End of Life Care Facilitator - Alison Doyle

1. End of Life Care Facilitator - Alison Doyle The North West End of Life Care Programme for Care Homes

2. Step 1 Objectives: Review Induction Post Death Information Audit Route to Success - Step 1 Prognostic Indicator Guidance North West Model and Register Mental Capacity, Best Interests To Do - Portfolios

3. Portfolios - Induction To Do List: Feedback to team Post Death Audit Form Engage with G.P.’s etc Share philosophy with team

4. What is a good death?

5. The Route to Success Step 1

6. Where do we start?

7. How do we know someone is in the last year of life?

8. Prognostic Indicator (GSF 2008) 3 triggers for supportive/palliative care: Choice/need Clinical indicators Surprise question

9. ? Ask yourself “Would I be surprised if This resident where to Die in the next 6/12 months?”

10. Clinical Indicators Cancer patients Organ failure Frailty and Dementia

11. Advance Care Planning

12. Advance Care Planning “Advance care planning (ACP) is a voluntary process of discussion about future care between an individual and their care providers, irrespective of discipline”

13. A.C.P. Discussion may include: Concerns and wishes Important values, care goals Understanding about their illness, prognosis Preferences/wishes for care in the future, availability of this care Documentation - no set format

14. A.C.P. Communication issues: Fear of making it happen Fear of upsetting residents, families Whose responsibility is it? (avoidance) Fear of being misunderstood/misquoted

15. A.C.P. is key form of shared decision making “no decision about me, without me” (Equity & Excellance, Liberating the NHS, DH 2010)

16. Patient Centered Approach

17. A.C.P. Ongoing dialogue Opportunistic conversation But……..

18. Advance Care Planning It should never be forced

19. A.C.P. Advance Statement Formalizes what patients DO want - not legally binding Advance Decision (living wills) Formalises what patients DON’T want - legally binding

20. Decision making Mental Capacity Best Interests

21. Mental Capacity Act (2005) 5 principles: Person must be assumed to have capacity unless lack of capacity is established Must not be treated as unable to make decision unless all practical steps taken to help to do so have been taken without success. Person not treated as lacking capacity because they make unwise decision An act/decision for or on behalf of someone lacking capacity must be in their best interests Regard made to whether the purpose can be as effectively achieved in a way less restrictive of rights and freedom of action.

22. Mental Capacity Be clear about the decision to be made - focus May be able to make some decisions but not all Is this a temporary lack of capacity Who is the decision maker?

23. Decision maker - heiarchy The person The person with Advance Directive Attorney (personal welfare, property & affairs) Court of protection Court appointed deputy Best interests decision maker

24. Best Interests Keep the person at the centre Decisions - minor or major consequences? Must not be based on age, behaviour, judgments Consider previous wishes Not motivated by speeding up death List goes on…….. Use Best Interests Guidance

25. Portfolios Feedback to all staff Identify residents who may be in last yr of life Commence North West End of Life Care Register Assessment tools - for next workshop Post Death Information Audit Form Evidence in portfolio Policy

26. Any questions?