Australia is lagging behind its fellow OECD countries in the provision of home-based palliative care, new research has shown.
The report from the Grattan Institute shows Australians die at home at half the rate of people in countries such as New Zealand, the US, Ireland and France. While 70 per cent of Australians want to die at home, only 14 per cent do so.
The Grattan report, Dying Well, found that despite their wishes, about half of Australians die in hospital and a third in residential care.
The report, released on Monday, adds to the figures released by the Australian Institute of Health and Welfare last week that documented the rise in the use of hospital-based palliative care services.
Grattan Institute report shows Australia lagging behind
Among the causes for the lack of home-based palliative care cited by the Grattan report were medical and community attitudes coupled with a lack of targeted funds.
The authors urged policy and attitudinal change to enable more people to die comfortably at home and in home-like environments, surrounded by family, friends and effective services.
The report found that because most people did not speak up about the way they would like to die, they often experience a disconnected, confusing and distressing array of services, interventions and relationships with health professionals.
The Grattan report recommended:
- more public discussion, including an education campaign, about the limits of healthcare as death approaches and the need to focus on end-of-life care
- the widespread adoption of advance care plans
- greater investment in community-based care to enable services for those dying of chronic illness to shift their focus from cures and institutional care to supporting people’s wishes to die at home.
The report argued that doubling the number of people who die at home would cost $237 million a year, but almost the same amount of institutional care funds could be released to pay for it.
“The baby boomers are growing old and in the next 25 years the number of Australians who die each year will double,” said report co-author, Professor Hal Swerissen. “We need the courage to promote a national discussion about a subject that we might dislike but cannot avoid.”
Rise in hospital-based palliative care
The Grattan report adds to the latest figures on palliative care services, released by the AIHW last week.
That report showed the number of palliative care-related hospital admissions rose by 52 per cent between 2002-03 and 2011-12.
There were a total of 57,614 palliative care related hospitalisations to public and private hospitals during the 2011-12 financial year.
Palliative Care Services in Australia 2014 showed that in the five years to 2012-13, the amount in benefits paid for all palliative medicine specialist services that were subsidised through the Medicare Benefits Schedule rose by an average of 20 per cent each year.
Patients aged 75 years and over accounted for almost half of palliative care hospitalisations for the 2011-12 financial year.
The report showed that of the 226,000 permanent residential aged care residents who had completed Aged Care Funding Instrument assessments in 2012-13, one in 18 were assessed as needing palliative care.
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Residential aged care in Australia means a home-like environment. There are thousands of aged care communities, comprised of two bedroom flats with varying levels of maintenance. They have living rooms, bedrooms, kitchens, etc. However, in the US, residential aged care primarily exists as high needs facilities. Although I’m not an expert in this subject, in my opinion, retirement communities in the US are counted as homes, but in Australia they are counted as residential care.
I am nearly 80 & get some personal care @ home as I have a neurological untreatable condition. I hope I can stay @ home but that will depend on my 86 year old husband who does his best & is fit a present. I ‘m glad I’m in WA as it appears this state is relatively well set up for aged people.
Hi Tommy
I am the author of the article that that graph is taken from, so am interested in your comments.
Firstly I should say that I entirely agree with your point about the different terminologies used – that does cause difficulties when conducting research, in particular for finding appropriate material. For the purposes of the paper, “residential aged care” includes those who need 24-hour care & no longer live independently, but are cared for in an institution or special facility for the purpose. It does not include retirement villages, sheltered housing or supportive care such flats with wardens. Yes, there will be slight differences in terms and care levels included. The data we used were obtained from many sources. Those for Australia were obtained from the Australian Institute for Health and Welfare (AIHW). Their sources were the AIHW Hospital Separations data and the records for Permanent and Respite Care. For USA, we used CDC reports of Nursing-home/long term care. For NZ, we used death certificates. Because deaths are part of well-established official records, the data are unlikely to have missed many people. So although there is potential for inconsistent definitions, this is likely to be slight when comparing Australian, USA & NZ data.
Secondly, our study was not limited to OECD countries, but to what information we could find for populations anywhere. Please note that the reworked graph included above shows only deaths of those aged over 65 years.
Thirdly, & importantly, we did not make any value judgement about any country being “better” or “worse”. We assembled the data to enable more informed debate about how how people want to live the final days of their lives, especially if they cannot look after themselves. It is encouraging to see the report being used to spark discussion and that it may inform policy and practice.
Thank you for raising the terminology question and providing an opportunity to discussion. I hope this feedback eases your concern.
Joanna Broad
University of Auckland