Why does Continuity of Care matter at the End of Life?
When someone is close to death, they often see many different people, including nurses, doctors, care workers, and hospital staff. Each has a role. But what’s often missing is a steady person who stays involved the whole way through.
Continuity of care means someone is there from start to finish, helping to build trust and making things feel more stable. It helps lower stress and makes things clearer for the person who is dying and the people supporting them.
The Problem with Fragmented Care
Today, care is often broken up. People are moved between services. They have to repeat the same details over again, multiple times. Workers change. Plans can get lost. This makes it harder to feel safe or supported. Plans can get lost or misunderstood, leading to feelings of anxiety, neglect, or disconnection.
Transitions between care settings can jeopardise continuity, patient safety, and quality of care. One study found that 62% of patients experienced one or more transitions during the last three months of life, highlighting the need for consistent support [1].
What Continuity Brings
Having someone involved from beginning to end brings a sense of calm and personal connection. The individual feels seen as a whole person, not just a patient. Their values, beliefs, and wishes are more likely to be respected.
Continuity offers:
- Stronger relationships built on trust and understanding
- Less repetition and confusion across care settings
- Clearer communication between the person, family, and care team
- Better planning and follow-through on wishes and goals
- More emotional support and fewer surprises
The Role of an End of Life Doula
End of Life Doulas are uniquely positioned to provide ongoing support. Unlike clinical staff who may work in shifts or rotate through cases, doulas often remain involved throughout the entire journey – before, during, and after death.
They work alongside the care team, offering stability and presence. Whether sitting quietly, helping explain next steps, or comforting a family member, doulas help maintain continuity when things feel uncertain or fast-moving.
End of Life Doulas play a key role in providing continuity. [Learn more about what they do.]
A five-year review of the National Survey of Bereaved People in England found that patients who received good continuity of primary and palliative care experienced better overall quality of end-of-life care [2].
The 95% Rule: A Call to Community
Professor Allan Kellehear, a pioneer in public health palliative care, introduced the “95% rule.” He observed that people with life-limiting illnesses spend just 5% of their final year in direct contact with health professionals. The rest of their time is spent with family, friends, and community [3]. This highlights the importance of non-clinical roles, like doulas, who provide support across the remaining 95%.
Doulas work to help bridge this gap, ensuring the person’s emotional, spiritual, and practical needs are met consistently and compassionately.
A Steady Hand in a Time of Change
Continuity of care doesn’t require complex systems or high costs. Often, it’s about showing up, being consistent, and staying connected. This kind of care helps people feel safe and supported – not just in body, but in mind and spirit too.
Want to Learn More?
If you’re looking for steady, compassionate support during the end of life, we’re here to help. Visit www.yourpathguide.com.au to book a free 20-minute call.
About the Author
Shannon Beresford is an End of Life Doula, Sound Therapy Practitioner, and founder of Your Path Guide in Adelaide, South Australia. He provides calm, ongoing support to clients and families through all stages of end-of-life care. Shannon is also Vice Chair of HELD Australia Ltd, the peak body for holistic end-of-life and death care.
References
- Teno, J. M., Gozalo, P., Bynum, J. P. W., et al. (2013). Change in end-of-life care for Medicare beneficiaries. JAMA, 309(5), 470–477. https://jamanetwork.com/journals/jama/fullarticle/1568250
- Abel, J., Pring, A., Rich, A., Malik, T., Verne, J., & Lloyd, C. (2023). Better end-of-life care through improved continuity: A five-year national study. British Journal of General Practice, 73(731), e443. https://bjgp.org/content/73/731/e443
- Kellehear, A. (2023). Being an End of Life Doula: The 95% rule and public health palliative care. British Journal of Community Nursing, https://www.britishjournalofcommunitynursing.com/content/palliative-care/being-an-end-of-life-doula
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