Nursing homes are a tough place to do palliative care. There is extremely high staff turnover, physicians are often not present except for the occasional monthly visit, many residents die with untreated symptoms usually after multiple hospitalizations and burdensome life-prolonging treatments, and specialty palliative care - well that is nowhere to be found in most nursing homes outside of hospice. So what can we do to improve the palliative care outlook in nursing homes? On todays podcast we talk with Lieve Van den Block about her recent palliative care intervention that was published in JAMA IM this week. Lieve led a multicomponent intervention to integrate basic nonspecialist palliative care in in 78 nursing homes located in 7 different European countries. Just take a moment to grasp the size of this study - 7 counties, 78 nursing homes. I struggle with just trying to improve palliative care in one site! We discuss with Lieve the results of the study, her take on why they got the outcomes that they did, and her view on a path forward to improving palliative care in these settings. We also have the authors of the accompanying JAMA IM editorial with us too (that was easy, it was Alex and our recurring guest host Lauren Hunt.) So take a listen and tell us what you think in the comments below, on social media, or on our GeriPal phone # (929-GeriPal).