1. ACP Learning Pack Session Six1 ACP Learning Pack Session Six Offering ACP in your care home

2. ACP Learning Pack Session Six2 Groupwork One If ACP is not part of what you offer in your care home in any structured way, then this will need to be introduced to all relevant people. In your groups consider how you can do this. For example, who needs to know? How can you inform and prepare each group of people?

3. ACP Learning Pack Session Six3 Who needs to know? Residents People close to the residents, eg relatives All staff GPs Other relevant visiting professionals

4. ACP Learning Pack Session Six4 Informing and preparing residents - 1 Possible methods:- an overview of ACP in a regular newsletter ‘one-to-one’ contact with competent member of staff letter to each resident written information resident’s meeting

5. ACP Learning Pack Session Six5 Informing and preparing residents - 2 A sensitive approach is needed, so that people are not alarmed. Reassurance that thinking about, discussing and recording wishes for the future is a voluntary process. There is no compulsion to take part, but is an ‘opportunity’ only. ACP can be seen as a natural progression from thinking about care now, to thinking about possible care in the future

6. ACP Learning Pack Session Six6 Informing and preparing people close to the residents, eg relatives an overview in a regular newsletter ‘one-to-one’ contact with competent member of staff letter written information relatives meeting

7. ACP Learning Pack Session Six7 Informing and preparing staff an overview in a regular newsletter ‘one-to-one’ contact with competent member of staff letter written information staff meeting at supervision

8. ACP Learning Pack Session Six8 Informing and preparing GPs ‘one-to-one’ contact with competent and senior member of staff eg Manager invitation to GP(s) to join a working group letter to surgeries and/or written information about what is planned meeting with Practice Manager

9. ACP Learning Pack Session Six9 Informing and preparing other visiting professionals ‘one-to-one’ contact with competent senior member of staff eg Manager invitation to professional to join a working group letter and/or written information about what is planned

10. ACP Learning Pack Session Six10 Groupwork Two Devise a letter for a prospective resident introducing ACP and the approach to ACP in your home. The letter should set out what ACP is in clear terms and explain what benefit ACP can bring to the resident.

11. ACP Learning Pack Session Six11 Practical considerations for ACP Where should wishes for the future be recorded? Where should the document be stored? Who should have a copy? Who should be aware of a resident’s ACP? How often should an ACP be reviewed?

12. ACP Learning Pack Session Six12 Where should wishes for the future be recorded? In the care plan (service user plan)? In a separate document? On the computer? Issues to consider:- Accessibility Confidentiality

13. ACP Learning Pack Session Six13 Where should the document be stored? Issues to consider:- Accessibility Confidentiality

14. ACP Learning Pack Session Six14 Who should have a copy or be aware of the ACP? Care Home Resident GP Relative? Other professionals? On transfer?

15. ACP Learning Pack Session Six15 How often should an ACP be reviewed? On the request of the person – at any time When the care plan is reviewed each month A formal review at least annually

16. ACP Learning Pack Session Six16 How could religion, culture and ethnicity affect the approach to ACP? Each resident will have their own perspective on ACP Religion,culture and ethnic origin may have some influence on this Do not make assumptions about the effect of religion,culture and ethnic origin

17. ACP Learning Pack Session Six17 What are the main religions of the world? Baha’i Buddhism Christianity Christian Science Hinduism Jainism Judaism Islam Paganism Rastafarianism Sikhism Zoroastrianism References:- Jackson C (2002, revised 2005) 'The religious, spiritual and cultural needs of patients: a guide and reference document for staff'. Derby Hospitals NHS Foundation Trust. Mootoo JS (2005) 'A guide to cultural and spiritual awareness.' Nursing Older People. Vol 17. No 5.

18. ACP Learning Pack Session Six18 Baha'i No rituals before death Baha'i are always buried, never cremated Place of internment within one hour's journey of place of death Prayers and observations arranged by family or local Baha'i community References:- Jackson C (2002, revised 2005) 'The religious, spiritual and cultural needs of patients: a guide and reference document for staff'. Derby Hospitals NHS Foundation Trust. Mootoo JS (2005) 'A guide to cultural and spiritual awareness.' Nursing Older People. Vol 17. No 5.

19. ACP Learning Pack Session Six19 Buddhism Resuscitation is acceptable Like full information about imminent death, to make preparation May not want sedatives and pain killers near to death. Buddhist priest to be informed as soon as possible after death. References:- Jackson C (2002, revised 2005) 'The religious, spiritual and cultural needs of patients: a guide and reference document for staff'. Derby Hospitals NHS Foundation Trust. Mootoo JS (2005) 'A guide to cultural and spiritual awareness.' Nursing Older People. Vol 17. No 5.

20. ACP Learning Pack Session Six20 Christianity Different views within different denominations of Christian religion, eg Roman Catholic, Church of England, Free churches Roman Catholic – visit by priest to receive Holy Communion and/or Sacrament of the Sick (Last Rites)‏ Afro-Caribbean people may want to have singing and special prayers near to death Many Travellers are Christian and Roman Catholic References:- Jackson C (2002, revised 2005) 'The religious, spiritual and cultural needs of patients: a guide and reference document for staff'. Derby Hospitals NHS Foundation Trust. Mootoo JS (2005) 'A guide to cultural and spiritual awareness.' Nursing Older People. Vol 17. No 5.

