A focus on enabling people to die in their preferred environment is allowing more freedom of choice for patients to have a say in their care in those final stages of life.
The choice of receiving end-of-life care at home.
Approximately 74% of people express the preference to spend their final stages of life at home.
A focus on enabling people to die in their preferred environment is allowing more freedom of choice for people to have a say in their care in those final stages of life. Many people have strong wishes, not be admitted to a hospital or hospice for many reasons, including being somewhere that brings them comfort with people around them to support them in their final moments. It also gives them more confidence that their wishes will be adhered to and have more control in their care. Increasingly people are making the choice to die at home and is expected to continue to rise.
High-quality end of life care is important to ensure people approaching the end of their life, their family, and carers, have access to the right level of care during a very vulnerable time in their lives, which raises the question about whether the right staff with the right skills to support people in their own homes are prepared for the increasing level of demand. Personalised care to the preferences of the individual, with the correct support in place allows people to plan for those eventualities with confidence and comfort that their wishes will be carried out.
Often the topic of planning for end of life is overlooked and not discussed with people, whether that be due to the topic being uncomfortable or the fear that it will bring fear. Yet it is something which affects us all which raises the subject of why people are not exploring end of life care, what makes a good death and what needs to happen to ensure that everyone has access to the care and support they need as they approach the end of their lives. Not discussing this at the appropriate time to plan ahead can bring many problems later down the line when people may lose capacity to make those decisions, leading to question the extent to which people are able to make meaningful choices in their final weeks and months of their life to ensure people are in ‘good’ places to die.
On average in the last 3 months of life 64% of people will have at least one emergency admission into hospital, which can often determine their place of death if no plans are discussed and arranged prior to a decline in their health. The complex nature of end-of-life care can be challenging, often requiring the skills of various professionals and domiciliary care workers to be involved in the provision care. Often people are admitted into hospital and then await a place in a hospice, where places are scarce. This often means that whilst waiting for that place the patient passes away whilst still in a hospital setting.
This highlights the importance of greater communication between home care agencies, GP’s, Hospital discharge teams, community nursing teams and families, to ensure specialist care in the community is available at the right times to those who wish to die at home.
In addition to having end of life care in a more comfortable, familiar environment for the patient, it can often mean more practical and emotional support for carers and families supporting their loved one allowing more involvement in their care.
Studies have found older adults who died at home were more satisfied with their end-of-life care than those who were in a hospital setting. This includes the ability to be surrounded by family in the familiar environment of their home rather than a more sterile environment, like a hospital, that lacks privacy and comfort. Aside from the emotional benefit, people who receive home care are less likely to experience emergency admissions into hospital, resulting in lower costs to the healthcare system.
It is clear from research conducted, preferences and feelings around end-of-life care can have a significant impact on the quality of people’s final weeks and months of their life and facilitate a greater well-being.
When should end-of-life discussions take place, and with who?
Many people will discuss end-of-life issues with their GP, often pertaining to subjects such as DNACPR (AKA do not resuscitate). However, discussions about end-of-life need to go much further than this to address the abundance of varying factors and concerns shared by people reaching the end of life and their families: understanding prognosis, fears about dying, end-of-life goals and wishes and how their physical and mental needs can be met in the environment of choice. The facilitation of a comprehensive treatment plan reflecting a person wishes can often be achieved in a simple 4 step approach with the person and their family/carer; (1) Initiate the discussion – this is often best had in a familiar, comfortable setting where there is least disruption and clear decision-making can be made at a suitable time. (2) Clarifying prognosis – ensuring the patient and the family are aware of any diagnosis and the implications this may have on their wishes or what level of care may be needed to ensure they can remain in their chosen environment. (3) Discuss and decision of end-of-life goals/wishes – facilitate open discussion on desired medical care, any remaining life goals. Treatment wishes – for instance pain medication, avoiding hospitalisation or any unnecessary procedures. (4) Developing the plan – sharing amongst all professionals involved to ensure everyone involved in that person’s care is aware of their wishes. Involving family and other professionals/carers in these discussions can strengthen support and reduce isolation for the person in question.
Ensuring these plans are documented and shared can reduce the possibility of instances of conflict if family/carers thoughts or beliefs do not align with the wishes of the person at end-of-life.
Home Instead Cleveland provide the highest quality end-of-life support for people wishing to remain at home in their final stages of life. Helping to facilitate the wishes of that person whilst consistently advocating for them to ensure their needs and desires are met. Often our Care Professionals become a source of strength and comfort for people experiencing end-of-life, reducing isolation, and ensuring the highest quality of care is received.
If you would like to know more about how Home Instead can help you with end-of-life care, please contact us.