NA47-End of Life Care and Advance Care Planning Policy

Registration Number: {{org_field_registration_no}}

End of Life Care and Advance Care Planning Policy

1. Purpose

The purpose of this policy is to provide a clear and comprehensive framework for staff employed by {{org_field_name}} to deliver compassionate, safe, person-centred end of life care and to contribute to effective advance care planning (ACP) for individuals receiving care. As a temporary staffing agency providing registered nurses and healthcare assistants to care homes and other healthcare settings, {{org_field_name}} is committed to ensuring that all agency workers deliver care in line with legal, ethical, and best practice standards. The policy aims to ensure that staff understand their role and responsibilities in supporting service users who are approaching the end of their lives and are involved in advance care planning processes where appropriate. This policy is aligned with relevant legislation and national guidance including the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the Care Act 2014, the Mental Capacity Act 2005, the Equality Act 2010, the Human Rights Act 1998, the NICE Guidelines for Care of Dying Adults (NG31), the General Medical Council (GMC) guidance on end of life care, and the Nursing and Midwifery Council (NMC) Code.

2. Scope

This policy applies to all: Registered nurses, healthcare assistants, and temporary workers supplied by {{org_field_name}} on zero-hours or other flexible contracts. Agency staff working in client placements including care homes, nursing homes, and other healthcare environments. Situations where agency staff are directly involved in providing or supporting end of life care or where they contribute to discussions or actions relating to advance care planning. Directors of {{org_field_name}}, who are responsible for implementing, managing, and reviewing this policy in the absence of a registered manager.

3. Related Policies

Safeguarding Adults Policy – Consent, Mental Capacity and Best Interests Policy – Record Keeping and Documentation Policy – Incident Reporting Policy – Equality, Diversity and Inclusion Policy – Complaints and Whistleblowing Policy – Staff Training and Development Policy

4. Policy Statement

{{org_field_name}} is committed to supporting service users to die with dignity, free from pain and distress, in an environment that respects their choices, needs, and wishes. All agency workers will work in partnership with service users, families, placement staff, and other health and social care professionals to ensure high-quality end of life care. Advance care planning is promoted to enable individuals to express their preferences and plan for future care needs. Agency workers must respect, implement, and support advance care decisions wherever lawful and applicable.

5. Responsibilities

Directors The directors of {{org_field_name}} are responsible for: Ensuring all staff receive induction and ongoing training on end of life care and advance care planning. Monitoring compliance with this policy. Providing staff with appropriate support and supervision in delivering care. Ensuring that staff understand their duties under the Mental Capacity Act 2005 when providing care to individuals who may lack capacity. Liaising with clients to confirm that agency workers are familiar with the client’s end of life care protocols and advance care planning procedures. Investigating any concerns or incidents relating to end of life care in line with the agency’s incident management process.

Agency Workers Agency workers supplied by {{org_field_name}} are responsible for: Delivering care in line with this policy and the policies and procedures of the placement. Supporting service users with dignity, sensitivity, and compassion. Participating in advance care planning discussions when appropriate, under the guidance of placement staff. Recognising signs of deterioration and ensuring prompt communication with the client’s responsible clinicians. Respecting the expressed wishes of service users, including advance decisions, religious or cultural preferences, and preferred place of care or death. Maintaining clear and accurate records of care delivered.

6. Definition of End of Life Care

End of life care refers to the care of people who are in the last year of life, although for some this may be shorter. The aim of end of life care is to optimise quality of life and support individuals to die with dignity and in accordance with their wishes. End of life care includes: Pain and symptom management. Emotional, psychological, and spiritual support. Supporting family and significant others. Respecting and following advance care plans. Providing after-death care and bereavement support.

7. Definition of Advance Care Planning (ACP)

Advance Care Planning is a voluntary process that enables individuals to express their preferences and choices regarding their future care, particularly towards the end of life. ACP may include: Advance statements. Advance decisions to refuse treatment (ADRT). Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions. Preferred priorities of care. Lasting Power of Attorney (LPA) arrangements.

