Background There is limited evidence on the impact of multi-component interventions to support the delivery of palliative care in care homes. In 2015, one hospice established an innovative ‘Hospice in Your Care Home’ team using a number of interventions: role modelling and working alongside staff, responses to urgent referrals, advance care planning and training courses. This project has been externally evaluated.

Aims • To evaluate the process and outcomes of the ‘Hospice in Your Care Home’ initiative, with specific reference to hospital admissions and end of life care practices.

• To ascertain the costs of delivering the project.

• To identify facilitators and barriers to the implementation of the initiative.

Methods The responsive evaluation comprised:

• an analysis of secondary service provision data

• focus group interviews with care home managers (n=7), care home staff (n=11) and the project team (n=6)

• preliminary analysis of cost (time and finance).

Secondary data was analysed using descriptive and inferential statistics. Framework analysis structured the qualitative data analysis.

Results Nine care homes participated with one facility leaving and one joining part way through. Hospital admissions were significantly reduced by 25% (p=0.01), between 2015 and 2016. Resident status meetings were conducted in each facility, with 4479 residents discussed at 217 meetings. Staff described increased confidence in their ability to care for residents with palliative care needs. To establish this project three stages of implementation were identified: initiation, assimilation, and ‘everyday’ running. The project was facilitated by the hospice team’s flexibility and supportive approach. Reported barriers reflected the ongoing challenges regarding staffing levels and release of staff to attend training.

Conclusions This hospice model has demonstrated significant reductions in hospital admissions and increased confidence of care home staff in end of life practices. It has the potential to be expanded in other localities.