A dignified end of life for everyone – shared instructions for nursing homes

Everyone with a terminal and progressing illness must receive active and comprehensive care. The aim is to alleviate suffering and value the quality of life – it is the fundamental right of each person.

The recently prepared shared instructions specify the competencies required of the personnel and how the residents’ wishes should be taken into consideration.

Project Manager Paula Niittymäki says that this matter is of utmost importance to the personnel.

“Death is deeply tied to personal values, and everyone wants end-of-life care to be as good as possible. Every municipality in Western Uusimaa wanted to participate in creating these new instructions,” says Project Manager Niittymäki.

Paula Niittymäki has managed the work of the 13-person team since January. In practice, Niittymäki’s team has been seeking to answer the following question: what is dignified end-of-life care like?

Niittymäki talks about death in an admirably natural way, not shying away from the topic.

“Death affects us all. This is why I want to encourage people to think about their living will, for example: what are your wishes for your end of life? The living will can include even the most common wishes. Some may wish to have red wine and chocolate every Friday, others may wish for something completely different.”

However, Niittymäki says that not everyone is able to talk about death, and others should accept this. Conversely, professionals need to be able to face difficult topics – this is their responsibility.

Through working together across Western Uusimaa, the operators also want to increase the competencies of geriatric professionals in terms of palliative and end-of-life care, even if the care is mostly high-quality even now, according to Niittymäki.

According to an extensive review by the Ministry of Social Affairs and Health, approaching death is not always recognised and care based on symptoms is not always started on time. Improving competencies is a solution for this.

Although the new shared concept is based on extensive studies and various discussions, it is not an all-encompassing guidebook; the instructions do not specifically state what dignified end of life means at an individual level. Niittymäki has a simple answer to this question: it means different things to different people. It is the job of the professionals to find out the customers’ wishes by listening to them in a respectful manner.

“It is important that decisions are not made on the customers’ behalf. You can ask about the topic simply by enquiring which wishes and fears the person has related to death."

It has been noted that a dying person may not feel good if they see their loved ones suffering. The death of a loved one may be a major crisis, which is why professionals also need to support families as a part of end-of-life care.

“Even though the last days can be affected in many ways, people may have pain related to the life they have lived. There may not be medication for that. The most important thing is being there for them.”

The concept for dignified end of life was developed in the Western Uusimaa Social and Health Services Programme(external link, opens in a new window)