Improving Dementia end of life care at local aged care facilities.

The intervention will be implemented over 18 months. We will use a train-the-trainer model, whereby a paid Palliative Care Planning Coordinator (PCPC) is trained and then supported to train other nursing and personal care staff at each intervention residential aged care facility (RACF). PCPCs will be the team leader in each RACF responsible for implementing the case conferencing (CC) model as per the protocol and providing ongoing education and mentoring to other RACF staff. PCPCs from all 10 intervention facilities will attend an initial training programme for 1 week. They will learn to identify ‘triggers’ that warrant initiation of a Facilitated Case Conferencing (FCC). Where a trigger for FCC has been identified, the point of disease progression will be mapped onto relevant domains to indicate whether survival time will likely be measured in months, weeks or days. The “map” for each resident will highlight issues for discussion at CC, including pre-emptive planning for predicted deterioration. Training in facilitating general practitioner involvement will also be given to PCPCs. Ongoing support in the Intervention arm will be provided following initial training and for the rest of the study period. The team will liaise monthly with each PCPC to discuss progress and difficulties and plan support of staff training and CCs where monitoring data indicate this is required. Finally, training will assist RACF staff to provide a “palliative” space (an area which provides the resident and family a quiet, homelike private environment 24 hours per day. PCC training will make use of experiential and adult learning approaches, guidance on how family members can be involved as much as possible in decision-making about care planning, implementation and monitoring, and support reconceptualisation from a “service focus” to person-centred focus.