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Fresh call for improved palliative care in residential aged care


Advocates say that latest official figures show not all aged care residents who need palliative care are receiving it.

New Australian Institute of Health and Welfare data released this week showed that of the 231,500 residents with completed Aged Care Funding Instrument (ACFI) appraisals in 2014-15, one in 25, or 9,144 residents, had an appraisal indicating the need for palliative care.

These figures highlighted the “extremely concerning” gap between the need among residential aged care residents for palliative care and the levels of recognition and response to this need, said Odette Waanders, CEO of Palliative Care Victoria.

She pointed to a 2011 government review in the UK which found “a minimal estimate of 37 per cent of deaths” required palliative care, which if applied to the Australian figures would suggest that “at a minimum you would expect the number of permanent residents with a completed ACFI appraisal would be at least double what it was in 2014-15.”

“There is significant variability among residential aged care services regarding the provision of palliative care,” Ms Waanders told Australian Ageing Agenda.

“We field calls from family members who do not have confidence in residential aged care services to provide the quality of palliative care and end-of-life care they want for their loved one.”

Aged care residents now have very complex care needs due to multiple chronic diseases and palliative care has been indicated as beneficial for the leading causes of death, she said.

The applications for ACFI were an indicator of insufficient recognition of the need for palliative care among this population, Ms Waanders said.

However, Professor Deborah Parker, director of the New South Wales Centre for Evidence Based Health Care, said that the criteria for claiming palliative care funding under ACFI was very specific and there were several reasons why it was not claimed by all residents who die.

For instance, not all residents would meet the “very intensive clinical care” requirement under ACFI, she said.

A directive by a qualified person, such as a clinical nurse consultant in pain or palliative care, was also required, “and this may be difficult for many facilities to access or GPs who may not be willing to provide the directive,” said Professor Parker.

“Under the complex care needs section of ACFI a resident may have already reached the maximum points and therefore adding palliative care is not required as it will not result in further remuneration,” she added.

Professor Parker said it was important to distinguish that ACFI is a resource allocation instrument and not by default taken to represent the number of residents who require or receive palliative care in residential aged care facilities. Rather it was “the number who meet the ACFI criteria and where the facility has submitted that claim,” she said.

Ms Waanders said that qualitative research was needed to examine the quality of end-of-life care that residents receive.

“This would be very valuable in identifying factors that account for the variability among residential aged care facilities and how this could be improved so that a high standard of palliative care and end-of-life care is provided in all residential care facilities,” she said.

The AIHW data showed that of the residents who received palliative care, 23 per cent had been diagnosed with cancer, with  prostate cancer (21 per cent) and lung cancer (17 per cent) being the types of cancer most often reported.

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4 Responses to Fresh call for improved palliative care in residential aged care

  1. Gary October 21, 2016 at 12:16 pm #

    Aged Care is suffering greatly because of lack of funding and lack of staff. Simple as that.
    As long as this punitive approach to funding exists in Australia Aged care staff will continue to be under enormous pressure to deliver good care. We all need to lobby Governments.

  2. M. Slater-Oliphant. October 26, 2016 at 2:23 pm #

    Palliative Care needs to be available to all. My Mother was diagnosed with bowel cancer which then spread to the liver and stomach. Her wishes were NO chemo and NO surgery to be made pain free and comfortable.

    The Doctor in the hospital approached me and said she needed an operation on the bowel to relieve pressure. I asked why would you want to do that when she is dying and her wishes are clear – no surgery. He continued to argue with me. I said I want you to give her more morphine as she has requested otherwise, I’ll find someone, somewhere, who will. How clear do family have to be with Hospital staff. Keeping people alive unnecessarily and in pain is a disgrace. Its time for change.

  3. Kelley Wylie October 28, 2016 at 1:05 pm #

    Deborah Parker is spot-on in her reply, it is so diffulcult to maintain a claim for palliative care in ACFI that many facilities are afraid to make the claim 12.14. In my 27 years experience in Residential Aged Care, palliative care is a well established model of care that embraces not only the physical, psychosocial and emotional needs of the resident but also those of their family members and significant others. Nurses are a special breed of human beings and provide exceptional care to all residents, most specifically those who require palliative care as they near their final breath.

  4. Lynette February 27, 2017 at 8:07 pm #

    ACFI palliative care claims are often not made due to the restrictions on claiming, as suggested as Intensive clinical nursing and the required assessments, diagnosis and other documentation required to support the claim, which is all required to be gained and dated prior to claim submission. Often by the time all this is gained the patient has passed away. This does not mean that they have not received the best palliative care from all staff involved in their care and the wonderful support for loved ones.
    Patients with a palliative diagnosis are treated as so right from the time of diagnosis but the aged care facilities are only able to claim for the end stages of life ( hours/days). Ms Waanders needs to come work in an aged care facility and learn the actual ACFI rules, and hey why not go through a grueling 3 day validation from 3 validators to grab back that precious little amount of palliative and complex funding that has taken over a week to apply for.

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