Does the ‘PACE steps to Success’ programme reduce hospital use in the last month of life of nursing home residents?

Only 43 days to #EAPC2020 … The 11th World Research Congress of the European Association for Palliative Care which, for the first time ever, will take place online with interactive online sessions 7 to 9 October 2020 and on-demand content available from 21 September.

Ahead of the congress, we’re delighted to give some highlights of what’s in store at #EAPC2020. Today, Elisabeth Honinx MSc, doctoral researcher, End-of-Life Care Research Group, Vrije Universiteit Brussels, Belgium, gives a glimpse of the plenary lecture she will give on 9 October.  

Elisabeth Honinx.

European societies are ageing and the population group of 60 years and over will increase substantially. Many older people will die following a prolonged trajectory of multiple chronic diseases and complex care needs, which will have an immense socio-economic and clinical impact. In some countries, older people are encouraged to stay at home for as long as possible; however, many will need long-term institutional end-of-life care and a considerable percentage will someday die in a nursing home. This puts nursing homes in a unique position to provide palliative care to older people. Despite these widely known facts, it is only in the past decade that palliative care has been advocated as the preferred approach to nursing home care. The PACE (PAlliative Care for older people in long-term care facilities in Europe1) project is a European Union-funded project (2014-2019). Focused on palliative care in nursing homes, it has worked to improve palliative care for nursing home residents, advocating the need for a general palliative care approach to improve quality of care for all residents.

We believe that the culture around palliative care needs to change. First, healthcare policies still regard palliative care as an economic challenge: they are concerned about containing the cost of ageing. However, investment policies for palliative care in nursing homes are important, as again became apparent during the COVID-19 crisis. Second, a taboo on the term ‘palliative care’ has spread fear of imminent death. To address these challenges, we promote palliative care as a complementary care in nursing homes helping older people to live and die with dignity.

As part of the PACE project, the ‘PACE Steps to Success’ programme was developed. This train-the-trainer programme was based on the UK’s Route to Success training programme and aimed to integrate palliative care into mainstream nursing home care with the use of external trainers, key internal champions, and a one-year stepwise approach. We evaluated the effect of the PACE programme on the care residents received, as well as on staff competencies, inBelgium, England, Finland, Italy, the Netherlands, Poland and Switzerland.2Although the programme did not change the comfort of residents in their last week of life, it did improve the quality of care in the last month, but this was a secondary outcome and should therefore be interpreted with caution.

Based on this knowledge, our team aimed to explore further whether the PACE programme had an effect on hospital use at the end of life in a secondary analysis. While avoiding hospitalizations is not a distinct goal in the PACE training programme, the topic is addressed as part of the intervention. Whether or not a person dies in the hospital is also an important quality indicator of end-of-life care; although sometimes needed, hospitalization of older patients with complex care needs comes with several drawbacks and should thus be avoided as much as possible. However, up to half of the nursing home residents are hospitalized in the last month of life.3–5

My presentation will outline the results of this study on hospital use in the last month of life: i.e. visits to the emergency room, hospital admissions, the length of hospital stay if admitted, admission to the intensive care unit (ICU), total nights spent in the ICU, place of death and, if death occurred in hospital, the reason for the last admission. From this, I will argue for the need to develop specific policies and programmes to reduce avoidable hospitalizations at the end of life. These need to include a focus on acute symptom management and close involvement of general practitioners or specialist palliative care services.

Join Elisabeth Honinx for her plenary presentation, which will be one of the interactive online sessions on 9 October. View the Full Programme of Interactive Days 7 to 9 October here: 

Elisabeth’s lecture, ‘Effects of the ‘PACE steps to Success’ programme on hospital admissions in the last month of life and the place of death of nursing home residents in 7 European countries’ will also be recorded and released for on-demand viewing by registered delegates until January 2021. Read the abstract of her lecture, and all other congress presentations and posters, in the Book of Abstracts for the 11th EAPC World Research Congress, to be published by ‘Palliative Medicine’ – available online from 21 September until January 2021.


  1. PACE | PACE – Palliative Care for Older People in care and nursing homes in Europe. Accessed January 14, 2020:
  2. Van den Block L, Honinx E, Pivodic L, et al. Evaluation of a Palliative Care Program for Nursing Homes in 7 Countries: The PACE Cluster-Randomized Clinical Trial. JAMA Intern Med. Published online November 11, 2019:1-10. doi:10.1001/jamainternmed.2019.5349.
  3. Menec VH, Nowicki S, Blandford A, Veselyuk D. Hospitalizations at the end of life among long-term care residents. J Gerontol A Biol Sci Med Sci. 2009;64(3): 395-402. doi:10.1093/gerona/gln034.
  4. Fried TR, Mor V. Frailty and hospitalization of long-term stay nursing home residents. J Am Geriatr Soc. 1997;45(3): 265-269.
  5. Hoffmann F, Strautmann A, Allers K. Hospitalization at the end of life among nursing home residents with dementia: a systematic review. BMC Palliat Care. 2019;18(1):77. doi:10.1186/s12904-019-0462-1. (Open access).

Links and resources

Read more posts about the 11TH EAPC World Research Congress Online on the EAPC blog

JOIN PALLIATIVE CARE SPECIALISTS FROM ACROSS THE WORLD AT #EAPC2020 –11th EAPC WORLD RESEARCH CONGRESS ONLINE 2020 – Interactive online sessions 7 to 9 October 2020 with on-demand content available from 21 September.

All registered delegates will receive a unique login to access the congress platform on the day we go live on 21 September – so keep an eye on your inbox!

A blend of Pre-recorded On-demand Sessions, Live Presentations, Live Panels hosted by international experts, Children’s Seminar, Poster Sessions and EAPC Group Meetings, will bring you all the latest research from the world’s top researchers in palliative and end-of-life care. CME accreditation will be available. Masses of content will be available on demand from late September until January 2021. Meet some of our plenary speakers on the EAPC YouTube channel. Learn and interact with leading researchers and chat with other registered delegates from the global palliative care community – all in the safety of your own home or office. View or download the Full Programme of Interactive Days 7 to 9 October here.  Register here.

This entry was posted in 11th EAPC World Research Congress Online, EAPC World Research Congresses, PACE and tagged , . Bookmark the permalink.

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