Many people at the end of life live alone. They may have a carer who lives elsewhere, such as an adult child, or they may appear to have no one at all.

The patient may nominate a carer who visits rarely or not all. This leaves little opportunity for discussions with the carer about the patient’s needs or  verification of their wish to be a carer.

The patient may understand that they will die but be unaware of the dying process. They may not realise that for at least some of the time they will be unable to get to the front door, the kitchen or the toilet, and will need a lot of care.

Friends and neighbours

  • Ask the patient about friends or neighbours who might be prepared to help
  • If possible, discuss with the nominated friend or neighbour what may be required and what they are prepared to do. For example, they may be willing to visit daily to make sure the patient is comfortable and their basic needs are being met.
  • Consider issues of privacy and confidentiality when dealing with friends and neighbours. Obtain the patient's consent about what you can share.

Safety

Sometimes sick patients are determined to go home even if there is no one to look after them.

It is the patient’s right to go home, even if the team considers it unsafe. However, consider the person's capacity to make decisions.

Discuss with the patient any perceived lack of safety and the possible implications.

Notify the general practitioner.

Consider referral to a new service for case management.

Consider all options for reducing risks, for example a personal alarm, such as MePACS Personal Alarm Care Service or VitalCall. Note that such services rely on the patient having emergency contacts who live nearby.

‘Flag’ in the patient’s history that there is no nominated carer.

Talk with the patient about a backup plan if they no longer feel comfortable or safe at home.

Backup plans

  • Keep the bed open for the patient to return within 24 hours
  • Make a provisional referral for the patient to an inpatient palliative care unit. Although the patient may never require the bed, the inpatient unit is now aware of potential urgent need. This is known as a 'backup bed'. The referral process is the same as for a regular referral.

Refer to Therapeutic Guidelines Palliative Care 2016 Version 4 on the Clinicians Health Channel at your health service