1. Carers

2. Why Care About Carers? Carers health suffers as a result. 52% report stress related illness. 51% report physical injury from caring. 70% of carers think GPs are unaware of their needs.

3. Some Examples 55 year old woman whose mother is in NH with advanced Alzheimer's. As a result her mother isn’t eating much. Daughter spends hours trying to feed her. Off work with stress and depression. How could we help?

4. Case 2 60 year old woman whose husband is dying at home. District nurses go in to change syringe driver. At 10am she smells strongly of alcohol. DN has a quiet word with you. What should you do?

5. Case 3 75 yr old woman with IHD. Husband with metastatic bowel ca is sent home from hospital on Friday pm. 1 call per day from Social Services. No equipment at home. Deteriorates quickly and wife can’t cope. Admitted to NH for respite on Sunday by OOH. Dies in NH, when he really wanted to die at home. How could this be prevented?

6. Helping Carers Record in their notes that they are a carer. Always ask how they are coping. Keep them informed. Ensure they know how to contact you. Provide written instructions and a clear plan for what to do in an emergency.

7. Physically Ask DNs to give practical advice on nursing skills. Check they have equipment. Ensure they have been offered SS input. Every carer has right to ask for a full assessment of their needs by SS. Consider respite options.

8. Financially Attendance allowance = tax free benefit for those > 65 who need looking after. Disability Living Allowance = if <65. Carer’s allowance = if caring for >35 hrs/wk. Can be speeded up if ‘terminally ill.’ This means progressive illness with death expected within 6 months. GP needs to fill in DS 1500 report.

9. Bereavement Traditional model 1) Shock – detachment, disbelief, numbness. 2) Yearning – Pining, anxiety, grief. 3) Despair – Apathy, withdrawal, pessimism. 4) Recovery – Rebuilding identity and purpose.

10. How Can We Help? Flag notes to show recent bereavement. Actively follow up bereaved patients. Ensure all referrals and appointments are cancelled for the deceased. Watch for depression, anxiety, substance misuse, self neglect.

11. Abnormal Grief Reactions Types Inhibited grief – absent/ minimal. Delayed grief – Late onset. Prolonged/chronic grief – inability to rebuild life. If abnormal grief suspected:- Monitor carefully. Consider bereavement counselling. Refer to psych if persistent/ suicidal.