International Observatory on End of Life Care Experiences of Older People in Residential Care Homes (The EPOCH Study): Mapping the living-dying transition [i] Froggatt , [ii] Goodman , [ii] Mathie , [ii] Wright , Katherine Claire Elspeth Jayne Clare [iii] [ii] [iv] [iv] [iv] Crang , Di Thompson , Alex Mendoza ,Daphne Westwood , Marion Cowe , Stephen Barclay[iii], Steve Iliffe[v], Jill Manthorpe[vi] Background Many older people live in a care home. Dying is a part of care home life and an important aspect of the overall quality of care provided. Recent initiatives in England seek to improve access to palliative care provision, and the quality of care for residents towards the end of life. How individuals experience and engage with this living and dying transition in a care home over time has received little attention. Methods This study draws on the principles of complex evaluation (Campbell et al 2007) using qualitative and quantitative Evidence. A range of data collection methods have been used (Figure 1). Figure 1: Planned data collection methods Research Aims • To understand how the care home environment influences the views, experiences and expectations of end of life care in care homes for residents. • To identify the treatments and interventions received and services and resources used leading up to the older person’s death •To establish what kind of palliative care support is required to ensure older people, relatives and care home staff achieve good end of life outcomes Review of data collection: Six care homes have participated and the following data collection completed to date: Interviews with: - 59 older people (+33 second interviews) - 27 staff A case note review for 116 residents Fieldnotes completed following site visits Findings(1) Individual experiences All residents, even people living with dementia were able to recount their experiences of living and loss in this setting. Present within older people’s experiences and views of living in a care home are accounts of losses, and to a lesser extent dying. Inherent in these accounts are mixed threads of satisfaction and dissatisfaction with care. This mirrors the acceptance of personal dying and ambivalence about discussions of this topic. For further information contact: Katherine Froggatt: k.froggatt@lancaster.ac.uk or Claire Goodman: c.goodman@herts.ac.uk. Findings (2) Wider structural issues The cultural context on a number of dimensions has the potential to shape older people’s quality of care towards the end of life. These dimensions can be strong or weakly present and include: Transparency and openness about dying and death within the care home amongst staff and with residents and their families. This is illustrated by the extent to which a resident's death is shared with other residents either in conversations or through formal modes of communication such as newsletters. Conclusions Individual’s experiences need to be understood in the context of wider cultural issues regarding care and dying. Both elements then need to be addressed if the quality of end of life care in care homes is to be improved. Wider values and beliefs regarding how care for older people is provided with respect to person--centred values or not sits alongside beliefs about what constitutes a good death and how this can be achieved. Leadership and senior staff’s attitudes to staff development with respect to end of life issues also contribute to the wider culture of care. This study is funded by the NIHR under their Research for Patient Benefit programme. We acknowledge the role of East and North Herts PCT for hosting the study [i] International Observatory on End of Life Care, Lancaster University, UK [ii] Centre for Research in Primary and Community Care, University of Hertfordshire, UK [iii] Department of Public Health and Primary Care, University of Cambridge, UK [iv]Lay members of CRIPACC’s Public Involvement in Research (PIR) Group, University of Hertfordshire, UK [v] Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK [vi] Social Care Workforce Research Unit, King’s College London, UK