Background Living with frailty means living with vulnerability to sudden deteriorations, fluctuating capacity, increased risk of mortality and institutionalization (Clegg, et al. Lancet. 2013; 381 (9868): 752–62), and a symptom burden similar to that of people accessing palliative care (Nicholson, et al. Ann Palliat Med. 2018;7(Suppl 3):S164–75). Care homes are a space where increasing numbers of older people are living and dying with frailty, but the need for palliative care is under-recognised and under-researched in this setting (Van den Block, et al. J Am Med Dir Assoc. 2016;17(6):566.e1–7).

Aims To develop the relationship between residential care homes and the hospice to better support engagement with palliative care and promote living well now.

Method The project followed quality improvement methodology. A project team was formed with key stakeholders including hospice staff representing biopsychosocial and spiritual care, education and community action; Age UK; and key Integrated Care Board representatives. The plan was to work with nine Croydon residential homes over three PDSA cycles. Cycle one offered care home staff training and a resident and family event which included rehabilitation, decision-making, deprescribing, and connecting with community services. Adaptations were made for the following two cycles to streamline the events following feedback from all stakeholders.

Results Key learning: residents needed the mental capacity to engage in the programme and this was not always understood. While most residents were bereaved, they rarely received support - this need was not initially appreciated. There were multiple opportunities for deprescribing and advance care planning. Positive outcomes included: developing care home staff’s understanding regarding frailty and end-of-life care, the support the hospice offers, and sign-posting to useful services; resident specific outcomes such as enabling a resident who loved to read to join Age UK reading session in partnership with The Reader charity.

Conclusion A large percentage of the care home residents were able to engage with the hospice for a short spell of care to help with deprescribing, future planning and connect with other community services.