Interdisciplinary group members often cannot identify the timing of decline/death, causing care planning delays, less than ideal service intensities, slow palliation of symptoms, and family dissatisfaction. In this session, interdisciplinary group members will learn to use evidence-based research and clinical practice standards to identify early signs of transitioning or imminent death, enabling them to improve care planning with optimal service intensities and symptom palliation. With this information, we can transform the patient and family experience of care.