Planning for an Expected Death at Home An Initiative of The South East Palliative & End-of-Life Care Network Service Delivery Committee.

Palliative Care Care for those living with life-limiting, life-threatening illness Advance care planning is recommended as soon as you are able to introduce the topic to patient & family

Model for Palliative Care 3/22/2017 Model for Palliative Care Frank Ferris Oct 2005 Therapies to modify disease End-of-life Care Hospice Palliative Care The diagonal line is dashed to indicate that it is never really straight and that instead the degree to which curative and palliative interventions are employed is highly variable along the illness trajectory. The end-of-life phase is a relatively small portion of the continuum. Presentation Death Therapies to relieve suffering and/or improve quality of life Bereavement Care 3

Planning for a Home Death Who pronounces death? Who is responsible for certification of death? Who does the family contact at time of death? What about the DNRC form? How do we help families prepare for death? Who makes sure everything gets done?

We Need a Plan! Working group established under the direction of the Palliative & End of Life Care Network Reported to the Service Delivery Committee of the Network Consultation with nurses, case managers, physicians, EMS, funeral directors

Do not resuscitate A plan of treatment is developed that reflects the expressed wish of the patient (or consent of the substitute decision maker for the person who is not capable) that CPR is not in the patient’s plan of treatment. DNRC form is completed providing direction for EMS practitioners

The Yellow Folder

Yellow Folder Contents DNRC Form Yellow Magnet Algorithm Guidelines Brochure When Death Occurs at Home A checklist for Case Managers in folders at CCAC

What do you do with the magnet? The magnet is a signal that the yellow folder is in the home May be very helpful for EMS on a 911 call It is meant to be placed on the refrigerator door

The Algorithm A tool to assist with planning for pronouncement and certification of death Nurses (RN or RPN) can pronounce death Only a physician or RN(EC) can sign a death certificate

EXPECTED DEATH IN THE COMMUNITY PLANNING TOOL Patient’s Name_____________________ Will attend home to pronounce and certify 24/7 MD or RN (EC) or Medical Group will certify as soon as possible (within 24 hours of death) MD or RN (EC) Medical Group Will not attend home to pronounce or not available 24/7 Nurse pronounces Funeral Home will accept nurse pronouncement and certification within 24 hours of death Funeral Home will not accept nurse pronouncement and certification within 24 hours of death MD or RN (EC) or Medical Group will not certify within 24 hours of death Following discussion with family and physician indicate/circle plan. Name____________________________ Date_____________________________ Determine how to get death certificate to Funeral Home after completion Explore local options: Alternate MD or RN (EC) or Medical Group to attend home to pronounce and certify 24/7 Explore local options: Alternate MD or RN (EC) or Medical Group to certify within 24 hours of death

Avoid calling the coroner unless there are reasons to contact them Avoid transfer of the body to ER for pronouncement and certification It is inappropriate to sign a death certificate prior to the death

Guidelines/Checklist Family/Caregiver/Agency at Time of Death Completed with family/informal caregiver Numbers to call at time of death: - professionals - family/friends Cultural considerations at time of death

Brochure: When Death Occurs at Home Guide for informal caregivers What to expect; what to do Information re: appetite, swallowing, sleep, confusion, breathing, bladder & bowel function, skin colour and temperature What will happen at the time of death

Who Introduces the Yellow Folder CCAC case manager Visiting nurse Consider PPS level & initiate discussion

Developed by Victoria Hospice Society

Who coordinates the process? The CCAC Case Manager will have a checklist of tasks to be completed. As each part of the process is completed, the Case Manager will record it on the checklist The Case Manager will address any gaps in the process Community Nurses to inform CM when yellow folder is in the home

Facilitation of planning for expected death in the home will result in: DNR status identified appropriately Plans for pronouncement & certification in place Family is supported through the dying process Avoidance of unnecessary calls to EMS

Questions? Thanks!