Palliative Care in Residential Settings

Many residential care settings for older people have been established on a culture of rehabilitation; however, this is changing radically. In many Western countries, recent policy is encouraging frail older people to stay longer in their own homes before going into 24-h care. As a result, on admission to these settings, older people are often considerably more dependent and frail than 10 years ago. The palliative care needs of frail older people with multiple comorbidities admitted to residential care settings are significant, and palliative care is now core to their work. Such settings are being compared to hospices that founded the new hospice movement over 50 years ago and seen as the “de facto” hospice. Residential care settings across the world bore a huge burden during the COVID-19 pandemic, but despite difficulties, research reveals often huge resilience and dedicated care. Hospices have an important role to play in reaching out to staff in residential care settings and the frail older people they care for, in order to support and enhance a palliative care approach. This chapter describes some of the differences between palliative care for people with advanced cancer (often dying in mid-life) and those dying as a frail older person at the end of life with multiple comorbidities. It highlights a number of different quality improvement initiatives through which staff in residential care settings can be supported to adopt a greater palliative care approach. Currently, nearly a quarter of the population in the UK, in Canada, and the USA die in care homes. In other countries, such as the Netherlands and Norway where there is greater on-site healthcare provision including physicians, it is nearer 50% of the country’s population.