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End of Life and Palliative Care Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides high-quality, compassionate, and person-centred end-of-life and palliative care to individuals receiving domiciliary care. This policy establishes how we support service users and their families, ensuring dignity, comfort, and respect during their final stages of life.

We are committed to:

• Providing holistic, person-centred care tailored to individuals’ wishes, religious beliefs, and cultural preferences.
• Managing pain and symptoms effectively, ensuring comfort and quality of life.
• Supporting emotional, psychological, and spiritual well-being for both service users and their families.
• Ensuring all care is delivered with dignity and respect, following best practices in palliative care.
• Working collaboratively with healthcare professionals, including GPs, district nurses, palliative care teams, and hospices.

This policy ensures compliance with Care Inspectorate Wales (CIW) regulations and national palliative care guidelines.

2. Scope

This policy applies to:

• Service users receiving end-of-life or palliative care in their own homes.
• Family members and carers, ensuring they are supported throughout the process.
• All employees, including care staff, senior carers, managers, and administrative personnel.
• The Registered Manager and Responsible Individual, who ensure regulatory compliance.
• Healthcare professionals, including GPs, hospice teams, and palliative care specialists involved in delivering care.

3. Legal and Regulatory Framework

This policy is in line with the following legislation, regulations, and best practices:

• The Regulation and Inspection of Social Care (Wales) Act 2016, ensuring care services meet legal and ethical standards.
• The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, mandating that providers deliver safe, high-quality care.
• The Social Services and Well-being (Wales) Act 2014, promoting person-centred and holistic care planning.
• The Mental Capacity Act 2005, ensuring that individuals lacking capacity receive care based on their best interests.
• The Health and Social Care (Quality and Engagement) (Wales) Act 2020, reinforcing care providers’ responsibility to ensure safe and compassionate care.
• NICE Guidelines for End-of-Life Care, setting out best practices for symptom management and care planning.
• The Gold Standards Framework (GSF) for palliative care, supporting a structured approach to end-of-life care.

4. Principles of End-of-Life and Palliative Care

Our approach is based on the following principles:

• Dignity and Respect – Ensuring all individuals receive care that upholds their self-worth and personal choices.
• Pain and Symptom Control – Managing distressing symptoms effectively, in coordination with healthcare professionals.
• Emotional and Psychological Support – Providing reassurance and comfort to service users and their families.
• Choice and Personal Preferences – Respecting individuals’ wishes regarding where and how they receive care.
• Collaboration and Communication – Working closely with families, GPs, nurses, and palliative care teams.

5. Assessment and Care Planning

5.1 Initial Assessment

Upon identifying a service user requiring palliative or end-of-life care, our care team:

1. Conducts a comprehensive assessment in collaboration with healthcare professionals, the individual, and their family.
2. Develops a personalised care plan focused on pain relief, comfort, and emotional well-being.
3. Reviews any existing advance care plans, DNAR (Do Not Attempt Resuscitation) orders, or Lasting Power of Attorney arrangements.

How we manage this efficiently:

• A digital care planning system ensures updates and access for care teams.
• Regular communication with healthcare providers ensures an integrated approach to care.
• A senior care coordinator is assigned to oversee the service user’s care and liaise with family members.

5.2 Advance Care Planning (ACP)

Advance care planning ensures that service users’ preferences and values are documented and respected. ACP discussions cover:

• Preferred place of care (e.g., home, hospice, hospital).
• Medical interventions they do or do not wish to receive.
• Religious or spiritual beliefs that should be honoured.
• Funeral or bereavement planning (if the individual wishes to discuss it).

How we manage this efficiently:

• Trained care staff facilitate ACP discussions sensitively.
• ACP documents are securely stored and accessible to relevant care professionals.
• Care plans are regularly reviewed to ensure they align with the individual’s changing needs.

6. Pain and Symptom Management

Effective pain and symptom control is a core priority in palliative care. We work with:

• GPs and district nurses to ensure appropriate medication management.
• Palliative care teams to provide expert symptom relief.
• Physiotherapists and occupational therapists to improve mobility and comfort.

How we manage this efficiently:

• Care staff are trained to identify signs of pain or discomfort.
• Protocols for medication administration are strictly followed.
• Daily symptom monitoring ensures prompt interventions.

7. Emotional, Psychological, and Spiritual Support

Palliative care should address not just physical symptoms, but also emotional, psychological, and spiritual well-being.

We offer:

• Counselling and emotional support for individuals and families.
• Bereavement support and signposting to grief counselling services.
• Spiritual care, respecting individual faiths and cultural needs.

How we manage this efficiently:

• Care staff receive specialist training in grief support and active listening.
• Families are provided with resources and guidance on coping with loss.
• Religious representatives are available upon request for spiritual care.

8. Family and Carer Involvement

Families play a crucial role in end-of-life care. We ensure:

• Regular family meetings to discuss the individual’s care plan.
• Guidance on supporting their loved one at home.
• Emotional support to prepare them for the individual’s passing.

How we manage this efficiently:

• A dedicated key worker ensures clear communication with families.
• Printed and online resources are provided to help families navigate end-of-life care.

9. End-of-Life Care in the Final Days

As a service user approaches the final stage of life, we focus on:

• Providing round-the-clock care and support.
• Minimising distress and discomfort.
• Ensuring family members are present and supported if they wish.

How we manage this efficiently:

• A rapid response protocol ensures all necessary support is in place.
• Care teams remain flexible to meet changing needs.
• 24/7 support is available for families requiring guidance and reassurance.

10. After Death Care and Bereavement Support

Following a service user’s passing, we:

• Provide immediate support to the family.
• Ensure all legal and procedural requirements are followed.
• Offer bereavement support and signpost to specialist services.

How we manage this efficiently:

• A post-death care checklist ensures compassionate and dignified aftercare.
• Bereavement support is available for families for up to 12 months.

11. Related Policies

This policy aligns with:

• Safeguarding Adults Policy (DCW13).
• Medication Management Policy (DCW21).
• Risk Management and Assessment Policy (DCW18).
• Mental Capacity and DNAR Policy (DCW39).

12. Policy Review

This policy will be reviewed annually or sooner if required due to legislative changes, business needs, or CIW updates. The Registered Manager and Responsible Individual are responsible for ensuring compliance.

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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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