Role modelling GSF principles of end-of-life care to care homes

End of Life Journal, 2013, Vol 3, No 3 Page 1 of 9 The care of frail older people living and dying in care homes has changed considerably since the introduction of the Community Care Act 1990. This Act encouraged the closure of long-term ‘geriatric’ wards in favour of older people being cared for in the community. Monies from the health budget were given to social services in order to pay for care to be provided either in people’s own homes or, as necessary, in care homes. Before this time, many older people had admitted themselves to a care home, often for companionship. When they became ‘ill’, the majority of residents were transferred to hospital to die (Hockley, 2006). As a result of the Community Care Act 1990, frail older people are staying longer in their own homes. Consequently, by the time they are admitted to care homes, people have become increasingly frail and dependent, with 80% of residents in care homes having dementia or severe memory problems (Alzheimer’s Society, 2013). Currently, 19% of the UK population who die each year do so in care homes (Department of Health (DH), 2012). The End of Life Care Strategy (DH, 2008) recognises the important place that care homes (especially care homes providing nursing care) now have in the care of dying residents. Care homes are expected to provide good end-of-life care (Finucane et al, 2013). End-of-life care tools, such as the Gold Standards Framework (Thomas, 2003; Gold Standards Framework, 2012) and the Liverpool Care Pathway for the Dying Patient (LCP) (Ellershaw and Wilkinson, 2003), have become key structures to help care homes improve the quality of end-of-life care.