Social work and end-of-life care

Social work is important in end-of-life care

Help people plan for their time of dying and support community and family care

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Michael Wolff wrote about the illness and death of his mother in The Observer yesterday; the article has already appeared in a longer form in New York Magazine.

The article covers a lot of ground, but it provides some useful pointers for others in the same position. However, it is based on American law and practice and does not fully apply to the situation in the UK. In particular,the assumptions about hospices passingly mentioned in the article do not reflect the position in the UK, where hospices are less long-term care institutions for people at the end-of-life, but shorter-term specialist provision.

The points made are:

  • Once an older person starts to have serious episodes of ill-health, it’s important to think about what the future will hold and plan for a continuing deterioration in their condition.
  • Once someone has severe dementia and has lost their ‘mental capacity’, doctors and other healthcare professionals will be obliged by their ethics to continue treating people when they fall ill. They will thus be keeping them alive even though the older person’s quality of life is not good. Unless you have what in the UK are called ‘lasting powers of attorney’ for making decisions on health and welfare matters, it will be hard for relatives to challenge the professionals’ decisions.
  • Constant admissions to hospital are damaging but because healthcare professionals in the community do not want to have to cope with the responsibility of caring for people with very changeable conditions. or do not have the resources to do so, it is often what happens. Try to avoid it by employing, as this family did, a live-in carer around which family members can contribute what support and involvement they are able to offer.

The lessons for service development are that we to help people plan as soon as possible in someone care career. We also need to train and support community and care home staff to avoid hospital admissions and we need to get much better at supporting people in their homes or in a suitable local setting, without  imposing too much of a burden on their families.

Link to the Observer article.

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Written by Malcolm Payne

23 July 2012 at 3:11 pm

Posted in End-of-life care

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