Talking to someone who lives alone
Please be aware - this information is for healthcare professionals
Some people with a terminal illness may be content living alone, but others may find it more difficult. Living alone may increase feelings of isolation, causing anxiety and depression. There may also be practical problems, like difficulties with cooking or cleaning.
Asking the patient some questions can help you begin to understand their needs so you can take active steps to accommodate them.
Use your own expertise and judgment on what’s appropriate to develop a rapport with the patient. Below are 10 discussion points that you might want to raise with them. These points are here to act as a guide, not a checklist.
Be aware that some people with a terminal illness may feel isolated because they believe no one can understand what they are going through, they don’t feel like themselves or because of changes in their appearance due to illness or treatment.
Loneliness can take its toll on anyone’s physical, mental and emotional health. A patient may have friends or loved ones they would like to see more often. As they reach the end of their life , many people want to say goodbye to friends and family on good terms and settle any unresolved issues. If this isn’t possible, just talking to you might help the patient feel better. If there is no one for company, you could encourage the patient to get involved in local activities that interest them.
Most hospices have a day centre, and they may even provide transport to get there. Other day services may be provided by the local church, Age UK or a day hospital. These services can provide a way to meet like-minded people and talk about common problems, issues or ways to cope. For people who are housebound, several charities offer visiting and befriending services.
There may also be practical issues that affect a person’s social life. For example, they may have difficulty opening the front door to let people in, in which case they may benefit from some home adjustments or equipment. Before the person receives any equipment or has adaptations made to their home, they will need to be assessed by an occupational therapist. You should contact the district nurse, specialist nurse or GP about this.
When someone has a terminal illness, their needs change over time. You might be the first person to notice that they need a different bed, new arrangements for using the toilet or someone to help with the housework. If this is the case, contact the district nurse, specialist nurse or GP.
Therapists on the care team can help if the patient is having problems with mobility or managing everyday tasks. Their GP or a district nurse can make these referrals.
Transport can also be a problem for people with a terminal illness who live alone. You should find out how the patient gets to medical appointments, and contact their GP about NHS patient transport services, if they need it. The surgery will normally make the transport booking. While people are still well enough, it’s important for them to get out and about for leisure too.
The local council or charities might be able to offer a service such as Dial a Ride or taxi vouchers. Getting out to do the shopping may become difficult, so you could suggest shopping online or using companies who deliver ready-made meals. In some areas, charities provide a short-term shopping service. It might be helpful to find out if these services are available locally.
Changes to the patient’s condition
As the end of life gets closer, your patient will likely be aware that their symptoms are changing and that they are less able to carry out simple tasks. For example, opening packets or tins of food may become an issue.
It’s important to be aware that this loss of independence can be distressing for some people. Talking about this gives a person a chance to talk about their concerns. It also gives you an opportunity to discuss things like how they’d like their symptoms to be managed at this point, and if they need any further support to complete daily activities.
If the patient has no one living with them, they may struggle with practical issues, such as collecting their medication or remembering what to take and when.
Without encouragement, the patient may skip or cut down on the doses (a problem called non-concordance). If you’re worried about this, talk to the patient’s district nurse, specialist nurse or GP. Often, the GP will rationalise the number of drugs that are prescribed, particularly as the patient approaches the end of their life.
Pill organisers or dosette boxes may help and are available from most pharmacies. Pre-filled blister packs are available, although the GP will need to request these. If swallowing is an issue, your patient may need an assessment by a speech and language therapist, who will create a management plan.
Choosing where to be cared for
If your patient doesn’t live with someone who can care for them, they may be especially worried about staying at home. However, if it’s their wish to die at home, every effort should be made to support them to do this.
National Institute for Health and Care Excellence (NICE) guidelines state that everyone living with a terminal illness should have the opportunity to discuss and develop a personalised care plan for current and future support and treatment.
This plan should include information such as where they want to spend their last days and hours. Everyone in the multidisciplinary team has a role in helping a person with a terminal illness to explore their options.
