Background Despite increasing numbers of older people living and dying in care homes, palliative care needs within care homes are not always recognised or supported. The British Geriatrics Society report of June 2011 stated “no model of co-ordinated healthcare has been developed to meet the needs of care home residents.” 19% of residents die in care homes – their preferred place of care (CQC, 2012).

Aims The Clinical Commissioning Group commissioned the hospice to increase care staffs’ confidence and competence when delivering end of life care through better understanding and knowledge of residents’ needs. To enable staff to support residents’ end of life care needs through collaborative working to avoid inappropriate admission to hospital at end of life.

Methods An end of life care programme was delivered to eight care homes by a multidisciplinary hospice team using a coaching and reflective style of training. The programme was evaluated analysing data collected through semi structured interviews with managers and care staff confidence surveys.

Results All care staff reported an improvement in confidence discussing end of life care issues with residents including recognising those approaching end of life and assessing care needs. Care home managers reported more staff initiating conversations regarding residents’ end of life care. Care homes implemented changes in practice to improve end of life care including increasing the number of advanced care plans being completed.

Conclusion Staff shortages meant releasing care home staff to attend the training sessions proved challenging. As some carers felt they lacked influence to implement changes a tool was development to support care home staff to recognise when a resident is deteriorating and nearing end of life.