Background and objectives Fostered by a legislative initiative in 2015, German nursing homes face the challenge to implement ACP- structures. Project background is to conceptualize and evaluate a practicable ACP-concept for the region Würzburg (130.000 inhabitants, Bavaria) with 12 nursing homes. In advance of a concept development, the current status of advance care practices in nursing homes, requirements of nursing homes and possible barriers were assessed.

Methods Written survey addressed to directors of 12 nursing homes in Würzburg. The questionnaire focusses – amongst others – on structural data (number of nursing places, nursing level of residents, qualifications of staff members …), regional networking (cooperation with general practitioners, hospitals, hospices …), reasons for and extend of hospital admissions and reanimations, dealing with cardiac arrest, kind and amount of documentation of residents will related to end of life care, professions with function in ACP, possible barriers towards ACP and need for further support in implementing ACP.

Results NH are still not prepared for implementing an ACP-Concept. Development of structures and support are as necessary as development of human resources and establishment of cross-provider networks. Misperceptions about legal requirements, uncertainties in communication and little time are some further barriers that have to be addressed in an ACP-concept.

Conclusion The sustainable implementation of a viable ACP-concept assumes the development of structural and personal resources and has to address popular misperceptions and communicative barriers.