“It’s better to die in a care home” Extols Professor Malcolm Johnson from the University of Bath, in a letter to the Times dated May 2009.

He was responding to a report by the Public Accounts Committee (PAC) in which criticizes the unsatisfactory nature of much of end of life care in England (report May 14 2010).Further criticism of care homes came from help the Aged who have suggested, from their own research, that some older people may be dying undignified deaths, and that high standards of care is not always provided. The main finding from the PAC report concern acute hospitals which account for some 58% of deaths in the over 75 age group, the main issue being  that hospital are not able to provide the sensitive and  personal nature of care required at  this  time, and wards are often impersonal and public. Each year there is estimated to be around half a million deaths; two thirds of these are over 75 with 17% of these dying in care homes. From Professor Johnsons own research “ End of life care in Care Homes” (May 2009) shows “ What impressive care, sensitivity and attention are given to the wishes of dying residents and their families”(Times 19/5/2009). However later in his letter he does state that Care Home staff are amongst the least educated in the workforce, but acknowledges that “Staff’s positive motivation and the life experience they bring to end of life care is an undervalued and unexplored resource”.

This article will explore the implications and complexities outlined in the letter, and will look at how palliative care is defined and, more importantly what knowledge and competencies staff needs to develop to become effective in delivering high quality care at this very emotive time.

Palliative care is described as ~ Holistic care of people with advanced progressive illness, incorporating pain and symptom management with spiritual and social support. Essentially it is about adding quality to life for people and their families or as Admiral Nursing, who specialise in Dementia Care, state “ it is not just about end of life care, it is about the persons journey”.(Admiral Care 2008). The journey will need companions who are sensitive and caring but also, adequately trained. Skills for Care (SFC) have recently produced core competencies for staff of different levels including those in social care. These competencies are to run alongside present occupational standards and competencies. The principles of care outline that all care and support should centre on the needs, wishes and priorities of the individual receiving care. For care home staff there will be a need to develop new knowledge and skills which, with an increasing ageing population, will become more necessary as more people require care. It will certainly mean a greater need for co-operation for care home staff to work with the community staff e.g. Macmillan or similar staff, who can provide valuable guidance and support. In terms of training, many homes have joined the Macmillan Gold Standards Framework programme the aim of which is “to ensure high quality services for the most vulnerable people in our communities” (GSF 2009). Over 1000 homes have joined the programme with many reaching Gold Standard accreditation each year. This programme fundamentally requires the whole of the care home to examine its attitudes and practices in relation to end of life and palliative care. Palliative care is also now considered for sufferers of dementia, as they have life threatening illnesses not amenable to care, many of whom, in increasing numbers, may find themselves requiring residential or nursing care. Staff need to be trained and the SFC recommendations must be implemented with appropriate training courses  being developed and supported by providers to ensure high quality end of life care . We must also retain the “the impressive care, sensitivity and attention” discovered by Professor Johnson during his research.

The Quantum Group have a palliative care course and are corporate supporters of the department of Health’s ten point Dignity in Care challenge.

Quantum Training Services
Tel: 01332 332727
www.quantum-group.co.uk