1. The Centre for Housing Policy http://www.york.ac.uk/chp/ Delivering end of life care in housing with care settings Karen Croucher Centre for Housing Policy University of York

2. The Centre for Housing Policy http://www.york.ac.uk/chp/ Background Delivering End of Life Care in Housing with Care Settings: Housing LIN Factsheet 18 http://www.cat.csip.org.uk/_library/docs/Housing/F actsheet18.pdf Housing with Care for Later Life: A literature Review http://www.jrf.org.uk/bookshop/details.asp?pubID= 76

3. The Centre for Housing Policy http://www.york.ac.uk/chp/ Overview Current policy on end of life care Definitions of end of life care End of life care “tools” End of life care in housing with care settings

4. The Centre for Housing Policy http://www.york.ac.uk/chp/ End of life care: policy context Building on the Best: Choice, Responsiveness and Equity in the NHS (DH,2004) A New Ambition for Old Age: Next Steps in Implementing the NSF for Older People (DH, 2006) Emphasis on choice and dignity at the end of life New investment in EoL

5. The Centre for Housing Policy http://www.york.ac.uk/chp/ “End of life care for seniors requires an active, compassionate approach that treats, comforts and supports older individuals who are living with or dying from progressive or chronic life threatening conditions. Such care is sensitive to personal, cultural and spiritual values, beliefs and practices and encompasses support for families and friends up to and including the period of bereavement” Ross and Fisher, 2000 What is end of life care?

6. The Centre for Housing Policy http://www.york.ac.uk/chp/ NHS End of Life Care Programme “To improve the quality of life at the end of life for all patients and enable more patients to live and die in the place of their choice” Reduce emergency admissions to hospital Reduce admissions from care homes to hospital in last weeks of life http://www.endoflifecare.nhs.uk

7. The Centre for Housing Policy http://www.york.ac.uk/chp/ EoL Care Practice Tools Preferred Place of Care Plan (PPC) http://www.cancerlancashire.org.uk/ppc.html Gold Standards Framework (GSF) http://www.goldstandardsframework.nhs.uk Liverpool Care Pathway for the Dying Patient (LCP) http://lcp-mariecurie.org.uk

8. The Centre for Housing Policy http://www.york.ac.uk/chp/ EoL Care in Housing with Care Settings (1) Tension between promoting independence and active ageing and addressing EoL issues Types of need Levels of input from health and social services and developing a shared commitment to delivering EoL; On-site staff skills; Design of space

9. The Centre for Housing Policy http://www.york.ac.uk/chp/ EoL Care in Housing with Care Settings (2) “Attempts to combat ageism by promoting a positive, healthier and more independent image of old age can also marginalise the needs of vulnerable older people. Indeed a preoccupation with independence in much of the policy literature obscures any meaningful debate about how to improve the quality of life of older people facing death” Seymour et al, 2005

10. The Centre for Housing Policy http://www.york.ac.uk/chp/ EoL Care in Housing with Care Setting (3) Different end of life trajectories for different conditions Realistic about what can be delivered at home Meeting high level needs over prolonged periods, particularly care at night

11. The Centre for Housing Policy http://www.york.ac.uk/chp/ EoL Care in Housing with Care Setting (4) Partnership working – EoL tools are intended to promote this Confusion over the role of different agencies, and how different care packages are funded Role of informal carers and family members Training for care staff http://eolc.cbcl.co.uk/eolc/Education/ Space for carers, aids, adaptations, medical equipment, families to stay

12. The Centre for Housing Policy http://www.york.ac.uk/chp/ EoL Care in Housing with Care Setting: Practice issues Working with residents Preference for place of death Announcing death of residents to people living and working in the scheme Commemorating residents who have died

13. The Centre for Housing Policy http://www.york.ac.uk/chp/ EoL Care in Housing with Care Settings: Practice Issues Assessment and Care Delivery Do residents’ care plans include EoL care? Residents who are approaching the end of their lives – what are their care and support needs? How many residents have died either at home or after transfer to other care settings – what are the main lessons that can be learned from these experiences?

14. The Centre for Housing Policy http://www.york.ac.uk/chp/ EoL Care in Housing with Care Settings: Practice Issues Partnerships How do your residents’ GPs provide out of hours care? Does the local community/district nursing service provide out of hours care? Links with community palliative care schemes, and specialist palliative care providers? Links with bereavement counselling services such as CRUSE?

15. The Centre for Housing Policy http://www.york.ac.uk/chp/ EoL Care in Housing with Care Settings: Practice Issues Staff training What are the training needs of care staff with regard to end of life care? How might the EoL Care Tools (PCC, GSF, LCP) be used in housing with care settings? What support is offered to care staff following the death of a resident?