CH38-End of Life and Palliative Care Policy
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End of Life and Palliative Care Policy
1. Purpose
The purpose of this policy is to ensure that all people we support receive high-quality, compassionate, and person-centred end-of-life and palliative care. This policy sets out how {{org_field_name}} supports individuals nearing the end of life by managing their physical, psychological, social, and spiritual needs while maintaining dignity, respect, and comfort This policy supports compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (as amended) and the Care Quality Commission (Registration) Regulations 2009, including (as relevant) Regulations 9, 9A, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 and 20A (Fundamental Standards) and the statutory notification duties to the CQC (including notifications of deaths and other notifiable incidents). This policy is also aligned to the CQC’s Single Assessment Framework, which assesses services against the five key questions (safe, effective, caring, responsive and well-led) and the associated quality statements.
2. Scope
This policy applies to all staff members involved in the care and support of people receiving end-of-life or palliative care, including:
Care workers, nurses, and healthcare assistants responsible for delivering daily care and support.
Care managers and senior leadership overseeing the quality and effectiveness of end-of-life care.
Medical professionals working alongside our care team, including GPs and specialist nurses.
External stakeholders, including hospice services and palliative care teams, to ensure an integrated approach.
Family members and advocates of the person receiving care, ensuring they are supported and involved in decision-making.
3. Legal and Regulatory Framework
End of life and palliative care will be delivered in line with:
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (as amended) (Fundamental Standards, including consent, safety, safeguarding, governance, staffing, duty of candour and visiting rights).
Care Quality Commission (Registration) Regulations 2009 (including Regulation 16: notification of death of a person using the service, and other notification requirements).
The CQC Single Assessment Framework (evidence will be collected and reviewed against the quality statements under the five key questions).
Where other laws apply (e.g., mental capacity/consent, information governance, safeguarding), these will be followed alongside this policy and the home’s related procedures.
4. Definitions
Palliative Care: A holistic approach aimed at improving the quality of life of individuals with life-limiting conditions through pain management, symptom control, psychological support, and social and spiritual care. This approach ensures comfort and dignity while maximising independence for as long as possible.
End-of-Life Care: Specialised care provided in the last 12 months of life, ensuring comfort, dignity, and support for the person and their family. This includes coordination with medical professionals, symptom management, and psychosocial support.
Advance Care Planning (ACP): A process where individuals discuss and document their preferences for future care, including preferred place of care, treatment choices, and wishes regarding interventions. ACP aims to align care with personal values and beliefs.
5. Principles of Care
{{org_field_name}} is committed to the following principles in delivering end-of-life and palliative care:
Person-Centred Approach: Each person’s needs, wishes, and preferences are respected and form the foundation of their care plan. Care is planned in consultation with the individual, their family, and relevant professionals.
Dignity and Respect: Ensuring that people are treated with respect, privacy, and compassion at all times. This includes respecting personal, cultural, and religious preferences.
Holistic Care: Addressing not only physical symptoms but also emotional, spiritual, and social needs to support overall well-being.
Symptom Management: Proactive assessment and management of pain, nausea, breathlessness, and other distressing symptoms through evidence-based practices.
Family and Carer Involvement: Providing support, education, and bereavement care to families and carers, ensuring they are included in care discussions.
Coordination of Care: Working in collaboration with GPs, palliative care teams, hospitals, and hospices to provide seamless, high-quality care that aligns with best practices and individual preferences.
6. Advance Care Planning (ACP)
All individuals receiving palliative care are encouraged to participate in Advance Care Planning (ACP) discussions, ensuring their wishes are respected and documented.
ACPs are documented in a centralised system, regularly reviewed, and updated as circumstances change.
ACP includes:
Preferred place of care and death, ensuring a familiar and comforting environment.
Decisions regarding life-sustaining treatments, including CPR decisions (DNACPR) and, where used locally, a ReSPECT plan or equivalent treatment-escalation plan. These decisions will be made and reviewed in line with national guidance, be clearly documented, shared appropriately with relevant professionals, and communicated sensitively with the person (and those important to them), unless doing so would cause serious harm.
Religious and spiritual preferences, ensuring faith-based care is provided where needed.
Pain and symptom management preferences, ensuring the individual’s comfort is prioritised.
Any Advance Decision to Refuse Treatment (ADRT) will be checked for validity/applicability and recorded.
