End-of-life care in a care home: what families should know
By CareFinder Team · Published 2026-06-30 · Last reviewed 2026-09-18
Many people receive end-of-life care in their own care home, with staff working alongside the GP, community nurses and hospice teams. Good care focuses on comfort, dignity and the person's wishes, best recorded early in an advance care plan. In England, someone deteriorating quickly near the end of life may have care funded in full through the NHS Continuing Healthcare fast track.
Many people receive end-of-life care in the care home where they live, with staff working alongside the GP, district or specialist palliative care nurses, and hospices. Good care focuses on comfort, dignity and the person's wishes, which are best recorded early in an advance care plan. In England, if someone is deteriorating quickly and nearing the end of life, the NHS may fund their care in full through the Continuing Healthcare fast-track pathway.
What do palliative care and end-of-life care mean?
Palliative care means care that aims to relieve symptoms such as pain, breathlessness, sickness or anxiety, and to support the person and their family, when an illness cannot be cured. It can go on for months or years alongside other treatment.
End-of-life care is the part of palliative care for people likely to be in the last months of life, including the final days. The NHS guide to end of life care explains what it involves, where it can happen and how to plan ahead.
How does end-of-life care work in a care home?
Care home staff provide the day-to-day care, and health professionals come in as needed:
- the GP, who reviews symptoms and prescribes medicines, including "anticipatory" medicines kept ready in case symptoms change
- district or community nurses, who can visit residential homes to give injections, manage syringe pumps and help with symptoms
- nurses in the home, if it is a nursing home, who can give clinical care on site at any time
- specialist palliative care teams and hospices, who give advice on complex symptoms and support staff and families
- out-of-hours services and NHS 111 when help is needed urgently
A residential home can often care for someone at the end of life with this community support. A nursing home has nurses on duty around the clock, which may matter if needs are complex.
What is advance care planning?
Advance care planning means talking, while your relative is able to, about what matters to them and what they would and would not want. It helps staff and doctors follow their wishes if they later cannot say. It can include:
- An advance statement of wishes and preferences, such as where they would like to be cared for, who they want with them, or their faith and cultural needs. It is not legally binding but must be taken into account.
- An advance decision to refuse treatment. In England and Wales, according to the NHS page on advance decisions, this is legally binding if it complies with the Mental Capacity Act, is valid and applies to the situation. To refuse life-sustaining treatment it must be written, signed and witnessed, and state that it applies even if life is at risk. The person must be 18 or over and have capacity when they make it.
- A health and welfare lasting power of attorney, which lets a chosen person make decisions about care and treatment if your relative loses capacity. It must say explicitly if the attorney can make decisions about life-sustaining treatment.
- A DNACPR decision or a ReSPECT form, which record recommendations about resuscitation and emergency treatment.
Scotland and Northern Ireland have different laws on capacity and advance decisions, so check local guidance there.
What does a DNACPR decision mean?
A "do not attempt cardiopulmonary resuscitation" decision means that if your relative's heart or breathing stops, the team will not try to restart it. According to the NHS guide to DNACPR decisions, it is about CPR only: your relative should continue to get all other appropriate care and treatment. Doctors should involve the person, or those close to them, in the discussion, and DNACPR decisions must never be applied to a group of people at once.
Who pays for end-of-life care in a care home?
NHS Continuing Healthcare fast track
In England, if your relative's health is deteriorating quickly and they are nearing the end of life, they should be considered for the NHS Continuing Healthcare fast-track pathway, as the NHS guide to Continuing Healthcare explains. A suitable clinician, such as the GP or a nurse, completes the fast-track tool, and the integrated care board should arrange funding promptly. If eligible, the NHS pays for care in full, and it is not means-tested. Wales has its own Continuing NHS Healthcare framework; Scotland and Northern Ireland have different arrangements.
Ask the GP or care home manager directly whether a fast-track referral is appropriate.
