End-of-life care ‘needs to improve in 40% of services’

The provision of palliative care in more than 40% of care homes in Scotland needs to improve, according to a regulator.

Staff in 449 homes of the 1036 inspected by the Care Commission were not aware that they should be delivering end-of-life care to residents with life-limiting illnesses.

The watchdog’s report also discovered that 54% of services had not fully trained their workers or given them enough support to deal with issues surrounding death, and this meant that staff members found it difficult to talk to residents, their relatives and carers about the issues.

Some 56% of care homes did not have policies in place to guide staff on how and when to contact members of the primary healthcare team, such as district nurses, GPs, or specialist palliative care services such as Macmillan and Marie Curie.

Susan Brimelow, the Care Commission’s director of healthcare regulation, said there were plenty of examples of good-quality palliative care provided in care homes across Scotland, but further action needed to be taken to ensure improved access for all residents. She said: “The increase in demand from an ageing population means that more people are living longer with life-limiting, long-term conditions and an increased need for palliative and end-of-life care.

“There are many examples of the excellent care and our report also features many letters of appreciation from relatives about the care their loved ones have had.

“However, it’s disappointing that the palliative care needs of residents in 43% of care homes in Scotland are not always recognised or well supported by staff.

“Care home providers and managers must recognise the need for increased knowledge, skills and educational support to ensure residents, families and carers receive high-quality palliative and end-of-life care. Improved access to this specialist care for every- one who needs it is vital.”

The report, Better Care Every Step of the Way, looked at palliative and end-of-life care after 1036 inspections and three investigations at care homes between April 2007 and March 2008.

The Care Commission highlighted several examples of good practice by care homes, but it also made 546 recommendations for improvement in specific care homes, including increasing training for staff.

A Scottish Government spokesman said: “Last October, we published Living and Dying Well, Scotland’s first national action plan for palliative and end-of-life care.

“Living and Dying Well recognises the importance of palliative and end-of-life care to support people and their families when they need it most, wherever they are receiving care.

“Work is now under way with the Care Commission and key stakeholders to ensure that, where appropriate, the recommendations from these inspections can be addressed through the implementation of Living and Dying Well.

“Later this year, we will be looking at how to update Scotland’s National Care Standards to inform people using care services and their families, both now and in the future, how their palliative and end-of-life care needs should be met.”