Where a person has a Lasting Power of Attorney (Health and Welfare), a Court-appointed deputy, or an advocate, their role in decisions will be followed in line with legal requirements and best practice, and clearly recorded in the care plan.
Consent and Mental Capacity
We will obtain and record valid consent for advance care planning discussions and any treatment/care interventions. Where a person may lack capacity for a specific decision, staff will follow the home’s Mental Capacity procedure: presume capacity unless established otherwise, support decision-making, and where capacity is lacking, make and record a best-interests decision with appropriate involvement (family, advocates and relevant professionals) and in the least restrictive way.
7. Pain and Symptom Management
Regular pain assessments are conducted using recognised pain management tools, ensuring accurate monitoring and intervention.
A multidisciplinary approach is used to manage symptoms, involving GPs, palliative care nurses, and other specialists where necessary.
Medication administration follows best practices and CQC medication management guidelines, ensuring safety and effectiveness.
Non-medical interventions (such as music therapy, aromatherapy, and relaxation techniques) are incorporated where appropriate to enhance comfort.
8. Emotional and Psychological Support
Emotional and psychological support is provided to both the individual and their family members, addressing anxiety, depression, and stress.
Specialist mental health support is available through trained professionals for individuals experiencing significant emotional distress.
Bereavement support services are offered to families before and after death, providing counselling and guidance.
9. Spiritual and Cultural Considerations
Spiritual care is provided based on the individual’s religious and cultural beliefs, ensuring they receive comfort and connection to their faith.
Chaplaincy services or faith leaders are available upon request to provide guidance and support.
Care is delivered with cultural sensitivity, ensuring dietary, prayer, and other religious practices are upheld.
10. Family and Carer Support
Families are involved in care planning and decision-making, ensuring transparency and inclusion.
Support and information are provided to families about the dying process and what to expect, reducing fear and uncertainty.
Visiting will be supported in a way that recognises people’s rights and wellbeing, including flexible/open visiting where this is in line with the person’s wishes and assessed needs. Any necessary restrictions will be risk-assessed, proportionate, and recorded, and we will ensure visiting arrangements support compassionate end-of-life care.
11. End-of-Life Care in the Final Days
A personalised end-of-life care plan is implemented in the last days or hours of life, ensuring comfort and dignity.
Staff use compassionate communication when discussing deterioration and prognosis, ensuring sensitivity and clarity.
Individuals are kept comfortable with appropriate symptom relief and care measures, minimising distress.
Staff ensure that a peaceful and respectful environment is maintained, supporting both the individual and their loved ones.
12. After Death Care and Bereavement Support
Families are given time and space to grieve, with staff providing emotional support and guidance.
Staff follow religious, cultural, and personal preferences regarding post-death care, including arrangements for the body.
The Registered Manager (or delegated senior on duty) must notify the Care Quality Commission without delay of the death of a person using the service where required by the Care Quality Commission (Registration) Regulations 2009, Regulation 16. Notifications will be submitted using the CQC notification process and retained as part of the governance record. Where the person was liable to be detained under the Mental Health Act, the relevant CQC notification requirement will also be followed.
Bereavement counselling is available to families who require additional support, ensuring emotional well-being.
13. Staff Training and Competency
All care staff receive mandatory palliative and end-of-life care training, ensuring high standards of care.
Ongoing professional development is encouraged through external training providers, ensuring staff remain skilled and updated.
Specialist palliative care training is provided for senior staff and managers, enabling advanced care planning and complex case management.
14. Multi-Agency Collaboration
Collaboration with hospices, Macmillan nurses, community palliative care teams, and local NHS services ensures integrated care.
Regular multidisciplinary meetings are held to review and update care plans, ensuring alignment with best practices.
Referrals to external palliative care specialists are made when necessary, ensuring access to expert care.
15. Compliance and Monitoring
End-of-life care quality will be monitored through the service’s quality assurance and governance arrangements, including: audit of ACP/DNACPR/ReSPECT documentation; medicines and symptom-management records; review of any incidents and safeguarding concerns; learning from deaths and feedback from families and professionals. Where an incident triggers the duty of candour, the service will act openly and transparently, record actions taken, and share learning to reduce recurrence. Evidence will be maintained in a way that supports the CQC’s Single Assessment Framework (safe, effective, caring, responsive and well-led) and the associated quality statements.
16. Policy Review
This policy is reviewed annually or sooner if there are changes in legislation, CQC guidance, or best practice recommendations.
Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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