Why place-based care and partnership working is crucial to supporting people who want to die at home

With home playing such an important part in the quality of our lives, it’s unsurprising that many people now choose to spend their final days receiving care in their familiar surroundings with the people they love.

Around 27% of people said that being at home was one of the most important priorities for them in their final days, according to the UK’s leading end of life charity Marie Curie Cymru’s Public Attitudes to Death and Dying in Wales Report.

With this in mind, housing associations recognise the crucial role that safe, secure and affordable housing can play not just throughout people’s lives, but also in supporting them to die with dignity.

Some have committed teams work across communities, alongside specialist nurses, to ensure people are listened to, respected, and supported as they make crucial decisions over their end of life care at home.

One housing association which recognises the importance of supporting people to die with dignity at home, is Hafod.

Its dedicated domiciliary care team frequently works with people living with terminal illnesses as part of its Home Care service. This person-centred service allows people to receive the right level of physical, emotional and mental support they need in the comfort of their home.

As part of the service, a carer visits the person needing support to provide one-to-one care, which allows them to live and receive treatment on their own terms. Hafod provides this service in the community, at its residential and nursing homes, and its extra care schemes.

While supporting those in need, Hafod’s carers often work alongside healthcare providers and specialist nurses, including Marie Curie, to ensure everyone supporting the individual is meeting their needs and respecting their wishes.

Helen Lewis, regional manager in domiciliary care at Hafod, said: “At Hafod, we do all we can to ensure people receive the level of care and support they need in their own home.

“It’s really important to us that while we provide this care in a home setting, everyone involved has a full understanding of the situation and what is next, so that we can all work together to offer the best care possible.

“It’s a very emotional time for colleagues who will have spent a significant amount of time with the individual and really want the best for them.

“Towards the end, our teams may be asked to increase their support to ensure the person can receive the level of care they need at home - and my team have never said no to this.”

Housing associations are committed to supporting their tenants health and wellbeing through targeted services and working with partners in communities.

This type of partnership approach to providing end of life care is often referred to as place-based care.

Place-based care encourages partnerships between organisations responsible for arranging and delivering health and care services, such as healthcare providers, and others with a role in improving health and wellbeing, such as housing associations.

By working together, they can help more people to receive quality end of life care in the comfort and security of their home.

Rhian Evans, Clinical Lead Community Services Wales at Marie Curie, said this place-based, partnership approach, needs to be properly supported to ensure it can offer the person the best care in their final days.

She said: “Some areas across Wales offering that local place-based care will have specialist support wrapped around them – but many places won’t, leaving a disjointed system for people to navigate at an already vulnerable time.

“If little or no investment is sustainably provided to local place-based services, then demand will inevitably fall upon the specialist and intensive services, which don’t always have the capacity to support everyone and are not the best services to support those people.

“Better place-based community care is key to supporting people in their own home and reducing the need for inappropriate hospital care. Marie Curie research, published in the Better End of Life report last autumn, found there are 30,000 ‘out-of-hours' emergency visits to A&E each year in Wales by people in their last year of life.

“Those visits aren’t always necessary, and lead to admission when there’s no need, due to a lack of provision of telephone advice, poor access to palliative medicines or crisis management out of hours, among other issues.

“The emphasis that place-based care puts on seamless support in the community presents a challenge to palliative and end of life care. It emphasises a direction of travel which many people in the sector are enthusiastic about – to equip local communities with the resources to support all people needing care at home and in their local ‘place’.

“Supporting and developing palliative and end of life care practice as part of a wider local offer could help to achieve this – with experts in the area able to share their knowledge with other providers, including housing association teams.”

Those involved, know that this can make all the difference to the individual and their family at the end of their life.

Rhian said: “We know good end of life care, which recognises the needs and wishes of the person dying, can lessen the risk of complex or prolonged grief. For family members, carers or friends, being able to spend time with someone in their final moments can help them in their bereavement.

Housing associations are committed to working with specialist services to ensure the people who live in their homes are able to make decisions over their wellbeing and care throughout their lives.

More information on the health, care and support work that we do on behalf of our housing association members can be found here.

Find out more about Marie Curie’s services here www.mariecurie.org.uk