Talk to the patient’s district nurse, specialist nurse or GP to find out if there is an advance care plan, or if they can help the patient create one.
Be aware that there will be specific issues around staying at home when a person lives alone, so forward planning is essential. Things like equipment and access to the property may need consideration. All local authorities have different guidelines about what is available to patients – for example some may fund a live-in carer while others may not. Think about the practicalities and talk them through with the patient.
You can also refer people to our information on choosing where to be cared for.
If the person has any pets, they may be worried about what will happen when they are no longer able to care for them. We have information about rehoming pets that the patient may find helpful.
Doctors and nurses involved in the patient’s care
It’s important that people living with a terminal illness and anyone caring for them are aware of the health and social care professionals who may be involved.
This involves colleagues from the GP surgery, social services, the specialist palliative care team and possibly the local hospital. Navigating the care system can seem complicated and it can be difficult to know who to contact for what. See our guide to services (hyperlink) to find out more.
You can also signpost your patient to our information about who is involved in their care.
Plan for emergencies
There should be a plan in place to manage symptoms, such as pain, that require immediate attention, especially at night or weekends. This may help to avoid unnecessary trips to hospital, and minimise distress.
Everyone on the multidisciplinary team, including the patient and any family or friends involved in their care, should know about this plan.
The plan should outline who to contact and how to reach them in an emergency. If there is a paper care plan in the house, make sure that any contact numbers listed on it are current and up to date. It may help to add a brief outline of role responsibility alongside the numbers.
Most areas in the UK have access to a call system, often referred to as a Lifeline. This is a button that can be pressed to summon help in an emergency. You may be able to assist with completing the paperwork to order one for your patient. The paperwork should be available from the local social services department, or may be downloadable from their website. Try to encourage the person to wear the button or carry it with them. Some people prefer to use a mobile phone to carry around – check that it is charged when you visit.
Hydration and nutrition
As people get closer to the end of their life, they often lose weight, have difficulty swallowing or lose their appetite. If they live alone, it can become difficult to keep up with shopping and cooking.
There are many reasons why they may be eating and drinking less, including physical and psychological issues. So it’s really important for health and social care professionals to take a sensitive approach when supporting their patient to manage hydration and nutrition issues.
If your patient hasn’t already had an assessment for difficulties eating and drinking, contact the district nurse, specialist nurse or GP.
There are companies who deliver ready-made meals, although these do require heating thoroughly. Some areas of the UK still have a ‘meals on wheels’ service. Make yourself aware of what is available locally. If carers are going in at meal times, make sure that the care plan reflects the person’s dietary requirements.
Looking ahead: the patient’s thoughts on the future
People with a terminal diagnosis are likely to experience a range of emotions throughout the course of their condition or illness. These may include sadness, fear, anger, guilt and regret.
Some people may be waiting for the opportunity to talk about how they feel, and you may be able to provide a listening ear. Alternatively, they may wish to talk to a chaplain or counsellor. These may be based in the hospice or specialist palliative care team. If you’re not sure how to put them in touch, ask your supervisor or the GP.
Your patient may ask questions about when they might die and what it will be like at the end. If you don’t know or can’t answer, signpost to the district nurse, specialist nurse or GP. It is important that you don’t speculate or provide inaccurate information.
Our information on talking to someone with a terminal illness about end of life can help.
Allowing the patient to open up
It’s important to give the patient permission to talk about anything else that is concerning them. This could be a small problem that you could help with, or lead to a significant conversation about approaching the end of their life.
Remember to take the time to understand the person’s needs, provide a listening ear and take active steps to understand and meet their care needs. They may want to discuss funeral plans or tell you where to find specific papers with instructions on their wishes for after they’ve died. These types of conversations can be very emotional and should be handled delicately.
Make the patient aware that, although your conversation is confidential, you may need to share any concerns with other professionals if safeguarding is an apparent issue.
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