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.
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.”
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.
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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