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Developing end-of-life care for older people in care homes.

In developed countries an increasing number of older people die in long-term care settings such as care homes. In the UK, approximately 20% of people aged 65 years and over die in care homes, compared to only 4% in hospices (Office for National Statistics, 2000). A case has been made that older people living in long-term care settings will benefit from palliative care (Kristjanson et al, 2005). Within the UK, the provision of palliative care in care homes is now the focus of a national and many local initiatives. This work promotes the use of specific end-of-life tools, e.g. the Gold Standards Framework, the Liverpool Care Pathway and the Preferred Place of Care Plan. These tools provide staff working in care homes with an ordered way to manage dying. They offer structure in the midst of the uncertainty that accompanies dying.