CARE HOME staff should concentrate as much on ensuring that residents have a good death as they do on maintaining a good quality of life for them, according to new government guidelines that challenge social taboos about mortality.

One in five of all deaths now takes place in a care home but, all too often, residents do not receive the crucial support they need to make their last moments bearable.

Simple measures such as making sure that residents are surrounded by relatives and friends of their choosing, allowing them some say over where they die and replacing drugs intended to treat illness with painkillers can greatly ease the final moments of those close to death.

Yet high staff turnover, which makes it difficult for care workers to get to know individual residents, combined with the difficulty of spotting the point at which a frail person enters the terminal phase of an illness, can mean that these steps are overlooked.

So, too, can being oversensitive about talking about death. Ian Philp, the Government’s National Director for Older People, said that it was wrong to assume that talking about death would cause distress to older people in care homes. “If you are old and in a care home, you know you are probably going to die quite soon. Most older people don’t think that dying is a tragedy, though they do think that dying with unresolved issues is,” he said.

Professor Philp said that whereas some care homes dealt with end-of-life care “fantastically” others failed even to acknowledge that it was an important part of care. He emphasised the importance of staff learning how to spot when a resident was close to death. “You get an instinct for this. People turn their head to the wall, they don’t want any more treatment.” End-of-life care was important not only for the person dying but for relatives and friends, too. This was why it was important, when recovery from illness no longer seemed possible, to control symptoms such as pain, breathlessness, nausea and vomiting.

“What happens in the last few hours and days of life often leaves a legacy that the family and loved ones live with for years afterwards,” Professor Philp said.

Under the new Department of Health guidelines for care homes, staff will be asked to identify which residents are nearing the end of their lives.

As well as helping residents with practical matters such as getting their affairs in order, staff should also explore their thoughts about life and what happens after death, the guidelines suggest. “All people are likely to have spiritual needs and some may also have practical things they need to do because of their religious beliefs,” the guidelines say.

Roman Catholics need to have a priest available for Last Rites; Muslims and Jews need to be buried within 24 hours. Jews also need to have their bodies washed after death by someone of the same faith.

Other wishes may need to be taken into account, too — a patient may, for example, want to feel grass underfoot again for one last time.

Residents should also have a written Advance Care Plan drawn up with staff, relatives and carers while they are still healthy, to consider the choices they might be expected to make as death approaches. The plan could include advance statements, or living wills, on whether a resident wishes to refuse specific medical treatments.

From April 2007, care homes will be legally required to take care plans into account when assessing the best interests of residents.

To avoid residents being unnecessarily moved to hospital in the last weeks of life, staff should also help them to draw up a written Preferred Place of Care Plan, which will include their preference on whether to die at a relative’s home, in the nursing home or in hospital. Information about the family can be recorded, so that staff can contact the right people when the time comes.

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