Transcript End of Life Care in General Practice

End of Life Care in
General Practice
Dr Katherine Teare
GP Educator Fellow
Content
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Financial support and benefits
Paperwork
Decision making in terminal care
Symptom control
Benefits for the Terminally Ill
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Attendance Allowance or Personal
Independence Payment
Disability Living Allowance
Employment and Support Allowance
Carers Allowance
Attendance Allowance
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Need care, are disabled and are aged 65+
Lived in GB for 2 of past 3 years, usually resident
Usually need to have needed looking after for past 6
months, but not if terminally ill
Considers how much help you need, doesn’t
consider whether you actually get help
Not usually means tested
Higher rate £79.15 per week, lower rate £53 per
week
Personal Independence
Payment
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Tax free benefit for those aged 16-64 with care
needs or difficulty getting about
Replaced DLA for those in this age group
Benefit for those with long term illness or disability
Lived in GB for 2 of past 3 years, usually resident
Needed looking after for 3 months before claim,
unless terminally ill
Payments for care (at £53 or 79.15 per week) and/or
mobililty (£20.55 or £54.05 per week)
Not usually means assessed
Disability Living Allowance
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For children aged under 16
Child must have needed looking after for 3 months prior to claim,
unless terminally ill
Must need more help than a child without illness or disability
and/or difficulty walking
Care rates
 Lowest – help for some of day or night (£21/week)
 Middle – frequent help/supervision during day or supervision at
night (£53/week)
 Highest – terminally ill or help/supervision thoughout day and
night (£79.15/week)
Mobility rates
 Lowest – Child can walk but needs help/supervision outside
(£21/week)
 Highest – can’t walk/short distance or is blind or deaf (£55.25pw)
Employment & Support
Allowance
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Aged under 65 and problems working because of
illness or disability
Entitlement usually dependent on NI record
Assessment phase rate – first 13 weeks until Work
Capability Assessment
Main phase rate – from week 14
After assessment
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Either Work Related Activity Group – expected to do work
related interviews
Or Support Group – illness has severe effect on ability to
work
Carers Allowance
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If you are over 16 and look after someone who is ill
or disabled in their own home
Spend at least 35hrs/week caring for them
Cannot claim if earn >£100pw after tax
Cannot claim if in full time education
Must have lived in GB for 2 of last 3 years
Person cared for must be receiving Attendance
Allowance or Care component of DLA or Constant
attendance allowance(…)
£59.75 per week
DS1500
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Factual information – prognosis not required
If requested by patient/representative and
you consider they have terminal illness
Needs to contain details of patients
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Diagnosis, whether patient aware
Current/proposed treatment
Brief clinical information
Nursing care at home
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Request assessment for individual
District nurse usually assess persons needs
and decide what support required
Social care, district nursing care, hospice at
home and Palliative care nurses
OT –adaptations
DNs – hospital beds, pressure relieving
mattresses
Fitness to Make Decisions
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Mental Capacity (2005 Act)
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Ability to take actions affecting daily life and/or
make more major decisions
Decision specific
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Understand information and consequences
Retain informtaion
Weigh up information
Communicate decision
Lasting Power of Attorney
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Draw up any time when person has capacity, 2
types
Must be registered with Office Public Guardian to
have legal standing
Property and affairs LPA – money, can use when
individual retains capacity
Personal welfare LPA – decisions about healthcare
and welfare, only active when individual lacks
capacity.
Advance decision – statement about wishes
regarding medical treatment if incapable, legally
binding
Symptomatic relief
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Anticipatory care
Stop unnecessary medication
Establish patients concerns and anxieties
Dorothy House handbook
Just in case medications
Management plan clear with all agencies
informed incl OOH