Dr Eileen Burns is the recently elected BGS President Elect and is a Consultant Geriatrician at St James’s Hospital, Leeds.
“My Mum no longer recognises me or my sisters. She needs help with everything- washing and dressing, eating and drinking. She is incontinent. If she could see herself like this she would be distraught. We were very relieved when her GP met with us to discuss what we felt she would have wanted for herself in this situation. We don’t feel that there is anything to be gained for her by another hospital admission- unless she has a problem which is causing her distress which they can’t alleviate here in the home. We’d like her to die here with the dignity she has left in the place and with the carers she’s familiar with”
The recent spotlight on increasing death rates in care homes accompanied by commentaries implying that this is an unwanted and regrettable development put a naive and simplistic gloss on a complex issue.
The average length of time spent by a care home resident has fallen over the last decade as people tend to enter care homes later in life, with a higher level of frailty, dependency and with more advanced medical conditions.
Recent publications have highlighted the reasons why death rates are not a useful indicator of quality of care. In many cases where residents have advanced diseases including dementia an advance care plan may have been drawn up to allow the views of the resident to be recorded and respected.
The small size of many care homes means that variations in death rates can be expected from year to year.
There are better measures of quality of care in care homes- for example, the Resident assessment instrument (RAI) used in the USA provides data about pressure ulcer formation amongst other indicators, and is used as a quality indicator.
The National Voices survey, asked bereaved relatives for their opinions regarding the care their deceased family member received at the end of their life. The report showed that care in care homes was regarded more highly than hospital care.
Much work has gone into the support of care home staff to provide care for residents as they approach and then enter the final phase of their illness. Support has variably come from hospices, GPs , specialist nurses and geriatricians. Staff who work closely with care home residents have no concerns that the move to allow very frail older people suffering from advanced multiple long term conditions, often including dementia, to end their days in a familiar environment is misplaced.
However, transfer of end of life care from hospitals to care homes must be supported by appropriate resource and expertise to ensure that the quality of end of life care is improved by such a transfer.
Quality of care in care homes must be measured and as a society we need to be more interested in how our elders are treated. However, misplaced agitations against measure which are in the interests of residents are unhelpful.
For further information about the quality of healthcare support for older people in care homes, the Quest for Quality report makes recommendations for national action by government and local action by NHS commissioners, planners and clinical services to improve the quality of NHS support to care homes.