NHS-funded nursing care
In a nursing home in England, if your relative needs registered nursing care but is not eligible for Continuing Healthcare, the NHS pays a weekly contribution directly to the home towards the nursing part of the fees.
The council means test
Otherwise, the usual rules apply. The council assesses needs and finances. In England, for 2026/27, people with capital above £23,250 usually pay the full fee. Scotland provides free personal and nursing care payments for people assessed as needing them.
Benefits under the special rules
People who are likely to have 12 months or less to live can claim some benefits faster under the special rules, according to GOV.UK's guide to benefits for people nearing the end of life. At State Pension age this means Attendance Allowance; a doctor or other medical professional completes an SR1 form, and only one form is needed even for several benefits. Someone else can apply on your relative's behalf.
This is general information. For decisions about money, contracts or law, speak to the council, the NHS team or a solicitor.
What should you ask a care home about end-of-life care?
- Can my relative stay here until the end of their life, including if their needs increase?
- How do you work with the GP, district nurses and local hospice?
- How quickly can anticipatory medicines and equipment be arranged, including at night and at weekends?
- What end-of-life training do staff have?
- How do you record and share advance care plans, DNACPR decisions and ReSPECT forms?
- Can family stay overnight and visit at any time towards the end?
- How do you support faith, cultural and personal wishes before and after death?
What does good end-of-life care look like?
- symptoms such as pain, breathlessness and agitation are noticed and treated quickly
- mouth care, comfortable positioning, and help with eating and drinking as long as your relative wants them
- the person's wishes, including about hospital admission, are known and respected where possible
- the family are kept informed and supported, including at night
- calm, unhurried staff who explain what is happening
If you are worried, speak to the manager and ask for the GP or palliative care team to review your relative. You can raise concerns with the regulator, and hospice teams can often give advice by phone.
Looking after yourself
This is an intensely hard time. Hospices and charities such as Marie Curie offer information and bereavement support to families, including when the person is in a care home. Take breaks, accept help, and ask staff what to expect in the last days so fewer things come as a shock.
What happens after a death in a care home?
The home will contact the GP, and a doctor will confirm the cause of death with a medical examiner. You then register the death, within 5 days in England and Wales or 8 days in Scotland, and can usually use the Tell Us Once service to inform government departments. The home will explain how to collect belongings and settle the final account; check the contract for any fees charged after death.
Frequently asked questions
Can my relative stay in their care home rather than go to hospital?
Often, yes. Many people are cared for at the end of life in their care home with support from the GP, community nurses and hospice teams. Record your relative's wishes in an advance care plan and ask the home how it would manage.
Is end-of-life care free in a care home?
It can be. In England, NHS Continuing Healthcare, including the fast-track pathway for people deteriorating quickly, pays in full and is not means-tested. Otherwise, the usual council means test applies, with NHS-funded nursing care towards nursing costs in a nursing home.
What is the difference between a DNACPR and an advance decision?
A DNACPR decision is a clinical decision about resuscitation only. An advance decision to refuse treatment is made by your relative in advance, and in England and Wales can be legally binding for the specific treatments it covers.
Can benefits be claimed quickly if someone is terminally ill?
Yes. Under the special rules, people likely to have 12 months or less to live can claim benefits such as Attendance Allowance faster, supported by an SR1 form from a medical professional.
Who decides if my relative lacks capacity to decide?
If your relative cannot make a decision, the professionals must act in their best interests, consulting family and any attorney. A health and welfare attorney or valid advance decision must be followed within its scope.
Key takeaways
- End-of-life care in a care home combines care staff with the GP, community nurses and hospice teams.
- Start advance care planning early, and share plans, DNACPR decisions and ReSPECT forms with the home.
- In England, ask about the NHS Continuing Healthcare fast-track pathway if your relative is deteriorating quickly.
- The special rules speed up benefit claims for people likely to have 12 months or less to live.
- Ask the home how it would care for your relative at the end, and look after yourself too.