21. ACP Learning Pack Session Six21 Christian Science Relies on God for healing, so may not wish to have drug treatment Church does enable people to make their own choices about what treatments they will accept or refuse. There are no last rites References:- Jackson C (2002, revised 2005) 'The religious, spiritual and cultural needs of patients: a guide and reference document for staff'. Derby Hospitals NHS Foundation Trust. Mootoo JS (2005) 'A guide to cultural and spiritual awareness.' Nursing Older People. Vol 17. No 5.

22. ACP Learning Pack Session Six22 Hinduism Prefer to die at home, as death in hospital can cause distress Readings from the Bhagavad Gita (Holy Book)‏ May wish to lie on the floor, near to death, to symbolise the closeness to Mother Earth Holy Rites, including a thread tied around the wrist or neck Eldest son to be present before, during and after death After death non Hindus should not touch the body unless wearing gloves All adult Hindus are cremated References:- Jackson C (2002, revised 2005) 'The religious, spiritual and cultural needs of patients: a guide and reference document for staff'. Derby Hospitals NHS Foundation Trust. Mootoo JS (2005) 'A guide to cultural and spiritual awareness.' Nursing Older People. Vol 17. No 5.

23. ACP Learning Pack Session Six23 Jainism Family to be present near to and after death References:- Jackson C (2002, revised 2005) 'The religious, spiritual and cultural needs of patients: a guide and reference document for staff'. Derby Hospitals NHS Foundation Trust. Mootoo JS (2005) 'A guide to cultural and spiritual awareness.' Nursing Older People. Vol 17. No 5.

24. ACP Learning Pack Session Six24 Judaism Orthodox (conservative) or Progressive (liberal) – needs will vary Jewish law forbids euthanasia, as human life is sacred Psalms and prayers near to death Rabbi to visit and someone with the dying person at all times As little intervention as possible from staff Last offices usually by the Jewish Burial Society A 'watcher' to stay with the body until the burial References:- Jackson C (2002, revised 2005) 'The religious, spiritual and cultural needs of patients: a guide and reference document for staff'. Derby Hospitals NHS Foundation Trust. Mootoo JS (2005) 'A guide to cultural and spiritual awareness.' Nursing Older People. Vol 17. No 5.

25. ACP Learning Pack Session Six25 Islam Resuscitation allowed -a matter of choice Suicide and euthanasia are considered to be major sins Muslims may wish to lie or sit facing Mecca if near to death Readings from the Qur’an / Koran (Holy Book) may be recited. If possible non-Muslims should not touch the body after death, but if necessary gloves should be worn. People from Pakistan may be sent to Pakistan for burial. Burial, never cremation References:- Jackson C (2002, revised 2005) 'The religious, spiritual and cultural needs of patients: a guide and reference document for staff'. Derby Hospitals NHS Foundation Trust. Mootoo JS (2005) 'A guide to cultural and spiritual awareness.' Nursing Older People. Vol 17. No 5.

26. ACP Learning Pack Session Six26 Rastafarianism Unwillingness to receive any treatment which will contaminate the body Preference for alternative therapies, herbalism or acupuncture Visits in groups, with praying at the bedside Burial is preferred References:- Jackson C (2002, revised 2005) 'The religious, spiritual and cultural needs of patients: a guide and reference document for staff'. Derby Hospitals NHS Foundation Trust. Mootoo JS (2005) 'A guide to cultural and spiritual awareness.' Nursing Older People. Vol 17. No 5.

27. ACP Learning Pack Session Six27 Sikhism Wearing of the five symbols of Sikhism – these should not be removed unless absolutely necessary, even after death Reciting of readings from the Sikh Holy Book - Guru Granth Sahib After death the family may wish to wash and lay out the body Always cremation References:- Jackson C (2002, revised 2005) 'The religious, spiritual and cultural needs of patients: a guide and reference document for staff'. Derby Hospitals NHS Foundation Trust. Mootoo JS (2005) 'A guide to cultural and spiritual awareness.' Nursing Older People. Vol 17. No 5.

28. ACP Learning Pack Session Six28 Zoastrianism Special shirt and girdle to be worn after death and sometimes a cap or hat References:- Jackson C (2002, revised 2005) 'The religious, spiritual and cultural needs of patients: a guide and reference document for staff'. Derby Hospitals NHS Foundation Trust. Mootoo JS (2005) 'A guide to cultural and spiritual awareness.' Nursing Older People. Vol 17. No 5.

29. ACP Learning Pack Session Six29 What additional support may some residents need? Language – written and spoken Communication- making their views known Understanding their options Recording a signature Promoting equality and diversity – a ‘personalised approach’. (CSCI 2008)

30. ACP Learning Pack Session Six30 Groupwork Three Quiz – Reveiwing and Confirming knowledge of ACP

31. ACP Learning Pack Session Six31 Summary Advance Care Planning promotes residents’ dignity. With ACP residents can be supported at all times as they would want, even if they are unable to express their wishes. ACP enables their views to be recorded and known by all relevant people. Care Homes staff, GPs and other professionals can feel confident they are doing what the resident wants, as far as they are able. The Mental Capacity Act 2005 gives a framework to support care home staff with ACP. The process of ACP formalises acknowledged ‘good practice’ guidance. Care Home staff are well placed to offer ACP as they build trusting relationships with residents. ACP is a natural progression from planning care for now, to planning care for the future.

32. ACP Learning Pack Session Six32 One Care Home Manager’s view of ACP “I think it is very helpful. It gives us a clear indication of what people want. It gives us more confidence to speak on behalf of our residents, to Doctors etc. I think it helps to establish a firm understanding and subsequently support for and from the family.”

33. 33 Advance Care Planning: offering residents the opportunity to record their wishes for the future. Thank you for coming !