professionals. These pharmacies continually stock a range of palliative care medicines. You can find contact details of these community pharmacist on the NHS Lothian Lothian Palliative Care Community Pharmacy Network pages.
Palliative and end of life care | Turas | NES
Marie Curie Knowledge Zone Wide range of palliative care information & resources for health and social care workers
Support Around Death (SAD) This NHS Education for Scotland website aims to support health and social care staff who are working with patients, carers and families before, at, and after death. It provides key information on the clinical, legislative, and practical issues involved.
Palliative Care Education in Care Homes NHS Lothian Palliative Education Team also offer training for staff working in Care Homes across NHS Lothian.
Further information
For information on information relating to palliative care referral processes and training please see the following webpages.
Palliative Care: Referral Pathway
Palliative Care: Education and training – courses offered by NES and CET
Palliative Care: Education and training – courses offered by St Columba’s Hospice Care ECHO HUb
