Table 2.

Strategies suggested by participants for improving end-of-life care for residents living with dementia.

Key areas for improvement	Suggested strategies
Family education and participation	Gently promote family awareness and acceptance of the terminal nature and stages of dementia, death, dying and palliative approaches to care using accessible language.
	Invite families and carers to personalize the resident’s room.
	Ensure 24/7 visitor access to care homes.
	Provide carer support sessions for families and carers to facilitate early bereavement.
Advance care planning	Make advance care planning a national requirement for entry into a care home.
	Revisit advance care planning with the resident (where possible) and/or the family/substitute decision maker soon after admission.
	Support families and substitute decision makers to participate in ongoing advance care planning discussions when the resident no longer has capacity.
Staff experience and education	Provide ongoing opportunities for front line staff to gain practical experience and discuss end-of-life care in a supportive educational manner.
	Mandate essential palliative care experience training for all staff and volunteers, including care home affiliated GPs.
	Develop a palliative care committee of champions in the care home, with representation across all staff roles.
	Ensure staff are adequately supported by pastoral care and/or peer support.
	Enable staff to participate in cultural rituals related to residents dying.
Clinical approaches to care	Ensure all staff can recognize deterioration in the resident and escalate issues to appropriate clinical staff.
	Ensure care homes have adequate clinical back-up support from GPs and linkages to referral pathways for specialist palliative care and/or geriatric services where required.
	Roster regular staffing patterns to promote continuity of care.
	Allocate an extra staff member on shift when a resident is nearing end-of-life.
	Ensure end-of-life medications and equipment are always readily available on site in case of unexpected resident deterioration, and a trained nurse is available to administer.
	Include pastoral care staff in clinical handovers.