End of Life Care Policy

End-of-life care provides the support that is needed towards the end of someone’s life. Our aim is to allow our clients to pass in the most peaceful and comfortable way. While some people spend their final days in a hospital, hospice, or nursing home, end-of-life care at home has become a preferred option for those who wish to spend their last moments within their own home, and surrounded by their loved ones.

Aim

This policy is to set out the values, principles, and practices underpinning Seven Steps Support Ltd’s approach to the care of clients who are terminally ill and whose death may be imminent.

Policy Statement

The standard requires that “care and comfort are given to clients who are dying, their death is handled with dignity and propriety, and their spiritual needs, rights, and functions are observed.” The standard also requires support providers to have in place policies and procedures for handling death and dying and to ensure that these are observed by staff.

Principles of End of Life Care

Seven Steps Support Ltd implements as fully as possible the guidance on palliative care produced by the Department of Health and the Palliative Care protocols that have been approved by the National Institute for Clinical Excellence (NICE).

It is committed to continuing the care of its clients who choose to remain at home when terminally ill or in a terminal condition, unless there are good reasons for seeking an alternative. These are determined by the nature of the condition or illness, Seven Steps Support Ltd’s capacity to provide or procure the necessary care and support, and medical guidance and advice. The views of relatives are also taken into account, though the client’s own views, where stated, are the most important.

Seven Steps Support Ltd ensures that where it offers terminal care and support, the client and those close to them are treated with respect and dignity and their rights to spend time alone with one another are fully respected. Seven Steps Support Ltd thus tries to follow the principle that a person should be cared for in their final days as if he or she was in their own homes if that is their wish.

Seven Steps Support Ltd makes every effort to provide and procure all the care and support available from health and local services to make the client comfortable, safe, and as free from as much pain and discomfort as possible. This includes, where appropriate, the involvement of palliative care practitioners and services and provision of counseling and other forms of psychological support.

Clients who are undergoing palliative care, possibly involving specialist community medical and nursing staff, require specific care plans. These end-of-life plans are additional to the general client plan and are used in association with established procedures and clinical recording tools.

Each aspect of end-of-life care is handled sensitively, with the aim of ensuring people can die in a dignified, respectful manner, as free from pain and distress as possible and in accordance with their own wishes.

Seven Steps Support includes:

Personal care – supporting with bathing and showering
Support with toileting, including changing continence pads or using a commode
Mobility support, such as help moving position in bed and help with standing or sitting – and using hoists when required
Administering or prompting medication, and supporting with pain management
Changing bedding and housekeeping duties
Preparing meals and snacks to taste and dietary requirements
Complex care such as PEG feeding
Ongoing companionship and emotional support
Support to liaise with all medical and end-of-life care professionals to ensure the quality of care

Staff Roles and Responsibilities

The end-of-life care plan identifies staff roles and responsibilities and the practices and procedures that they should follow. Staff are expected to:

Maintain privacy and dignity at all times
Accept that each situation is an individual one and not to be treated as routine
Respect the individual’s wishes
Resolve constructively any conflicts of interest or differences of opinion with reference to the individual’s wishes
Work in partnership with relatives and friends
Ensure all cultural and religious preferences are observed and assisted (including secular preferences for those who are non-religious)
Work in partnership with the GP and other health care professionals involved
Attend to physical needs to ensure the person is as comfortable as possible and pain is being managed as effectively as possible – with resources to achieve this made available
Respond to emotional needs as well as physical needs
Respond to the needs for support of both relatives and staff who had a close relationship with the dying person

Seven Steps Support Ltd focuses on promoting independence and respecting your dignity and privacy. Seven Steps Management and client staff teams will work with clients and families to understand and ensure specific needs are met and how our staff can maintain those important boundaries.

Staff Support and Supervision

Staff closely involved in the implementation of a care plan for a terminally ill person receive supervision and good emotional support to help them provide a high standard of care. Seven Steps Support Ltd works on the basis that care staff involved in these situations should feel they can discuss their feelings and experiences with other staff members in supervisions and staff meetings.

Staff are expected to engage in, rather than avoid, awkward conversations, and also to talk naturally to the person, following their agenda.

Communication: Keeping Everyone Informed

Seven Steps Support Ltd care undertakes to keep everyone informed in the person’s care of changes and developments in the person’s condition.

A record is kept of all their contact details to assist communication and information passing, e.g., next of kin, other family members, friends, GP, specialist medical staff from Palliative Care Team, including Macmillan and community nurses, key worker and other care staff involved, religious/spiritual advisors such as priest, rabbi, imam, social worker/care manager, and other representatives such as advocates and legal guardians.

Core Principles for End-of-Life Care

Seven Steps Support Ltd and all staff aim that care at the end of life should embody the following principles:

Respect the dignity of both client and caregivers.
Be sensitive to and respectful of the patient’s and family’s wishes.
Use the most appropriate measures that are consistent with client choices.
Ensure that alleviation of pain and management of other physical symptoms are a high priority by liaising with medical professionals.
Recognize, assess, and address the associated psychological, social, spiritual, religious issues, and cultural taboos, realizing that different cultures may require significantly different approaches.
Ensure appropriate continuity of care by the client’s family physician and consulting physician when applicable.
Advocate for the client’s right to choose any therapy that may reasonably be expected to improve the patient’s quality of life, including alternative or non-traditional treatments.
Provide and aid access to palliative care and hospice care.
Respect the right to refuse treatment.
Respect the physician’s professional judgment and recommendations, with consideration for both client and family preferences.
Consider clinical and evidence-based research and education relative to providing care at the end of life.