8. Key Principles of End of Life Care

Agency staff must provide care that is: Person-centred: Respecting each person’s choices, beliefs, and preferences. Holistic: Meeting the physical, psychological, social, cultural, and spiritual needs of the individual and their family. Inclusive: Involving service users, families, and advocates in decision-making wherever possible. Dignified: Ensuring privacy, dignity, and comfort are maintained at all times. Sensitive: Delivering care with empathy and compassion, especially during distressing situations.

9. Communication

Effective communication is fundamental to high-quality end of life care. Staff must: Communicate sensitively with individuals and families, recognising the emotional challenges involved. Be open and honest within the limits of their role. Adapt communication to meet individual needs including those with sensory impairments, learning disabilities, or cognitive decline. Respect confidentiality while sharing information appropriately within the care team.

10. Mental Capacity and Decision Making

Staff must follow the Mental Capacity Act 2005 when supporting individuals who may lack capacity to make decisions about their care. This includes: Presuming capacity unless proven otherwise. Providing all practical support to enable the person to make decisions. Respecting advance decisions to refuse treatment (ADRT) where these are valid and applicable. Acting in the person’s best interests when making decisions on their behalf. Applying the least restrictive option when acting in the person’s best interests. Agency workers must not make final decisions relating to advance care planning but must contribute to supporting the process and escalate concerns appropriately.

11. Supporting Advance Care Planning

Where appropriate, agency workers may: Support the service user in expressing their wishes. Be aware of any existing ACP, DNACPR, ADRT, or Lasting Power of Attorney documents. Ensure that preferences recorded in advance care plans are respected. Escalate concerns to the placement manager or registered healthcare professional if conflicts or uncertainties arise. Record relevant information accurately, avoiding personal interpretations.

12. Symptom Management and Comfort

Agency staff must: Support service users with effective symptom management as directed by the care plan and registered healthcare professionals. Monitor and report symptoms such as pain, breathlessness, agitation, and distress. Assist with repositioning, mouth care, personal hygiene, and other comfort measures. Respect the dignity of the individual at all times.

13. Supporting Families and Significant Others

Agency staff have a key role in supporting families by: Demonstrating compassion and understanding. Providing appropriate information within their competence. Directing families to the client’s team for formal discussions, care planning, or decision-making. Recognising the emotional and psychological impact of bereavement and providing respectful support.

14. After Death Care

Agency staff involved in after-death care must: Follow the client’s after-death care protocols. Treat the deceased with dignity and respect. Document actions taken and inform the appropriate personnel promptly. Support family members who are present at the time of death in a compassionate and professional manner.

15. Safeguarding

Agency staff must be vigilant for signs of neglect, abuse, or poor practice, even at the end of life. All concerns must be reported immediately following {{org_field_name}}’s Safeguarding Adults Policy and local safeguarding procedures.

16. Equality, Diversity, and Inclusion

End of life care must always be delivered without discrimination. Staff must: Respect cultural, religious, and spiritual beliefs relating to death and dying. Adapt care to meet the needs of individuals from diverse backgrounds. Ensure equal access to appropriate care, support, and information.

17. Training

{{org_field_name}} will provide all temporary workers with training on: Principles of palliative and end of life care. Effective communication in end of life situations. Advance care planning and legal considerations. Symptom management and comfort care. Cultural and spiritual aspects of care. Documentation and reporting. Refresher training will be provided regularly to ensure ongoing competence.

18. Documentation

Agency staff must: Record all relevant care accurately, objectively, and in a timely manner. Document and report any changes in condition, symptoms, or concerns. Record advance care plans, DNACPR decisions, and advance decisions clearly when communicated by the placement.

19. Supervision and Support

{{org_field_name}} will: Provide agency staff with access to directors or designated senior staff for advice and guidance. Encourage staff to reflect on experiences of end of life care and seek support if needed. Offer additional supervision or debriefing following difficult or distressing cases.

20. Monitoring and Compliance

The directors of {{org_field_name}} will: Audit training records, documentation, and incident reports relating to end of life care. Investigate any complaints or concerns relating to end of life care or advance care planning. Review feedback from clients, service users, and staff. Share learning outcomes with staff and implement improvements where needed.

21. Policy Review

This policy will be reviewed annually or sooner if: There are changes to legislation, guidance, or best practice. Feedback from clients or staff indicates a need. Trends in incidents or complaints suggest areas for improvement.

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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