Key Messages

  • Enrolled nurses and care workers provide most direct care to older people. [1-5]
  • There is increasing scope for Nurse Practitioners to contribute to the care of older people. [6]
  • Training interventions should focus not only on knowledge but on organisational support for workers to improve workforce capacity and preparedness. [4,5]
  • When primary care professionals are involved in end of life care, people are more likely to die out of the hospital. [7]
  • Clinicians should be encouraged to use their clinical experience and one of the existing tools for early identification of patients for palliative care. [8]


Supporting older Australians to be cared for and die in the place of their choice requires a high-quality and well-prepared health workforce. The aged care industry comprises both health professionals and careworkers. [3]

The aged care workforce is a significant workforce with 366,027 workers of which 240,317 have direct care roles. [3] The size of the residential aged care workforce being estimated at 235,764 workers of which 153,854 have direct care roles: 386 Nurse Practitioners (NP), 22,455 Registered Nurses (RN), 15,697 Enrolled Nurses (EN) and 108,126 Personal Care Attendants (PCA), 2,210 Allied Health Professionals (AHP) and 4,979 Allied Health Assistants (AHA). [3] The size of the home care and home support aged care workforce is estimated at 130,263 of which 86,463 have direct care roles: 53 Nurse Practitioners, 6,969 RNs, 1,888 ENs, and 72,495 Community Care Workers, 4,062 Allied Health Professionals and 995 Allied Health Assistants. [3] AHPRA data reports that in 2018-19, there were 26,772 registered medical practitioners with general practice as listed speciality (GPs). [9]

Personal care attendants are also known as careworkers, nursing assistants and health care assistants. [1,2]

Evidence Summary

Enrolled nurses and careworkers provide most direct care to older people. [1-5] Vulnerabilities in the employment structures and skills shortages can add to complexity around competencies and scope of practice. Careworkers often provide care at the intersection between professional and informal care. Many have limited training and feel inadequately prepared for their job. [4] There is increasing recognition of the importance of staff training and education and on their effectiveness as interventions that achieve outcomes for staff and for the people for whom they provide care. [10] Recent evidence has shown that careworkers need support to cope with the death of residents particularly in relation the process of dying and palliative care, communication skills, and clinical skills and knowledge related to chronic illness. [1] The recently developed Palliative Approach for Nursing Assistants (PANA)_Knowledge Questionnaire (17 items), the PANA_Skills Questionnaire (13 items) and the PANA_Attitudes Questionnaire (10 items) (155kb pdf) have been shown to be valid tools for identifying palliative care educational needs in Australian careworkers in residential aged care. [2] These tools are sensitive to the careworkers’ skills, training and scope of practice. [2]

Primary care professionals are seen as an important link in preventing people dying in hospitals. [7] However, they must be willing to manage the uncertainty around palliative and end-of-life care. [11] Effective collaboration and interprofessional working may assist in providing care to older Australians at the end-of-life. [10,11] Tools to identify people with palliative care needs do exist and should be used alongside clinical judgement. [2,8] The Supportive and Palliative Care Indicators Tool (SPICT) is useful for identifying patients appropriate for referral to palliative care services and has been validated for use in the older person.

Nurse practitioner role may also be a valuable addition to the palliative care/aged care workforce. [6]

In 2018, Aged Care Workforce Strategy Taskforce published Australia’s Aged Care Workforce Strategy which outlines fourteen strategic actions to help guide the workforce of the future and improve the quality of aged care. [10]

Quality Statement

Few reviews included prospective comparative interventions. Many dealt with analyses of surveys, interviews and workforce reports. The conduct of the reviews was adequate.

