Diagnosing the dying process in the care home setting

Abstract

Over the past 15 years there has been a considerable increase in the number of older people dying in care homes, especially care homes providing nursing care. As a result of the Community Care Act 1990 in the UK, these care homes now provide the care that was formerly given in the NHS’s long-stay geriatric wards before their closure. This article raises important issues that require addressing in relation to the death and dying of frail, older people in care homes. It emphasises the importance of end-of-life decision-making, taking responsibility for diagnosing dying and anticipating and recognising the process of dying. This article describes the impact of care pathways with regard to optimising quality of care in the last weeks of life within the care home setting. (N.B. Although the term ‘care homes providing nursing care’ and ‘care homes providing personal care’ are now used to describe facilities that were once known as ‘nursing homes’ and ‘residential homes’ respectively, to ease the flow of writing in this article, the term ‘nursing home’ will be used when referring specifically to care homes providing nursing care. Conflicts of interest: none