Life is full of uncertainties, the only certainty we all face is death. The estimated number of deaths worldwide per minute is 108. (CIA World Factbook 2016). Most people have strong ideas about how they would like to spend their last years, months, or weeks, but for many discussing these ideas with family and friends is a step too far. As a nation, we generally do not like to talk about death.
I am a social worker and team manager within our Community Support and Social Work team at Jewish Care, the largest health and social care organisation for the Jewish community in the UK. Our small End of Life Care generalist team help in planning for and facing end of life. We use a multi-disciplinary approach and consult specialist professionals when appropriate. We encourage people to plan and discuss burial, organise lasting powers of attorney and share important information with family and those close to them. We help people to understand that putting affairs in order now can decrease distress later, when they no longer have mental capacity to make informed specific decisions.
Talking about dying isn’t an easy conversation to have at the best of times, but as people approach later life our team can help them consider what they really and our staff can support older people to communicate what matters to them. These conversations often lead to better end of life experiences for people and can help families with the grieving process.
Whether they are community or care home based, emphasis on training for staff to talk about end of life care and advanced wishes is essential. Increasing confidence enables staff to have a challenging conversation, feel less worried and more able to manage distress and anxiety with residents and families at end of life. Knowing they are contributing to a person’s dignity has a positive impact on the wellbeing of carers and staff. It also provided staff with a much-needed acknowledgement of the importance of their jobs and the daily challenges they face.
Communication skills are a key area of achieving good end of life care, incorporated in the 2008 National End of Life Care Strategy. Today, the emphasis is on local strategy, with a health and social care partnership and strong voluntary sector and community support. The six Ambitions for Palliative and End of Life Care provide a local framework to achieve effective care delivery, with communication skills still at the forefront of good practice.
The Six Ambitions are 1) Each Person is seen as an individual, 2) Each person gets fair access to care, 3) Maximising comfort and wellbeing, 4) Care is co-ordinated 5) All staff are prepared to care and 6) Each community is prepared to help. These Ambitions highlight the synergy between Jewish Care’s Values and the Gold Standard Framework, leading us to introduce this framework into our care homes as well as support to the community.
Our community networking has achieved strong partnerships with local GP’s, community specialist palliative care teams and with local hospices. Understanding the importance of honest conversations and working collaboratively, ensures individuals and their carers do not become deﬁned by their illness and instead, are able to live out the remainder of their lives as individuals and as comfortably as possible.
Death is as, after all, as inevitable as life, so the focus on enabling older people in our community to live meaningful lives continues, ensuring that the end of life is just as meaningful too.