Providing quality end of life care to older people dying in nursing care homes in the UK. Are we are asking the impossible?

Julie Kinley is a Nurse Consultant for care homes at St Christopher’s Hospice Care Home Project and Research team.

It is rare for any positive publicity to emerge from care homes these days. Press reports about care tend to be generally negative regardless of care setting, as illustrated by the recent Mid Staffordshire NHS Foundations Trust Public Inquiry report and the report More care less pathway, a review of the Liverpool Care Pathway’ by Julia Neuberger. Since there are three times as many beds in care home as there are in the NHS, there is actually an increased chance of such adverse publicity emerging from a care home setting.

The Community Care Act in the 1990’s led to the transfer of the care of older people from long-stay hospital-based geriatric wards into care homes in the community.  Many older people benefitted from the move to a social model of care, and there was rapid growth in residential and nursing care homes. In England the nursing home industry grew dramatically from 28,000 places in 1983 to 196,000 in 1999 whilst the number of NHS beds declined from around 400,000 in 1974 to 190,000 in 2000.

However, when patients were transferred from the NHS to care homes and responsibility for care transferred with them, there was no provision for the transfer of the healthcare previously provided by hospital-based professionals. This article suggests that more than twenty years later care homes are still grappling with the consequences of this situation. Care homes remain ‘isolated’ providers of care. For example, whilst more than 80% of the residents in the study had dementia or cognitive impairment only 11% of 2,317 residents had any support from a mental health care team in their last six months of life.

In 2013 the decision to reduce continuing care funding for health care in nursing care homes has resulted in many care homes discontinuing this service. For care homes, reduced funding meant that it was impossible to provide complex, high quality, end of life care within budget.  In the current economic climate funding is challenging in every area. Nonetheless, commissioning bodies clearly have a responsibility to fund the increasing demand for end of life care for frail older people dying in care homes in full, and furthermore there are long term financial savings in preventing inappropriate hospital admissions for end of life care.

End of life care now makes up a huge part of the care provided in care homes.  Twenty per cent of all UK deaths take place in care homes, and our study found that 56% of all residents admitted to nursing care homes died within their first year of admission.  End of life care needs to be fully funded, and the omission of end of life care training as a mandatory requirement needs to be urgently reviewed.

The full paper can be read on the Age and Ageing journal website here.