End of Life Care Policy & Procedure

How should a care service plan end of life care?

End of life care is the support a person gets in their final weeks and months, and the planning for it. For some conditions that period can last months or years. This end of life care policy and procedure uses two NICE guidelines together: NG142 for planning care and NG31 for the last days. It also shows how the service meets regulations 9, 10 and 11.

The template is written for care homes, home care and supported living. In home care and supported living, staff work alongside community nurses and the GP, and supported living staff also work with the landlord.

Planning ahead with the person

The procedure starts with spotting decline and talking to the GP, and NICE suggests tools such as the Gold Standards Framework or SPICT to help. Staff then offer the person a conversation about their wishes at a time that suits them, and record:

• where they would like to be cared for and to die, and who they want with them

• religious, spiritual and cultural wishes, before and after death

• any lasting power of attorney, a legal power the person gives someone to make decisions for them

• any advance decision to refuse treatment, and any resuscitation decision made by their doctor

A copy of the plan stays where the person lives, and a copy goes with them if they move to hospital or a hospice.

In the last days and after a death

Clinical decisions belong to the person's doctors and nurses. Care staff watch for signs such as increasing tiredness, mottled skin and changes in breathing, report pain or breathlessness at once, and offer frequent mouth care and sips of fluid as needed. Some people cannot say they are in pain, such as people with dementia or learning disabilities, so staff report changes in their behaviour.

After a death, the template covers who confirms it, care that respects the person's religious and cultural wishes, and the CQC death notification. Staff are offered a debrief. Families get clear information and are told where to find bereavement support.

Before you issue it

Delete the service-type lines that do not apply. Add your GP, community nursing, palliative care and out-of-hours contacts, and agree with local clinicians who confirms a death and how.

When a person lacks capacity for a decision, record the best interests steps on the Best Interests Decision Record. Drinks and mouth care in the last days link to the Nutrition & Hydration Policy. A death that may be linked to care also follows the Duty of Candour Policy & Procedure.