Talking to someone living in a care home or nursing home

Please be aware - this information is for healthcare professionals

If you look after people in a nursing or care home, you may often have residents who are approaching the end of their life.

Because you get to know your residents so well, you’re in a unique position to help them express and achieve their wishes for their final days and hours. It isn’t always easy to talk about death – and some people won’t want to – but you can use these questions as a guide to help start the conversation.

You can also ask your line manager about training on palliative and end of life care.

Use your own expertise and judgment on what’s appropriate in order to develop a rapport with your resident. These questions are here to act as a guide, not a checklist.

1. Changes in symptoms

As the end of life gets closer, your resident will likely be aware that their symptoms are changing and they may be less able to carry out simple tasks. By exploring this, you are giving them a chance to talk about any worries or concerns. It also gives you an opportunity to discuss things like how they’d like their symptoms to be managed at this point.

You may find it helpful to refer to our condition-specific guides.

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2. Choosing where to be cared for as their condition gets worse

Some people who die in hospital may not get any clinical benefit from being there. It depends on the patient’s individual situation and their wishes, but going to hospital is not always the best answer. They might be more comfortable and peaceful in the care home. This does not have to lead to a decision – it simply lets you know how your patient feels. Remember, many people may consider a care home to be their ‘home’.

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3. Doctors and nurses involved in the patient’s care

National Institute for Health and Clinical Care Excellence (NICE) guidelines state that everyone approaching the end of their life 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 explore their options.

Talk to your patient’s district nurse, specialist nurse or GP to find out if there is an advance care plan (see our informaiton for patients about planning your care in advance). If you are working in a care home, your relationship with your resident will make you well placed to explore and create an advance care plan if there is not one in place. Your employer or local hospice may be able to provide training on how to do this.

The plan tells staff what treatment the patient wants or does not want, in the case of an emergency. For example, some people decide they do not want resuscitation or hospital admission.

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4. Allowing the patient to open up about their worries

Talking to the patient about their worries gives the person a chance to voice their concerns. Some people fear being alone at the end, or are afraid of pain or losing control. Try not to interrupt and let the patient do the talking. Make sure they know you’re listening by nodding and maintaining eye contact. Try not to fill any silences – the person maybe thinking about what you have just said, or a response to what they have heard.

If the patient raises issues you can help with, give them information and reassurance. If you feel you can’t help at this time, you should seek advice from others on the team and make sure this is followed up. Document any concerns the resident has so that others on your team are aware.

For more details on having difficult conversations, see our information on talking to someone with a terminal illness who is approaching end of life.

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5. Talking about their family and friends 

Talking about this this may help you support friends and family when your patient dies. It might also make you aware of any potential conflicts, for example if the patient and the family have different views. You could also explore whether they would like particular family members to be present as death approaches or whether they want to set up a Power of Attorney. These details should be included in their advance care plan.

Your patient may find it helpful to read our information on planning ahead.

You can also signpost any friends and family to our information about being there for someone with a terminal illness.

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6. Resolving issues

When people are nearing the end of their life, they may start to think about past regrets. Having a chance to set things right, for example by ending a long-running argument in the family, can help them find a more peaceful state of mind. Even if this is not possible, they might feel better simply because they’ve told someone about it. Remember that effective communication is at the root of person-centred, holistic care. This means being patient, listening effectively without interruption and responding honestly and openly.

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7. Religion

Spirituality, faith and religion are very important to some people. The patient might welcome the chance to talk about their faith, though in your professional role it’s important not to force your own beliefs.

While others may not follow a religion or faith, they might still have some questions about life, death and meaning. The patient might take comfort from seeing a religious leader, or a chaplain from the local hospital or palliative care team. You may like to ask your patient if they have particular rituals related to their faith that you to be aware of.

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8. Creating a relaxing atmosphere

You already know your resident well, so you may feel you know what kind of surroundings would help their last days stay calm and gentle. But it’s important not to make assumptions, which is why asking this question may be useful. Although residents are encouraged to make their room their own, they may not feel comfortable doing so. There may be things from home or people that they would like around them, but find it difficult to ask for them. Some care homes are very vibrant and noisy, and it may be that a different room may be more appropriate to ensure a peaceful environment.

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9. Making their wishes known  

Some people may take comfort from knowing that their affairs are in order. This can provide peace of mind and a sense of control. For example, your patient may have been thinking about the funeral arrangements that they want. Even if they have written this down somewhere, some people may not bring up the subject because it’s difficult. This question opens the possibility for a discussion, but it’s phrased in a way that lets them close the conversation if they don’t want to talk about it.

We have information about planning ahead, including making a Will and planning your own funeral , which your resident may find helpful.

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10. Allowing the patient to open up

It’s important to give the patient a chance to talk about anything else that is concerning them. This could be a small problem that you could help with, or a significant conversation about approaching the end of 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.

It is important that you make the person 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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