Specialist palliative care use for older people receiving aged care

Early access to specialist palliative care has been shown to improve outcomes, including reduced hospitalisations, improved symptom control and supported decision-making (Kircher et.al 2025).

Among people aged 40 and over who died from predictable deaths in 2019–20, almost 2 in 3 (62%) first received specialist palliative care services in the last month of life and 49% in the last 2 weeks of life. This corresponds with a median of 15 days from first receipt of specialist palliative care service (in the last year of life) to death (AIHW 2024).

In this section early access is measured by calculating the median number of days, and incidence rate, from first specialist palliative care service received in the last year of life to death.

First specialist palliative care service received in the last 2 weeks of life

Among people in the study population (aged 65 and over), the median number of days between receipt of first specialist palliative care service and death was 12 days. The median was shorter when the first specialist palliative care service was a palliative care-related hospitalisation (7 days), and considerably longer when it was a Medicare-subsidised palliative care service (42 days).

While these findings are consistent with other studies, it is considerably shorter than what is recommended and supported by the evidence, which suggests at least 3–4 months of specialist palliative care provides the maximum benefit (Davis et al. 2015, Jordan et al. 2020).

Residential aged care users receive first specialist palliative care service later than other aged care users

The median number of days between receipt of first specialist palliative care and death was shorter for people living in residential aged care compared with people using home care and residential respite care (8 days and 13 days, respectively).

The first palliative care-related hospitalisation was later (closer to death) for people living in residential aged care compared with people using home care and residential respite care (5 days and 8 days, respectively). However, the first Medicare-subsidised palliative care service was earlier for people living in residential care compared with people using home care and residential respite care (77 days and 51 days, respectively).

Cancer patients received first specialist palliative care service earlier than other disease trajectories

The median number of days between receipt of first specialist palliative care service and death varied by the end-of-life disease trajectories:

• 26 days for people who died from cancer
• 5 days for people who followed the organ failure trajectory
• 6 days for people who followed the frailty and dementia trajectory.

The earlier receipt of specialist palliative care among cancer patients, reflects cancer generally following a clearer disease trajectory (making it easier to predict prognosis) and that specialist palliative care was originally developed for cancer care and continues to be largely used for cancer patients.

Specialist palliative care incidence rate lower for residential aged care users

When measuring access to specialist palliative care, it is important to present both the prevalence of receipt of service and the median time to access – reflected by the incidence rate. This reveals how many individuals received specialist palliative care and how early they typically accessed services, offering more actionable and meaningful insights.

The incidence rate was 110 per 100,000 person-days for the 38% of the study population who received specialist palliative care in the last year of life (a median of 12 days to death).

People living in residential aged care had a lower incidence rate than people using home care and residential respite care (60 per 100,000 person days and 145 per 100,000 person days, respectively) reflecting later access to palliative care.