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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. It ensures compliance with the Care Quality Commission (CQC) regulations, including Regulation 9 (Person-Centred Care), Regulation 10 (Dignity and Respect), and Regulation 12 (Safe Care and Treatment). This policy also ensures that our care home provides a safe, supportive, and well-coordinated approach that meets the needs of both the individuals and their families.

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. 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.

4. 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.

5. 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 Do Not Attempt Resuscitation (DNAR) orders.
  • Religious and spiritual preferences, ensuring faith-based care is provided where needed.
  • Pain and symptom management preferences, ensuring the individual’s comfort is prioritised.

6. 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.

7. 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.

8. 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.

9. 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.
• Open visiting hours are maintained to enable families to be present, offering emotional reassurance.

10. 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.

11. 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.
• Deaths are reported in compliance with CQC and local authority guidelines, ensuring transparency and accountability.
• Bereavement counselling is available to families who require additional support, ensuring emotional well-being.

12. 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.

13. 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.

14. Compliance and Monitoring

• Regular audits and reviews of end-of-life care documentation are conducted, ensuring adherence to policies and regulations.
• Feedback is sought from families and external professionals on the quality of care provided, fostering continuous improvement.
• CQC compliance checks ensure ongoing enhancement of care quality.

15. Policy Review

This policy is reviewed annually or sooner if there are changes in legislation, CQC guidance, or best practice recommendations.

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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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