Death: what is our role?

People die. It is, ironically, a fact of life. When one of our residents die, we usually will have seen it coming. You see a decline in mobility, reduced appetite, reduced urine output, a lack of motivation….. but quite often family can be blind to all of this. Quite often I will encounter families pointing the finger towards my care staff for not ‘getting someone up’, or giving enough support feeding. Most of the time this is borne, I believe, out of guilt. Misplaced guilt. There is still an unfortunate phrase that is too often uttered: “I am putting my mum in care”. This conveys a decision, ownership… care is a terminal destination in most cases. For family to ‘put’ someone there…. well, that just makes them feel as though they have given up, failed as a family. Nothing could be further from the truth. This setting should be a home.

It often seems as though our job is to prolong life as much as possible; indeed, should a resident refuse to drink (a common occurrence), then we are scrutinised over how much we have offered, how we have prompted the intake, what medical assistance we requested, how we have documented the decline… most of my complaints come after a resident has passed away. Family feel that guilt- the feeling that they are responsible-  families will argue with each other, misplacing the blame, until they find that the best way to unite is to find a common enemy: the care home.

I recently had a death of a former resident, and received a call from the family shortly after, and the sentence spoken has stuck with me: “We were not expecting it”. They must have been the only ones. My assistant suggested they were wearing blinkers. So it made me question, should we as home managers be telling families in a more open and honest way that their loved one is reaching the end of their life? On the one hand, forward planning is essential, and the more time they have to come to terms with this the better, it may remove the idea that the death is due to our errors or omissions. On the other hand, what if we get it wrong? I’m not paid for a clinical opinion.

My grandfather has recently been in hospital twice for sepsis. He is over 80, has vascular dementia, is hoisted, and has a reduced fluid intake. He doesn’t have long left. If he makes the year I would be amazed. I have been absolutely clear on that with my mother, and she gets it (being an ex registered manager herself), but I know it will be a huge shock to some of the family. It shouldn’t be. Family shouldn’t be getting stressed and arguing over his care. A little bit of stoicism carries a lot of weight.

My opinion is that we should be open and honest about declines we are seeing in residents, and encourage end of life planning from admission. Natural death is nobody’s fault, and our role should be to make our service users comfortable as nature takes its course.

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