Implementing high-quality palliative care in nursing homes

The world’s largest primary palliative care trial in nursing homes has shown moderate increases in the quality of end-of-life care delivered in the last month of life.


The 5.5M euro PACE project - Comparing Effectiveness of Palliative Care for Elderly People in Long-Term Care Facilities in Europe - was funded by the European Commission from 2014-2019.


Lancaster University researchers from the International Observatory on End of Life Care (IOELC) were among those from six countries involved in the project, with the results now published in JAMA Internal Medicine.


The PACE project’s Principal Investigator Professor Lieve Van den Block of the Vrije Universiteit Brussel (VUB) said: “The PACE study has shown that the delivery of high-quality palliative care in nursing homes is necessary and feasible, albeit sometimes very difficult to achieve. Success is highly dependent on the leadership in these settings, and on the fit between the trainer and training program with the specific nursing home.”


Palliative care is an approach aimed at improving the quality of life of all people with life-threatening illness and their families regardless of where they live. It is advocated as the preferred approach to care in nursing and care homes, as the length of stay is usually relatively short and people admitted to nursing homes very often have or develop serious health problems including frailty and dementia.


More specifically, primary or basic palliative care should be standard best practice care for all nursing home residents, and specialised palliative care services should be accessible when needed for people with complex problems.


As part of the PACE project, the PACE Steps to Success Training Programme was developed and tested in a large randomised controlled trial in 78 nursing homes in 7 countries (Belgium, the Netherlands, England, Finland, Poland, Italy and Switzerland). The PACE Steps to Success Programme is a one year primary palliative care intervention for nursing homes aimed at implementing basic non-specialised palliative care, using a train-the trainer approach.


It was developed under the coordination of a team led by Professor Sheila Payne from Lancaster University and is focused around six steps:

  • implementing advance care planning
  • assessment and care planning
  • multidisciplinary review meetings
  • high-quality care for pain and depression
  • care in the last days of life
  • care after death


The PACE Steps to Success Programme is now freely available for users on the European Association for Palliative Care website and there will be a free online course based on the Programme in March 2020.


Professor Payne said: “We recommend it for use to introduce basic non-specialist palliative care in nursing homes, albeit with close and ongoing monitoring and sufficient flexibility and tailoring to the local context during implementation.”


2 March 2020.