Aged care is expected to be safe, clinically sound and compliant. However, these expectations can unintentionally narrow care towards managing risk, decline and organisational requirements. For older people living with frailty, the more important question is whether care also protects identity, relationships, purpose, choice and the things that make each day worth living.

OneCare has adapted the Last 1000 Days Framework in response to this tension. The name reflects the reality that many people entering residential aged care are living with increasing frailty and may be approaching the later stage of life. It is not a countdown, a prediction of prognosis or an end-of-life pathway. It is a reminder that time matters and that good aged care must support people to live well, while also preparing thoughtfully and honestly for future decline and dying.

The framework is grounded in a simple principle: if we cannot always add days to life, we should focus on adding life to days. Translating that belief into consistent practice across a multi-site organisation, however, required more than a statement of values. It required changes to governance, clinical systems, workforce capability, measurement and everyday decision-making.

This presentation will describe how OneCare is embedding the Last 1000 Days as an organisational model of care rather than introducing it as another standalone clinical program. The model connects frailty recognition, reablement, dementia care, advance care planning, goals of care, palliative care and clinical governance. These areas are brought together through three practical actions: recognise changing needs early, respond according to what matters most to the person, and assure that care remains aligned with their preferences, goals and changing circumstances.

Through practical examples, the session will show how the framework influences decisions at key points in a resident’s journey: admission, care planning, early deterioration, hospital transfer, multidisciplinary review and end-of-life care. It will examine how teams balance autonomy, risk, function and comfort when no single clinical pathway provides the answer.

The presentation will examine how this approach has been translated into OneCare’s clinical roadmap and governance arrangements. This includes strengthening frailty assessment and escalation, improving the visibility of advance care plans and goals of care, integrating Palliative Aged Care Outcomes Program measures, supporting multidisciplinary review, developing workforce capability and using clinical dashboards to identify variation and opportunities for improvement. Reablement is positioned alongside palliative care, rather than in opposition to it, recognising that maintaining strength, independence and participation can remain meaningful even when a person is living with advanced frailty or a life-limiting condition.

Implementation has also required a shift in how clinical governance is understood. Traditional measures such as incidents, hospital transfers and compliance remain important, but they do not provide a complete picture of quality. A person may be clinically safe while becoming disconnected from the activities, people and decisions that give their life meaning. The framework therefore asks leaders and care teams to consider not only whether care was delivered correctly, but whether it was the right care for that person.

The session will share the practical challenges of implementation, including inconsistent understanding across sites, competing operational priorities, variable confidence in conversations about deterioration and dying, fragmented documentation and the risk of creating additional processes rather than changing existing ones. It will also explore the importance of visible leadership, shared language, clinical champions, education, multidisciplinary partnerships and honest use of data. Particular attention will be given to the need to involve older people and families, ensuring that what matters is not defined by clinicians or organisational systems alone.

While implementation is continuing, early experience has reinforced several lessons. A values-based framework must be visible in operational systems or it will remain an aspiration. Frailty, reablement and palliative care are most effective when treated as connected parts of one care journey. Measurement must extend beyond clinical risk to include whether personal goals and preferences are known, documented and acted upon. Most importantly, sustainable change requires alignment from the board and executive through to the people providing and receiving care each day.

Delegates will leave with a practical thoughts and concepts they can adapt within their own organisations. They will be able to identify how an overarching philosophy can be connected to clinical processes, governance and workforce development; consider mechanisms for integrating frailty, reablement, advance care planning and palliative care; and apply implementation lessons from OneCare’s experience.

The Last 1000 Days Framework does not claim to solve every challenge facing aged care. It provides a common question against which decisions can be tested: with the time this person has, are we helping them live the life that matters to them? By bringing together older people, families, care teams, clinicians, leaders and partners around that question, aged care can move beyond simply managing the final years of life and take greater responsibility for making those years meaningful.