DementiaRoadmap Wales

Promoting living well with dementia across Wales

End of life care

All people who develop dementia will have dementia at the end of their lives, either as the condition they die from or as a factor that may complicate the care of a different condition.

Diminishing capacity means that it is important for the person with dementia to consider the type of care they would want and where they would want to be at the end of their life as early as possible.

Problems with capacity and communication can also contribute to undignified treatment and the under treatment of pain in people with dementia at the end of their lives.

Significant, co-ordinated and holistic support is needed to ensure that all people with dementia end their lives with dignity, free from pain and in the place of their choosing.

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  • Dementia core skills education and training frameworkOctober 29 2015This framework published by Skills for Health, Health Education England and Skills for Care sets out the essential skills and knowledge necessary for all staff involved in dementia care.
  • Loss and bereavement in people with dementiaFebruary 26 2016This leaflet published by Alzheimer Scotland addresses the lack of help and information available for formal and informal carers of people with dementia who are bereaved.
  • Spirituality and ageing: implications for the care and support of older peopleJanuary 22 2013This briefing paper published the Institute for Research and Innovation in Social Services explores why our ageing population requires person-centred care and developmental support in order to maximise its chances of ageing well.
  • Duty of Candour: Information for all providersMarch 15 2015This document published by the Care Quality Commission sets out how meeting the Duty of Candour regulation will be central to both registration and inspection for NHS bodies and all other care providers regulated by the CQC.
  • Planning for your future careSeptember 16 2014This guidance published by the National Council for Palliative Care explains advance care planning to the public. It outlines the different options available to people when planning for their end of life care.
  • Dementia Action Plan for Wales 2018 – 2022November 20 2019The Welsh government have adopted the Dementia Action Plan for Wales 2018 - 2022, with Vaughan Gething, Cabinet Secretary for Health and Social Services, stating that,  "Our vision is for Wales to be a dementia friendly nation that recognises the rights of people with dementia to feel valued and to live as independently as possible in their communities."
  • Pain in People with Dementia: A Silent TragedyJanuary 7 2015This report, published by Napp Pharmaceuticals, draws on a survey of interviews with experts, major providers of care, and on desk research. It quantifies the problem and sets out the issues in recognising, assessing and managing pain in people with dementia.
  • QS30: Supporting people to live well with dementiaApril 3 2013This quality standard, published by the National Institute for Health and Care Excellence (NICE), covers the care and support of people with dementia.
  • Marie Curie End of Life Care AtlasJuly 4 2014The Marie Curie End of Life Care Atlas is an information portal that gives people who plan and commission end of life care new insight into care provision in their local areas.
  • Commissioning person-centred end of life careOctober 17 2012This toolkit published by the National End of Life Care Programme identifies the main elements involved in the commissioning process, explains the commissioning cycle in practical terms and offers a four-stage approach across all sectors.
  • Gold Standard Framework Prognostic Indicator GuidanceOctober 4 2011This guidance aims to help GPs, clinicians and other professionals in earlier identification of those adult patients nearing the end of their life who may need additional support.
  • Advance care planning toolkitOctober 19 2012This toolkit developed by the National End of Life Care Programme (NEoLCP) aims to help care providers approach the advance care planning process with confidence and knowledge.
  • Commissioning End of Life Care: Act & EarlyJuly 4 2011This guidance published by the National Council for Palliative Care aims to help healthcare commissioners to prioritise early action on end of life care to ensure people’s choices are met and to avoid unnecessary emergency hospital admissions.
  • RCGP Commissioning Guidance in End of Life CareMarch 4 2013This guidance offers a logical six-step framework and overview to support GP commissioners to deliver practical improvements in end of life care, aligned with national policy and quality standards.
  • End of life care for people with dementia commissioning and benchmarking toolJune 25 2010The commissioning and benchmarking tool helps you to assess local service requirements using the indicative benchmark as a starting point. With knowledge of your local population and its demographic, you can amend the benchmark to better reflect your local circumstances.
  • Matters of Life and Death: Helping people to live well until they dieAugust 4 2012This guidance aims to support practitioners to implement the End of Life Care Patient Charter, jointly produced by the Royal College of General Practitioners and the Royal College of Nursing.
  • Treatment and care towards the end of life: good practice in decision makingNovember 4 2010This guidance provides a framework for good practice aimed at doctors when providing treatment and care for patients who are reaching the end of their lives.
  • NICE quality standard QS13: End of life care for adultsNovember 17 2011This quality standard published by the National Clinical Institute for Health and Clinical Excellence (NICE) defines clinical best practice in provding end of life care for adults.
  • How would I know? What can I do?December 6 2012This guide, developed by the National Council for Palliative Care (NCPC), provides advice for carers and those who work with people with dementia on how to help with pain and distress in people with the condition.
  • End of life care for people with dementia commissioning guideJune 8 2010This commissioning guide provides support for the local implementation of NICE clinical guidelines through commissioning, and is a resource to help statutory and voluntary health and social care professionals in England to commission integrated end of life care (EOLC) services for people with dementia.
  • NHS Continuing Healthcare and NHS-funded Nursing CareMarch 28 2019NHS Continuing Healthcare  If you have complex health and care needs, the NHS may cover the cost of all your care at home or in a care home, including the services you receive from the local council. This is called continuing healthcare and is funded ...
  • National Audit of Dementia – third reportJuly 13 2017The National Audit of Dementia (NAD) (care in general hospitals) measures the performance of general hospitals against criteria relating to care delivery which are known to impact upon people with dementia while in hospital. The third audit collected data between April and November 2016.
  • Advance Care PlanningMarch 28 2019If you were to lose the capacity to make decisions about your life today, what are the important things you would like those caring for you to know about you and what you would want to happen? One way of making people aware of your wishes is by a process that is called advance care planning.
  • Caring for someone with dementiaNovember 20 2019Caring for someone with dementia is a comprehensive booklet published by Age UK, whose network includes Age Cymru in Wales.
  • Dementia wellbeing in the COVID-19 pandemicSeptember 28 2020This resource is primarily for clinicians working with people with dementia, but can also be used by carers and people with dementia. This document takes the Dementia Well Pathway and sets out the adjustments and amendments needed to respond to the COVID-19 pandemic. It highlights key priorities and actions for each step in the pathway.
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