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Significant unmet need for palliative services in residential care despite cost-effectiveness

Palliative and end-of-life care in residential facilities improves residents’ quality of life and saves public money through reduced use of ambulance and hospital services, but take up remains low, new economic analysis shows.

The research analysis by the National Centre for Social and Economic Modelling (NATSEM) at the University of Canberra looked at palliative care’s impact in seven areas including residential aged care, home-based care and hospitals.

It found that palliative care in all settings had positive outcomes for Australians while also reducing healthcare costs but that greater investment was needed to realise the care preferences of people approaching end of life.

Professor Laurie Brown

NATSEM’s convenor and deputy director of the Institute for Governance and Policy Analysis Professor Laurie Brown said palliative care and end-of-life care in residential aged care made “good economic sense”.

“It reduces unnecessary visits to emergency departments and transfers to hospital and costly interventions that neither the resident nor family want,” Professor Brown told Australian Ageing Agenda.

“And it allows the resident and their family in consultation with the aged care provider to make more informed choices about the resident’s end-of-life pathway.”

Unmet need

Despite its cost-effectiveness, there is “significant unmet need” for palliative care in residential aged care, where about a third of permanent residents die each year usually in their facility or following transfer to hospital, Professor Brown said.

Of the 55,600 permanent residents who died in aged care in 2014-15, over 87 per cent had been in care for more than three months and over half had stayed in care for more than two years, she said.

“Yet very few residents were assessed for needing palliative care, and the uptake of advanced care directives in residential aged care remains low,” Professor Brown said.

Only 4 per cent of residents in aged care in 2014-15 were assessed as requiring palliative care according to their Aged Care Funding Instrument appraisal.

This figure does not come close to the number of residents who die in aged care each year, said Palliative Care Australia CEO Liz Callaghan.

“More research is needed to establish why there is such a significant difference in these numbers and what can be done to ensure that all residents who require palliative care support are able to access it,” Ms Callaghan told AAA.

Action needed

Liz Callaghan

Residential aged care providers can better support residents at the end of life by investing in upskilling staff and engaging with specialist palliative care staff when required, Ms Callaghan said.

“The ability to recognise when a resident is dying should be a core competency for all staff,” she said.

Each resident should have an end-of-life plan that includes an advance care directive and wishes on pain and other symptom management to reduce hospitalisations, and providers should invest in the resources required to support people to die in place, Ms Callaghan said.

“Items such as syringe drivers, mobility aids and palliative medications should be available when required to reduce the need to transfer residents to hospital.”

Professor Brown also called for advance care planning throughout residential aged care along with the inclusion of palliative care health professionals as part of residential care teams to better meet demand for palliative care services.

Access the research here.

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4 Responses to Significant unmet need for palliative services in residential care despite cost-effectiveness

  1. Julie Baker August 2, 2017 at 2:05 pm #

    The reason the numbers appear low for Residential Aged Care Facilities (RACFs) providing Palliative Care is because many do not access ACFI funding for those last few days. Many people receiving palliation in RACFs, are already attracting higher funding and to complete the documentation needed to change the ACFI is very time consuming, taking the time away from the person who needs it. ACFI funding for Palliative Care used to be available for six months prior to death, now it is only available for the last days of life. Staff working in aged care would much rather spend the time caring for the person than doing paper work. For accurate data to be achieved talk to RACFs and they will tell you many more people are being afforded the opportunity to die in a place they know, with familiar staff and surrounded by their family.
    If funding was more accessible I believe your research results would look very different.

  2. Marion Harris August 3, 2017 at 11:52 am #

    Advanced Health Directives were required for all Residents when I worked in Aged Care for RSL Care and BLUE Care. The Residents and their families were able to make informed choices for their end stage of life. I have seen many quality deaths because of compassionate, trained Palliative Care Staff.
    I’m forever grateful to the staff at Dicky Beach Aged Care Facility Queensland who allowed my beautiful Mother, who became critically ill to pass away peacefully using quality Palliative Care.

    Retired RN with 40 years of acute clinical experience.

  3. Julie B August 11, 2017 at 1:00 pm #

    I am amazed how the connection was made to ACFI palliative care funding and not actual facts. Our elderly are provided with exceptional end of life care in most RACF’s, with advance care directives and professional pathways utilised to ensure the best care is provided. External palliative care services are often used as a support so admissions to an acute facility are avoided.
    ACFI palliative care funding is difficult to access and there have been occasions where auditors have knocked back this funding as the death of a resident was not deemed as ‘imminent’. It would be worthwhile providing education to this group on what end of life and palliative care is all about.

  4. SN August 12, 2017 at 5:22 pm #

    So agree with Julie Baker well said

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