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Death of a Service User in Care Homes (Scotland) Policy

Policy Statement

This policy sets out the values, principles and practices underpinning {{org_field_name}}’s approach to the death of any of its service users.

It is written in line with the values, principles and relevant standards described in My Life, My Support (2017), notably 1.7, which states, “I am supported to discuss significant changes in my life, including death or dying, and this is handled sensitively.”

It should be used with reference to the home’s policy on end-of-life care.

The coronavirus (Covid-19) pandemic presented specific challenges for care home service users, their families and the staff with regard to end-of-life care provision. Care home service users proved to be particularly vulnerable to the infection and outbreaks in care homes proved devastating.

It is {{org_field_name}}’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 other service users who may be affected.

In March 2022, changes to the national Health and Social Care Standards for Scotland’s adult care homes will position so called “Anne’s Law” into practical effect while legislation is being developed. Anne’s Law aims to ensure service users who live in adult care homes have rights to see and receive support from those significant to them.

Two new Standards outline the expectation that those living in care homes should have the right to see someone who is important to them, even during a Covid-19 outbreak, and be able to name a person or persons who may directly participate in meeting their care needs.

These Standards should be reflected by care homes in their policies, and the Care Inspectorate will consider whether they are being met when registering, inspecting and supporting homes. See New Health and Social Care Standards for Care Homes for more information.

Managing Bodies of Deceased with Covid-19

 

If a service user dies of suspected Covid-19 in {{org_field_name}}, all staff comply with the Health and Safety Executive’s guidance on Handling the Deceased with Suspected or Confirmed Covid-19.

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 deceased service users remain in {{org_field_name}} environment.

Precautions are outlined and include:

Practices that Involve Close Contact with the Body

During the Covid-19 pandemic, it was important that service users still had their cultural and religious beliefs respected as far as possible.

Viewing and hygienic preparations such as washing and post-mortem investigations are permitted when overseen or undertaken by those trained in handling bodies of the deceased.

Mourners should still be made aware of the significant risk for vulnerable people if the deceased is known to have Covid-19.

Further guidance for staff who manage the deceased is available in the HSE publication Managing Infection Risks when Handling the Deceased

Standard Infection Control Precautions (SICPs) and Transmission-Based Precautions (TBPs) must be used for handling bodies of the deceased. No further precautions are required unless Aerosol Generating Procedures (AGPs) are being undertaken.

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.

Procedures (not during a pandemic)

{{org_field_name}} applies the following principles when responding to the death of one of its service users (not during coronavirus pandemic).

Care home users should:

  1. be confident that any death in {{org_field_name}} will be handled with dignity, sensitivity and discretion
  2. be fully supported by staff if they lose someone close to them by having the opportunity to say goodbye or go to their funeral if they want
  3. be able to say what they want to happen and who should be informed about their physical, personal and spiritual care in dying, death and funeral arrangements; they should be confident that their wishes will be carried out
  4. be able to discuss with staff and others their preferred place of death and expect their wishes to be respected
  5. expect their end-of-life phase to be as free of pain as possible
  6. be able to choose whether or not they have people with them when they die and who they should be; staff should make every effort to ensure this happens
  7. expect the home to have or arrange for people to stay with them during their last few days and hours, if that is sought
  8. have their death treated with dignity, sensitivity and respect in line with their expressed social, cultural and religious preferences
  9. expect after their death that their bereaved relatives, friends and carers can spend as much time with them as they need to
  10. expect the home to support their relatives and friends through the formal processes relating to death, such as arrangements about belongings.

It is {{org_field_name}}’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 other service users who may be affected.

The key actions to be taken include:

  1. recording the date and time of death
  2. notifying the GP
  3. notifying the Care Inspectorate through its notification procedures
  4. identifying a responsible person to complete the laying out procedures
  5. identifying a responsible person to complete the necessary legal procedures, such as registering the death
  6. contacting next of kin and other relatives
  7. recording any unusual circumstances surrounding the death that might need further investigation
  8. determining if there is likely to be a post-mortem or requirement to notify the Procurator Fiscal and following the required procedures in the event
  9. identifying any bereavement support and counselling needs of staff or service users who are emotionally affected by the person’s death
  10. identifying who will be responsible for resolving any outstanding financial affairs and receiving any property and valuables and taking steps to address these.

