Background Discharge from in-patient palliative care units to long term care can be challenging. In the UK, hospice palliative care unit in-patients move to a care home if they no longer require specialist palliative care and cannot be discharged home. There is evidence from the UK and Australia to suggest that patients and families find the prospect of such a move distressing.

Aim To investigate the experiences of hospice in-patient multidisciplinary teams concerning discharging patients from hospice to a care home for end of life care.

Design A qualitative study, using thematic analysis to formulate themes from focus group discussions with hospice staff.

Setting/participants Five focus groups were conducted with staff at five UK hospices. Participants included multidisciplinary team members involved in discharge decisions. All groups had representation from a senior nurse and doctor at the hospice, with group size between three and eight participants. All but one group included physiotherapists, occupational therapists and family support workers.

Results Two main themes emerged: practical concerns and dilemmas around decision making. The latter are reported in this paper. Dilemmas included;

• Ethical concerns (dilemmas around the decision, lack of patient autonomy and allocation of resources);

• Communication challenges and;

• Discrepancies between the ideals and realities of hospice palliative care.

Conclusions Hospice palliative care unit staff find discharging patients to care homes necessary, but often unsatisfactory for themselves and distressing for patients and relatives. Further research is needed to understand patients‘ experiences concerning moving to care homes for end of life care, in order that interventions can be implemented to mitigate this distress.