End of life care is extremely important for care home residents and for all of those around them including care home staff, family, friends and medical staff.

The updated Ambitions for Palliative and End of Life Care describes 6 key principles which support high quality end of life care; the Ambitions Self-Assessment Framework can be used to help plan service improvements (note: the framework should be downloaded).

Unfortunately, although the death of many of our residents in care homes is predictable, conversations and decisions are frequently made in the very last weeks or days of life. This happens largely because we don’t adequately identify residents and plan their care. This often leads to distressing and futile hospital admissions or discussions that feel rushed with little time for carers and family to reflect on what is happening.

We know that when patients have been identified as approaching the last year or so of life and have a care plan reflecting their wishes and preferences this has been shown to improve the quality of life in the last year, months, weeks and days and is beneficial for all of those involved in their care.

There are several ‘tools’ available which enable clinical staff to identify patients who might be approaching the last year of life. These can be quite complicated and require some clinical knowledge.

We have developed SHADOW especially for care home staff to improve their confidence and ability to recognise those residents approaching the end of life. The guide has been developed by summarising key aspects of well recognised identification documents. This has been tested with care homes using Quality Improvement to ensure the guide is user-friendly and applicable in all care homes, both residential and nursing.

SHADOW should not require any additional training but care homes who are engaged with the Six Steps Programme or One Step or have received other training regarding end of life care will find the guide easier to follow. If any care home staff are unsure regarding their resident and whether they are in the last year of life, they are encouraged to seek medical advice.