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

Policy Statement

This policy sets out the values, principles and practices of our approach to people using services who die while in our care, or in hospital, while still resident in {{org_field_name}}.

The policy should be used with reference to other policies on end-of-life care, including the policy on advance care planning.

{{org_field_name}}’s policy is in line with the Social Services and Well-being (Wales) Act 2014, the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, (updated 2019) and national end-of-life care programmes.

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 ensure they are proportionate in securing improvement during post-pandemic recovery where it is needed most.

This care services are 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.

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.

Enabling People to Meet with Family and Friends Post-pandemic

The coronavirus (Covid-19) pandemic raised specific challenges for people who use care home services, 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 2 nominated essential visitors. They may visit separately or at the same time.

Following the publication of the Infection Prevention and Control in Social Care (Social Care Transition Plan), there is an expectation all providers should now welcome and encourage visitors in an open and flexible way. Routine indoor visiting should be supported without restrictions when there is no outbreak.

{{org_field_name}} is aware there should be no inappropriate restrictions on visitor numbers, days people can visit or on the length and frequency of visits. If there is a Covid outbreak at the service, people should still be able to have visits from two designated visitors, at the same time if preferred. Enforcement action will be considered if unnecessary restriction of visitors is undermining people’s rights and breaching regulations. This includes (but is not limited to) Regulations 15, 21,23 and 25.

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 people who use services who may be affected.

Guidance if a Person Dies with Suspected Coronavirus

If a person who uses services 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.

Practices that Involve Close Contact with the Body

Health and Safety Executive’s guidance on Handling the Deceased with Suspected or Confirmed Covid-19 concluded more research is required to understand the risk of transmission from handling the bodies of deceased persons with suspected or confirmed Covid-19 and they cannot eliminate risk for staff caring for the deceased.

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 can be found in the HSE publication Managing Infection Risks when Handling the Deceased.

Actions to be Taken after Death of a Person Who Uses Services

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

Verifying the death by a competent person
Recording the date and time of death.
Notifying the GP.
Notifying the Care and Social Services Inspectorate for Wales.
Identifying a responsible person to complete the laying out procedures.
Identifying a responsible person to complete the necessary legal procedures, such as registering the death.
Contacting next of kin and other relatives.
Recording any unusual circumstances surrounding the death that might need further investigation. The coroner will decide if further investigation into the causes and circumstances of the person’s death is then needed.
Following, if there is likely to be a post mortem or coroner’s inquest, the required procedures with the authorities concerned.
Identifying any bereavement support and counselling needs of staff or people who use services who are emotionally affected by the person’s death.
Identifying who will be responsible for resolving any outstanding financial affairs and receiving any property and valuables and taking steps to address these.

Managing bodies of deceased with Covid-19

Current guidance by the Health and Safety Executive 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 deceased people remain in {{org_field_name}} environment.

Precautions are outlined and include:

use of PPE as per guidance
maintaining a safe distance (at least 2m) from the bereaved and avoiding contact with others with suspected or confirmed Covid-19 infection; ask others to leave the room and any areas the deceased will travel through as they are moved
placing a barrier, such as a cloth or mask, over the mouth of the deceased when moving them to try and prevent the release of droplets from the respiratory tract
body bags are not deemed essential but could minimise infection risk; they are recommended where leakage of bodily fluids is likely
cloth wrappings (shrouds or wraps) and coffins may be used to manage the risk of contact transmission but are not a replacement for body bags, where recommended.

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

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 the Covid-19 Infection Prevention and Control (IPC) guidance.

During the pandemic, a more flexible approach was needed. This was 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.

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

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

In normal circumstances, the expectation is that there should be confirmation within the person’s record that death was expected, or that medical staff would appreciate nurse verification of death or for there to be a DNACPR recommendation.

Currently there is no relaxation of Deprivation of Liberty Safeguards (DoLS) associated with the coronavirus pandemic and care homes should ensure that they adhere to DoLS guidance until such time as new safeguards are in place.

The Deprivation of Liberty Safeguards (DoLS) is to be replaced with the Liberty Protection Safeguards (LPS).

This system will apply to England and Wales only and was postponed until April 2022. The Government then announced in December 2021 the planned implementation date for LPS of April 2022 could not be met. There is no new implementation date at this time.

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.

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.

If a doctor has not seen the deceased in the 28 days prior to their death or any time after death they can complete the medical certificate of cause of death; however, the registrar would need to refer the medical certificate of cause of death (MCCD) to the coroner.
Ability for medical practitioners to send MCCDs to registrars electronically. The MCCD can be scanned or photographed and sent from a secure email account to registrars as an attachment.

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

Procedures (Not During a Pandemic)

Following verification of death, the senior person on duty contacts the persons GP to arrange to certify the death. If the death has been expected or the GP has seen the person 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.
If the death is sudden or the person who uses services has not been seen by a GP for 28 days or more, the person’s GP will inform the coroner’s office and the body should not be moved until the coroner has been notified.
The death must be registered in the district where it took place.
The manager or key worker contacts the relatives of the dead person immediately or a soon as is practically possible, depending on any agreements with them that have been made with them.
It should be noted that {{org_field_name}} attempts to find out the person’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.
The manager or key worker contacts the person’s minister of religion or spiritual adviser 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 person’s religion or customs.
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 person’s notes. Furniture and other effects are also dealt with in similar ways once it is known how they should be dealt with.
Out of respect for the dead person and other people who use services, {{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.
{{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.
{{org_field_name}} also provides its staff, who are affected by the death of a person who received their care, emotional support and bereavement counselling if needed.
{{org_field_name}} routinely reviews its policies and practice in respect of any person who used services who received end-of-life care to identify if they need to be changed or improved in future cases. End-of-life Care Policy.)
In cases where the person had 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 and if it has a statutory duty to arrange the funeral.
{{org_field_name}} arranges for staff and other people who use services 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.
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.
{{org_field_name}} retains all of the individual’s care notes and records along with any other relevant documentation for at least three years as required by the Regulation and Inspection of Social Care (Wales) Act 2016.

Training

All new staff are taken through {{org_field_name}}’s policy on the death of a person who used services as part of their induction training, in line with the Social Care Induction Framework for Wales: Outcome 1, “Understand the Principles of Care”.

{{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 such as CRUSE 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 current guidance by the Health and Safety Executive 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}}

Next Review Date: {{next_review_date}}

WCH65. Death of a Person Using Services in Care Homes