Palliative Care
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Palliative Care

Palliative care is care that helps people live their life as fully and as comfortably as possible when living with a life-limiting or terminal illness. Palliative care identifies and treats symptoms which may be physical, emotional, spiritual or social. [1] Definitions of palliative care can vary, however, the definition defined by the World Health Organisation (WHO) has been broadly adopted with minor modification. The Australian government National Palliative Care Strategy 2018 [2] has adopted the WHO definition and this is applied throughout palliAGED.

Palliative care is for people of any age who have been told they have a serious illness or condition that cannot be cured from which they are likely to die. Palliative care assists people with illnesses such as cancer, motor neurone disease, dementia, end stage organ disease and progressive frailty to manage symptoms and improve quality of life. [3-5] Palliative care provision in the context of older age needs to consider some specific issues including multiple clinical diagnoses that require a variety of treatments; confusion, dementia, and/or communication difficulties may be present; and living and care arrangements. [6] Therefore a palliative approach to care may be useful across the illness and ageing trajectory and not just the terminal phase. [7,8] Although it is recognised that people with life-limiting illnesses other than cancer can benefit from palliative care, in 2017 almost 4 in 5 episodes of hospital based specialist palliative care (77.6%) involved a cancer diagnosis. [9]

Models of palliative care in Australia range from specialist palliative care provided in hospitals or as ambulatory services, to hospice and community-based care including primary care. [10] Many different health professionals can provide palliative care. Most people will be cared for by the generalist health providers. Specialist palliative care teams provide direct care for those with complex care needs. Specialist teams also support other health professionals working in the community or in hospitals to care for their patients as they approach the end of their lives. A needs-based approach underpins referral to specialist palliative care provision. [11]

Australian Bureau of Statistics (ABS) data shows that age specific death rates begin to increase for males around 55-59 years and for females around 50-59 years and then increase steadily. [12] The proportion of older deaths in residential aged care and in the community is increasing highlighting the need to ensure appropriate care for older Australians at the end of their lives. [13]

The Aged Care Funding Instrument (ACFI) Section 12 (Complex Health Care) Question 14 allows a service to claim funding for a palliative care program involving end-of-life care. This claim will involve very intensive clinical nursing and/or complex pain management in residential aged care. In Australian residential aged care for 2016-17, the need for palliative care was indicated for one in fifty residents through an ACFI appraisal. [9] Of those residents one third had a diagnosis of cancer. The non-cancer disease categories most often recorded among aged care residents requiring palliative care were circulatory system disease (18.5%) and musculoskeletal disease (10.3%).

Funding for palliative care 

Funding for palliative care depends on the site of care. [10]

In public and private hospitals funding for specialist palliative care is provided through a mix of state/territory funding and private health insurance. Community based palliative care is funded by states/territory funding of community services, with private health insurance providing coverage for substitute hospital treatment. RAC palliative care is funded under ACFI, while primary health care service provision of palliative care is covered via general Medicare benefits schedule consultation coverage as well as provisions for chronic disease management. This is supplemented with out-of-pocket costs paid by individuals and some funding distributed via Primary Health Networks (PHNs).

Page updated 05 July 2019

References

  1. Palliative Care Australia. National Palliative Care Standards (371kb pdf). 5th ed. Griffith (ACT): Palliative Care Australia; 2018.
  2. Australian Government Department of Health. National Palliative Care Strategy 2018 (6.01MB pdf). Canberra: Australian Government Department of Health; 2018 Dec.
  3. Siouta N, Van Beek K, van der Eerden ME, Preston N, Hasselaar JG, Hughes S, et al. Integrated palliative care in Europe: a qualitative systematic literature review of empirically-tested models in cancer and chronic disease. BMC Palliat Care. 2016 Jul 8;15:56. doi: 10.1186/s12904-016-0130-7.
  4. Pal L, Manning L. Palliative care for frail older people. Clin Med (Lond). 2014 Jun;(3):292-5.
  5. Parker D, Lewis J, Gourlay K. Palliative Care and Dementia (4.84MB pdf). Canberra: Dementia Australia; 2018. Paper No.: 43.
  6. May P, Garrido MM, Cassel JB, Kelley AS, Meier DE, Normand C, et al. Palliative Care Teams' Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities. Health Aff (Millwood). 2016 Jan;35(1):44-53. doi: 10.1377/hlthaff.2015.0752.
  7. Sawatzky R, Porterfield P, Lee J, Dixon D, Lounsbury K, Pesut B, et al. Conceptual foundations of a palliative approach: a knowledge synthesis. BMC Palliat Care. 2016 Jan 15;15:5. doi: 10.1186/s12904-016-0076-9.
  8. Guideline Adaptation Committee. Clinical Practice Guidelines and Principles of Care for People with Dementia. Sydney: Guideline Adaptation Committee; 2016.
  9. Australian Institute of Health and Welfare (AIHW). Palliative Care Services in Australia [Internet]. 2018. [updated 2018 Oct 17; cited 2019 Apr 26].
  10. Catholic Health Australia (CHA). Palliative Care in the Catholic Sector (788kb pdf). Canberra: CHA; 2019.
  11. Palliative Care Australia. Palliative Care Service Development Guidelines (340kb pdf). Griffith (ACT): Palliative Care Australia; 2018 Jan.
  12. Australian Bureau of Statistics (ABS). Deaths, Australia, 2017 [Internet]. 2018 [cited 2018 Apr 26]; ABS cat. no. 3302.0.
  13. Australian Institute of Health and Welfare (AIHW). Cause of death patterns and people’s use of aged care: a Pathways in Aged Care analysis of 2012–14 death statistics [Internet]. 2018 [cited 2019 Apr 26]; AIHW cat. no. AGE 83.