Verification of Death — Covid-19 Guidance

Verification of death can be undertaken by a registered nurse with appropriate competency, in agreement with local policies. Standard infection control precautions are adequate when undertaking the verification procedure as per Handling the Deceased with Suspected or Confirmed COVID-19 available on the HSE website.

Verification of death differs from certification of death, which is signing a death certificate and only be done by a medical practitioner.

During the pandemic, a more flexible approach was needed to reduce the spread of infection and improve the timeliness of verification. All registered professionals had to adhere to their professional code of practice and conduct with regard to this.

The Coronavirus Act 2020 put in place changes to registration and certification of deaths in the UK. This Act, which introduced easements to death certification processes and cremation forms during the pandemic, was repealed on 24 March 2022.

{{org_field_name}} continues to comply with relevant legislation and guidance.

Currently there is no relaxation of Deprivation of Liberty Safeguards (DoLS); however, DOLS orders are not automatically recognised under Scots law. This means that non-Scottish placing local authorities need to petition the Court of Session in Scotland to get such recognition in each individual case.

Coronavirus Legislation — Registration of Death

The Coronavirus Act 2020 and 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.

The following provisions are continuing.

New format MCCDs were introduced in Scotland in 2015, eliminating the need for doctors to complete separate cremation forms. In Scotland, a death should be registered by a registrar within eight days of the date of death and all deaths must be registered before a body is buried or cremated. If the informant wishes, a scanned copy of the Certificate of Registration of Death (Form 14) can be emailed to the funeral director, to allow funeral arrangements to be made.

The Scottish Form 14 is also sufficient to allow cremations in other parts of the UK.

Procedures (not during a pandemic)

  1. The senior person on duty arranges verification of death and the resident’s GP to certify the death. If the death has been expected or the GP has seen the service user in the last 28 days, and if the doctor can certify the cause of death, they will issue the person in charge with:
    a. a medical certificate that shows the cause of death (this will be in a sealed envelope addressed to the registrar)
    b. a formal notice that states that the doctor has signed the medical certificate and tells you how to go about registering the death.
  2. If the death is sudden or the service user has not been seen by a GP for 28 days or more, the service user’s GP will inform the Procurator Fiscal’s office and the body should not be moved until the Procurator Fiscal has been notified.
  3. The death must be registered in the district where it took place.
  4. The manager or key worker contacts the relatives of the dead person immediately or as soon as is practically possible, depending on any agreements that have been made with them.
  5. It should be noted that {{org_field_name}} attempts to find out the service user’s wishes on their funeral arrangements well in advance and these should have been recorded. If a cremation is required, two separate doctors sign the cremation form.
  6. The manager or key worker contacts the service user’s minister of religion or spiritual advisor if there is any uncertainly about whether there are any particular procedures or rituals which should be carried out or observed after death, according to the deceased service user’s religion or customs.
  7. At an appropriate time, the manager or key worker arranges for the person’s personal belongings to be collected by the next of kin or relatives acting on their behalf. Relatives sign a receipt for the personal belongings and this is filed with the service user’s notes. Furniture and other effects are also dealt with in similar ways once it is known how they should be dealt with.
  8. Out of respect for the dead person and other service users, {{org_field_name}} does not reallocate the dead person’s room until the full notice period has expired, all effects are cleared and the room is made fit for purpose for someone else.
  9. {{org_field_name}} is able to offer relatives of the dead person support, including any emotional support they need, over the arrangements surrounding the death.
  10. {{org_field_name}} also provides its staff who are affected by a service user’s death emotional support and bereavement counselling if needed.
  11. {{org_field_name}} routinely reviews its policies and practice in respect of any service user who has received end-of-life care to identify if they need to be changed or improved in future cases.
  12. In cases where service users have no next of kin or relatives who can be contacted, {{org_field_name}} contacts the local authority to find out about the proper procedures to follow.
  13. {{org_field_name}} arranges for staff and other service users to attend the funeral if they wish. It always sends at least one representative to attend a funeral as well as sending a condolence card or letter to the relatives.
  14. At an appropriate time, {{org_field_name}}’s administrative staff prepare a final statement of account to go to the person responsible for dealing with the dead person’s estate.
  15. The home retains all of the service user’s care notes and records along with any other relevant documentation for at least three years.

Training

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

{{org_field_name}} 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.

Nurses verifying death are trained and supported in the procedure and in the aftercare required by families and staff.

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


Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

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