Nurses and GPs can support the care of older people who are being cared for and who are dying at home.
When the practice is aware that a patient’s condition has worsened and that they are showing symptoms commonly associated with dying, it is an opportunity to review care arrangements. This may include checking the availability of appropriate supports for the family during the dying process, the need for additional prescribing to deal with common symptom issues, and arrangements for after death care.
It is also a chance to consider if assistance from a palliative care team is needed.
A terminal care plan will enable the GP and General Practice Nurse to:
- Review frequently with the older person and their caregivers about current priorities and focus of care.
- Cease burdensome interventions that do not improve the comfort of the older person.
- Provide care that is more sharply focused on the older person’s physical, emotional and spiritual comfort.
- Assist in provision of healthcare professional support focused on the older person and their family rather than on the disease.
- Consider the psychosocial and spiritual concerns of the older person and their family.
- Support the family and caregivers into the bereavement period.
The General Practice Nurse and the GP should consider the following things to support someone who wishes to die at home.
They include:
- The individual needs of the dying person and their family including cultural preferences, ACP documents.
- Capacity and needs of the family carer.
- Medication and symptom requirements.
- Documentation and communication processes.
- Identification of any equipment required or service supports.
- Provision of contact details of appropriate services that will be needed in the event of change or crisis.
- Provision of information about signs that death may be occurring.
- Advice on what to do after the death of an older person.
General Practice Nurses may act as a liaison point for the general practice, the family and other service providers. This may mean ensuring that symptom management is effective, supporting the family, and organising extra services, if required.
Family carers often immerse themselves in their role and may be loath to consider their own needs at this time. The General Practice Nurse can encourage carers to take a break, rest and eat properly. Importantly, they can also acknowledge and appreciate the care that the family member is providing.
The General Practice Nurse may also be able to help families make arrangements for immediately after the death. A doctor must sign a certificate that confirms the death. Funeral arrangements cannot be completed until the doctor has signed and issued this certificate.
Once this is signed, the funeral company can then take the deceased into their care.
The General Practice Nurse can acknowledge and recognise the loss of a family member if they are contacted by the family.
The General Practice Nurse can also suggest a follow up visit for the family carer with the GP.
This provides an opportunity for the family carer to ask any questions about the death and for the GP to discuss bereavement, grief and loss issues.
The General Practice Nurse can suggest whether external services may be needed to meet family or carer needs.
These services may include:
- Counseling – grief and bereavement
- Psychology
- Spiritual guidance
- Financial advice and support
- Carer advocacy and planning