Page updated 31 May 2021


  • References

  • About PubMed Search

  1. Cronin U, McCarthy J, Cornally N. The Role, Education, and Experience of Health Care Assistants in End-of-Life Care in Long-Term Care: A Scoping Review. J Gerontol Nurs. 2020 Jan 1;46(1):21-29. doi: 10.3928/19404921-20191022-01.
  2. Karacsony S, Good A, Chang E, Johnson A, Edenborough M. An instrument to assess the education needs of nursing assistants within a palliative approach in residential aged care facilities. BMC Palliat Care. 2019 Jul 23;18(1):61. doi: 10.1186/s12904-019-0447-0.
  3. Mavromaras K, Knight G, Isherwood L, Crettenden A, Flavel J, Moskos M, et al. 2016 National Aged Care Workforce Census and Survey - The Aged Care Workforce, 2016. Canberra: Department of Health; 2016.
  4. Herber OR, Johnston BM. The role of healthcare support workers in providing palliative and end-of-life care in the community: a systematic literature review. Health Soc Care Community. 2013 May;21(3):225-35. Epub 2012 Sep 13.
  5. Karacsony S, Chang E, Johnson A, Good A, Edenborough M. Measuring nursing assistants' knowledge, skills and attitudes in a palliative approach: A literature review. Nurse Educ Today. 2015 Dec;35(12):1232-9. Epub 2015 May 21.
  6. Clark S, Parker R, Prosser B, Davey R. Aged care nurse practitioners in Australia: evidence for the development of their role. Aust Health Rev. 2013 Nov;37(5):594-601.
  7. Kim SL, Tarn DM. Effect of Primary Care Involvement on End-of-Life Care Outcomes: A Systematic Review. J Am Geriatr Soc. 2016 Oct;64(10):1968-74. Epub 2016 Aug 22.
  8. Maas EA, Murray SA, Engels Y, Campbell C. What tools are available to identify patients with palliative care needs in primary care: a systematic literature review and survey of European practice. BMJ Support Palliat Care. 2013 Dec;3(4):444-51.
  9. Australian Health Practitioner Regulation Agency and the National Boards. 2018/19 Annual Report Our National Scheme: For safer healthcare. Melbourne: Australian Health Practitioner Regulation Agency (AHPRA); 2019.
  10. Oishi A, Murtagh FE. The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: a systematic review of views from patients, carers and health-care professionals. Palliat Med. 2014 Oct;28(9):1081-98. Epub 2014 May 12.
  11. Aged Care Workforce Strategy Taskforce. A Matter of Care: Australia’s Aged Care Workforce Strategy. Canberra: Commonwealth of Australia as represented by the Department of Health; 2018 


Health Manpower- Mesh
(Used also for Health Workforce)
The availability of HEALTH PERSONNEL. It includes the demand and recruitment of both professional and allied health personnel, their present and future supply and distribution, and their assignment and utilization.

Workforce string

(((staff[ti] OR carer*[ti] OR caregiver*[ti] OR care giver*[ti] OR careworker*[ti] OR care worker*[ti] OR nurses[ti] OR nurse[ti] OR therapist*[ti] OR allied health[ti] OR professional*[ti] OR dermatologist*[ti] OR clinician*[ti] OR dietician*[ti] OR dietitian*[ti] OR nutritionist*[ti] OR physiotherapist*[ti] OR psychologist*[ti] OR audiologist*[ti] OR APNs[ti] OR RNs[ti] OR ENs[ti] OR doctor[ti] OR doctors[ti] OR speech pathologist*[ti] OR social worker*[ti] OR counsellor*[ti] OR GP[ti] OR general practitioner*[ti] OR family physician*[ti] OR primary care physician*[ti] OR caregivers[mesh] OR allied health personnel[mesh] OR nurses[mesh] OR general practitioners[mesh] OR nurse’s role[mesh] OR social workers[mesh]) AND (role[ti] OR employ[ti] OR demand[ti] OR recruit*[ti] OR assignment[ti])) OR (Staffing[ti] OR manpower[ti] OR work force[ti] OR workforce[ti] OR manpower[sh] OR Personnel Staffing and Scheduling[majr] OR Health manpower[majr])) AND