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Death of a Person Using Services in Domiciliary Care (Wales) Policy

Policy Statement

This policy provides guidance to care staff in the event of their having a role to play in the arrangements that must be made after the death of a person using services.

The policy should be used with reference to the organisation’s policy on end-of-life care. It is written in line with all legal requirements and best practice guidance relating to the death of a person using services, the relevant Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2019, and the Social Services and Well-being (Wales) Act 2014.

Care Inspectorate Wales continues to collate, analyse and share data and intelligence to inform inspection activity and also inform the wider Welsh Government and partner approaches. They are prioritising inspection activity based on analysis of risk to enable them to be proportionate in securing improvement during post-pandemic recovery where it is needed most.

The care home is also aware of the 2022 Quality Statement for Palliative and End of Life Care for Wales, which outlined the vision for palliative and end-of-life care delivered in Wales for all who need it by people working closely together, at home when appropriate, defined by what matters to the person and underpinned by what works.

The coronavirus (Covid-19) pandemic raised specific challenges for people using services in the care home, their families and the staff with regard to end-of-life care provision and subsequently for those who died, either as a consequence of coronavirus or other causes.

The Welsh Government outlined that for some Covid-19 incidents or outbreaks, routine visiting may continue but if routine visiting is suspended, those living in care homes can continue to receive visits from their two nominated essential visitors. They may visit separately or at the same time.

If a person using services dies of suspected Covid-19, all staff must comply with the Health and Safety Executive’s guidance on Handling the Deceased with Suspected or Confirmed Covid-19.

It is the organisations policy to make sure that in the event of a death, either expected or sudden, it follows all required procedures and provides support to bereaved relatives, friends and other people using services who may be affected.

It is recognised that people receiving domiciliary care services could die for reasons that are unrelated to the services provided. In most cases, the agency will not be involved in the arrangements made after someone’s death.

Any death that the cause is unknown should be treated with appropriate precautions.

If notified of a death, the agency will send its condolences to the family members of the bereaved and will sensitively address any termination of contract issues as and when appropriate.

There could be instances, however, when someone dies while care service staff are actively involved, and they may need to act to make sure that due process is followed.

For example, care staff could find one of their people using services users dead when arriving or they could be present when a person dies. It is also possible that agency staff could be closely involved in the provision of end-of-life care.

It is the organisation’s policy to make sure that in the event of a death, either expected or sudden, it follows all required procedures and provides support to bereaved relatives, friends and others affected.

The key actions to be taken include the following (not during a pandemic).

  1. In the event of visiting a home and finding a person apparently dead, immediately call for an ambulance/emergency services.
  2. Notify the line manager to arrange for the death to be verified and to contact the next of kin, police or GP in response to the needs of the situation (or instruct the staff to do any of these things).
  3. Make note of the time of arrival and finding the person evidently dead. Record the date and time of death if this occurs in the care worker’s presence.
  4. Notify the GP if appropriate, though in most circumstances this will be done by a relative.

In certain circumstances, {{org_field_name}} manager might need to do the following.

  1. Notify the police, local safeguarding authority, and/or the Care Inspectorate Wales (CIW) if there is any suspicion or evidence that the service could be responsible or held responsible for the person’s death, for example, because its staff could have been negligent or committed acts of abuse.
  2. Identify a responsible person to complete the laying out procedures.
  3. Identify a responsible person to complete the necessary legal procedures, such as registering the death.
  4. Record any unusual circumstances surrounding the death that might need further investigation.
  5. Consider if there is likely to be a post-mortem or coroner’s inquest and follow the required procedures if so.
  6. Identify any bereavement support, counselling or occupational health support needs of staff who are emotionally affected by the person’s death or the events surrounding it.
  7. Identify who will be responsible for resolving the practical arrangements such as the funeral and any outstanding financial affairs concerning the agency ‚ÄĒ this will usually be a relative or in the case of outstanding financial payments, the executor of the person‚Äôs estate. Occasionally, the agency might need to contact the local authority, if the person to whom it has been providing a service has no next of kin or someone who can make the necessary arrangements.
  8. Be prepared to communicate and co-operate with any other agencies that might need to investigate the death, eg the police, local safeguarding authority, CIW.
  9. Prepare staff for any such involvement.

Managing bodies of deceased with Covid-19

Health and Safety Executive’s guidance on Handling the Deceased with Suspected or Confirmed Covid-19 will be followed by all staff:

This states that while risk of transmission from Covid-19 from the deceased is low, there may be ongoing risk of infection from handling body fluids and tissues where infection is suspected or confirmed. The exact duration that SARS-CoV-2 can remain infectious in body fluids and tissues in a deceased body is unknown. Standard infection control precautions (SICPs) and transmission-based precautions (TBPs) should be sufficient to protect those handling the deceased with suspected or confirmed Covid-19 while the deceased person remains in the care home environment.

Precautions are outlined which includes:

This guidance remains under review and may be updated in line with the changing situation as required. {{org_field_name}} will ensure it regularly checks for updates.

The UK Health Security Agency’s brief update, Covid-19 Transmission from the Deceased: A Rapid Review, concluded more research is required to understand the risk of transmission from handling the bodies of a deceased person with suspected or confirmed Covid-19, and they cannot eliminate risk for staff caring for the deceased.

Practices that involve close contact with the body

During and post Covid-19 pandemic, it is essential people have their cultural and religious beliefs respected.

In some communities, deceased bodies are cared for by appropriately trained volunteers, or other family members. It is recommended those with underlying conditions should consider seeking advice from health professionals regarding whether they should undertake such a role and provide care for the deceased.

Further guidance for staff who manage the deceased is available here.

Registration of death

The Coronavirus Act 2020 and the pandemic enabled a temporary change to the law, and this Act, which introduced easements to death certification processes and cremation forms during the pandemic, was repealed on 24 March 2022.

Prior to the Coronavirus Act 2020, it was a requirement that the medical practitioner had attended the deceased within 14 days. Post-pandemic, this time period will remain at 28 days and not revert to pre-pandemic 14 days.

The following provisions are continuing.

The form, Cremation 5, which was suspended during the pandemic, will not be re-introduced after the Coronavirus Act expires and has now permanently been abolished.

Training

All new staff are taken through the organisation’s policy on the death of a person as part of their induction training.

The organisation also provides staff with training on bereavement and loss as part of its ongoing training programme using staff from a bereavement counselling service as trainers.

This training focuses on how people cope with death, personally and culturally, and in respect of religious and non-religious beliefs. It also focuses on the diverse customs and practices used to mark a person’s death and how to provide emotional support to people who are grieving.

{{org_field_name}} ensures that staff are aware of and comply with current HSE guidance on Handling the Deceased with Suspected or Confirmed Covid-19.


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