End of Life Care in General Practice

Dr Katherine Teare

GP Educator Fellow

Content

Financial support and benefits Paperwork Decision making in terminal care Symptom control

Benefits for the Terminally Ill

Attendance Allowance or Personal Independence Payment

Disability Living Allowance Employment and Support Allowance Carers Allowance

Attendance Allowance

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

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 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

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

Either Work Related Activity Group – expected to do work related interviews

Or Support Group – illness has severe effect on ability to work

Carers Allowance

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

Factual information – prognosis not required If requested by patient/representative and

you consider they have terminal illness Needs to contain details of patients

Diagnosis, whether patient aware Current/proposed treatment Brief clinical information

Nursing care at home

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

Mental Capacity (2005 Act) Ability to take actions affecting daily life and/or

make more major decisions Decision specific

Understand information and consequences Retain informtaion Weigh up information Communicate decision

Lasting Power of Attorney 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

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