Background About 5% of community-dwelling older persons in Israel suffer from advanced dementia. Data on the quality of care in the community for older persons with advanced dementia (OPsWAD) is scarce.

Aim To examine the quality of care provided by the health services to OPsWAD living in the community.

Methods 117 family members of OPsWAD were identified from the register of one of the health plans in Israel. Subjects were interviewed over the telephone. About 65 of them were caring for a relative living at home and 52 had lately cared for a relative at home until his/her death. The average age of the patients was 87.

Results About 28% of OPsWAD used feeding tubes, 58% received medication for behavioural control and 36% suffered from pressure sores. About 73% of those who had died had suffered from discomfort close to death, 67% had problems swallowing and 55% suffered shortness of breath. About 86% of family members did not always know which physician was responsible for the care and 58% felt that their relative needed better medical homecare. Only 20% of OPsWAD had written advance directives and only 22% had a power of attorney. Moreover, only 15% of the family members reported that they had discussed ACP with a member of the care team.

Discussion and conclusion There is a need to implement palliative care programs for OPsWAD, and to improve the training of health-service professionals in the community in palliative care and in ACP discussing.