Someone living in a care home is likely to have complex health and care needs, with a combination of frailty, disability, and cognitive impairment. Admission to hospital, following a sudden change in health, is often not in their best interest. We examined ways to enhance care using the knowledge of the wider multidisciplinary team, and looked at how information could be shared effectively between health and care professionals involved in supporting people living in care homes in Scotland. During the 2 year study period there was an 84% increase in the number of excellent digital Anticipatory Care Plans and a 76% reduction in admissions to hospital. This approach requires professionals to invest time to proactively plan care. As well as delivering better outcomes, those involved valued the opportunity to connect, review and plan care together. This promoted better understanding, mutual respect and closer working relationships between the health and care professionals.