Relatives & Residents Association

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Response to pandemic devalued lives

4 December:

Blanket and inappropriate use of Do Not Attempt Cardiopulmonary Resuscitation (DNR) orders for care home residents caused potentially avoidable deaths, a Care Quality Commission report has found. The CQC’s review highlights the very worst fears of callers to our helpline, about the response to the pandemic devaluing the lives of older people.

Throughout the pandemic R&RA has raised concerns about the rights of older being side-lined. At the beginning of April we published our key messages, warning “the response to this emergency should not be discriminatory or devalue lives”. Sadly, our helpline heard concerns that older people’s rights were put at risk by inappropriate practice around DNRs but also poor care planning about end of life. We raised these concerns with Parliament and have fed them into the CQC review, many of which have been covered in the interim report, including:

  • Lack of consultation meant many relatives didn’t know a DNR order was in place
  • Conflating conversations about DNR with conversations about whether people would go to hospital to receive treatment, or people being asked to agree end of life plans that excluded hospitalisation, raising fears that the process of prioritising health services was being based on non-clinical factors such as age or disability
  • Lack of visits from health professionals, including GPs, with appointments and consultations taking place over phone/video where sensitive conversations about end of life care planning are much more difficult
  • Concerns about care staff lacking the training, expertise or equipment to provide appropriate palliative care
  • Visiting restrictions in care homes meaning family members/friends were not able to be there to support older people when these sensitive conversations took place, to aid with communication and understanding as well as providing emotional support

The systems and services designed to protect older people should look to our human rights and equality laws to help steer them through a time of crisis, to ensure no-one is left behind. We will continue to feed into the review as the CQC moves into the next phase of their work, to help uncover and stop inappropriate use of DNR orders and help define good practice in this area.

If you, or a relative/friend, has been affected by inappropriate use of a DNR order or poor practice around end of life care, please contact our helpline. One of the ways we can support you is by helping you to share your experience with the CQC as part of their review and the Tell Us About Your Care programme of work.

In the meantime, new guidance from the Government on visiting in care homes now provides more clarity for providers on ensuring meaningful visits can take place at the end of life. The guidance defines end of life care as the last year of life, supporting people to live as well as possible and to die with dignity. It states care homes should:

  • facilitate visiting as much as possible as appropriate for the individual’s situation
  • communicate well to enable good and timely decision making
  • proceed from the assumption that visits are enabled in the final months and weeks, not just the final days or hours

We will continue to support residents and their families to ensure these good intentions become a reality across care homes.


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