Background Residential aged care facilities (RACFs) are high-mortality settings and the provision of high-quality palliative and end-of-life care is crucial for residents due to their limited life expectancy, medical comorbidities, frailty and complex care issues.

Residential In-Reach programs (RIR) provide care, consultation, referral, education and support for clients and care providers in RACFs. They assist staff to develop their clinical skills and knowledge, and ensure care is delivered at the right place and time, thereby helping to prevent avoidable hospital presentations. They provide expertise in many aspects of care, including palliative/end-of-life support and advance care planning.

Objectives From the perspective of the RIR team, as well as from family members of residents who were at end-of-life during the IMPART trial, this presentation will:

1. highlight the role of RIR in providing palliative care in RACFs

2. discuss how RIR can work collaboratively with the RACF and the General Practitioner (GP) to provide high quality palliative care

3. explain the RIR experience with the IMPART trial, an intervention that aims to improve palliative care in RACFs.

4. discuss the provision of palliative care via telehealth

Methods IMPART is an NHMRC-funded, 2.5-year pragmatic stepped wedge cluster randomised trial (ACTRN12622000760774) being conducted with 10 RACFs in Melbourne, Australia. The IMPART program is a telehealth program that consists of (a) an interactive, needs-based end-of-life care education program for staff and GPs working in RACFs, and (b) timely end-of-life support from RIR teams. The 6-month intervention includes the establishment of a Planning Ahead Team, incorporating the RIR, that identifies areas of practice in the RACF where there are opportunities to improve, and then works on an action plan to improve them. The primary outcome is unplanned hospital admissions. Secondary outcomes include reduction of emergency department presentations, reductions in length of stay of unplanned hospital admissions, and whether IMPART improves residents’ quality of life, comfort, satisfaction, and quality of end-of-life care.

Results Two of five, 6-month intervention phases within four RACFs were completed in April 2024. A third phase started in May 2024 and will be completed in October 2024. The IMPART trial has facilitated RIR discussions with the RACF staff and the GPs, and the RIR expertise on palliative care has been conducive to telehealth consultations. The provision of palliative care support by the RIR team has included timely clinical assessment, symptom management, prognostication, facilitating conversations with families, education and consultations with staff, GP support, care coordination and referrals to local specialist outreach/community palliative care services (CPCS). Family members of recently deceased residents have reported the positive aspects of care and support provided by RIR.

Discussion This presentation highlights the important role of RIR in the provision of high-quality palliative care in RACFs. They provide a key service to RACFs and work together with the resident, their family, RACF staff, GPs and CPCS. An integrated care team is crucial for aged care staff to be supported and to optimise residents’ quality of life at end-of-life, which also impacts positively on bereavement experiences of family and friends.