Nursing Opinion

Supporting care homes in end of life care

Debbie Ripley, Regional Manager, Marie Curie Nursing Service London

Marie Curie is a charity that provides care and support for people who are dying or living with a terminal illness, as well as their loved ones. Our nurses care for people in their own homes or in our nine UK hospices, both with and without coronavirus.  

More recently we have developed our website to include a range of resources, a Palliative Care Knowledge Zone for Health Care Professionals and a free telephone Support Line open seven days a week.* 

Coronavirus has made us appreciate the complexity of being a charity trying to deliver care in challenging times. Staff sickness and lack of PPE have been our biggest struggles when delivering patient care. 

One area in this time of crisis where we hope we have helped, is by supporting our colleagues in care homes. We know they are struggling too doing a hugely challenging role battling with staff sickness and lack of PPE as well as the added stress of having to manage family’s expectations and altered visiting routines. 

In London we have a database “Coordinate My Care” (CMC) very similar to KIS in Scotland. CMC is much more than a clinical record, it is a care plan, and because it is visible to the London Ambulance Service it serves well as a record of discussions with patients and their families to communicate suitable treatment pathways for care home residents.  

During the pandemic Marie Curie had been approached by our commissioners to support GPs of care home residents practically and help facilitate these care plan discussions which are often very lengthy and detailed.

Unfortunately, a lack of explanation and understanding has led many people to think this relates to whether or not a care home resident or patient is for active resuscitation. Advance Care Planning is so much more than that and more often than not, includes some form of treatment. That treatment can be in the form of oral antibiotics for an infection, community based palliative care and hospital admission for intravenous medication and/or hydration. 

We know that those residents in care homes are there because they already need 24-hour care and the staff looking after them so well know them best.  

Many care home residents lack capacity and/or have some form of Dementia. Where possible, and in agreement with their loved ones, it is often their preferred place of care. Ensuring a high-level care plan for those times of illness and crisis are so vital. Coronavirus has placed an urgency on us to support our hospitals and that means stepping up our support to the care homes who are already looking after some of the most frail and vulnerable in the community.

Over the last few weeks a team of Marie Curie Registered Nurses has been working with care homes in South West London to ensure all residents and their families have the opportunity to discuss their future care wishes. The majority of the information is obtained for the care home staff who know their residents the best and it is always easier to talk about the “what if’s” when people are reasonably well.

During these difficult times of social distancing and isolation, families have welcomed the opportunity to have a conversation with a Marie Curie Nurse. Whilst the care homes have been run off their feet, they have seen the benefits of Advance Care Planning too. They can still call 111 or 999 for support but instead of having to have difficult conversations at 2am with a relative there is a clear plan of care and treatment for all those involved that they can confidently follow.

When we clap for carers on a Thursday night don’t forget the care homes. Their continued care and devotion to their residents is also saving the NHS.

Edel Harris





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