Strengthening Our Long Term Care Together:
Embedding Palliative Approaches to Care Spread Collaborative

With an aging population, demand for palliative care has grown. Palliative care improves the quality of life for people with life threatening conditions and their families, helping to manage their pain and other physical, social, emotional, and spiritual issues, make informed decisions about aggressive treatments, and helping them to die in their place of choice.

Embedding Palliative Approaches to Care Spread Collaborative 

Embedding Palliative Approaches to Care (EPAC) is a proven innovation that helps staff in long term care identify residents who could benefit from a palliative approach to care, have conversations with them and their families about what they want, and develop and implement comprehensive care plans.

CFHI is focusing on spreading and scaling proven innovations that deliver better care closer to home and community. The collaborative will support this shared federal/provincial/territorial priority by reducing the number of patients in hospital who could be better cared for at home or in the community.

How does EPAC work? 

The pillars of the EPAC model are flexible, enabling individual homes to adopt and adapt them to their unique local needs and strengths.


Using a train-the-trainer approach, this model will be spread throughout regions where participating organizations have regional responsibilities. Seven participating teams, across 5 provinces and one territory will spread the approach to 22 homes in this initial expansion.

The EPAC collaborative will run until November 2019.

Key Dates

Key Dates



In 2017, CFHI identified 26 innovations from the Call for Innovations in Palliative and End-of-Life Care. Eight were selected by an external merit review panel to present at CFHI’s 2017 CEO Forum and to receive a CFHI Innovation Award. Of the eight showcased at the CEO Forum, The Daisy Project: Embedding a Palliative Approach in Residential Settings was identified as a demonstrated innovation.

From 2012-2017, EPAC (previously known as DAISY) was implemented in 48 long term care homes, including urban and rural sites and homes caring for specialized populations such as acquired brain injury (ABI), Amyotrophic Lateral Sclerosis (ALS) and marginalized persons across Vancouver Coastal Health. The initiative was successful in enabling residents to receive improved end-of-life care at home, avoiding unnecessary hospital transfers and supporting all stakeholders through the experience.

The project team trained leaders and site champions, increasing capacity to deliver a palliative approach to care, increasing confidence to discuss goals of care with the resident or substitute decision maker, and contributing to cross-sector benefits for both acute and long term care. The original initiative achieved a 56 percent decrease in ED transfer rates and a 45 percent reduction in number of days residents spent in acute care in the last three months of life.

Last Updated: January 2019