Background Care homes are important places at the end-of-life for many and staff are the key providers of palliative and end-of-life care. The support provided to care homes from hospices has been shown to have clear benefits for residents and their families (Candy, Holman, Leurent, et al. Int J Nurs Stud. 2011;48(1):121–33). However, the impact on staff confidence is less well established.

Aim To understand how hospice and specialist palliative care services (SPCS) influence care home staff confidence to provide palliative and end-of-life care.

Methods An explanatory sequential mixed methods study. Care home leads completed an online cross-sectional survey (including Palliative Care Self-Efficacy Scale) and individual qualitative interviews. Quantitative analysis used a multivariate logistic regression and qualitative data used Framework Analysis. Integration used a ‘Following the Thread’ approach. Ethics approval from King’s College London Research Ethics Committee: MOD-20/21–18541.

Results 78% of care homes sought palliative and end-of-life care support from hospice or SPCS, with those who accessed support reporting higher confidence scores (F(1, 105)=11.07, p=0.001). Care homes with nursing provision accessed more support from hospice/SPCS than residential homes (92% nursing, 88% dual registered vs 63% of residential homes). Nursing home staff were significantly more confident to provide palliative and end-of-life care than residential home staff (p=0.02). Interviewees commented positively on the support from hospice/SPCS. Feelings of being well supported stemmed from the availability of advice over the phone and joined up working with other community teams.

Conclusion Support from hospice and SPCS can enhance care home staff confidence in providing palliative and end-of-life care, particularly for nursing home staff. However, access to hospice is currently inequitable, especially for people with dementia (Bradley, Dowrick, Lloyd-Williams. BMC Palliative Care. 2022;21(1):170; Sleeman, Ho, Verne, et al. BMC Neurol. 2014;14:1–9) who receive much end-of-life care from care homes (Office for National Statistics. Dementia and Alzheimer’s disease deaths including comorbidities, England and Wales: 2019 registrations.). Future research from authors will focus on access to hospice services for care home residents with dementia. Specifically, provision, effect on outcomes and family and staff experiences.