Specialist palliative care use for older people receiving aged care

As Australia’s population ages, there is an increasing need to ensure that aged care and palliative care services are accessible, effective, and responsive to the complex needs of older people. Palliative care plays a critical role in improving the quality of life of patients and their families facing a life-limiting illness, as well as reducing the physical and emotional stress of dying (WHO 2020). Despite its importance, there are gaps in our understanding of how, when, and where older people receive palliative care.

Palliative care is delivered in diverse settings – including hospitals, residential aged care, and community-based services – making it difficult to track service use and outcomes consistently. Most existing data collections focus on specific settings where specialist palliative care is delivered (as these are readily identified), leaving gaps in our understanding of other health services provided to people with life-limiting conditions.

Palliative care and health service use for people with life-limiting conditions (AIHW 2024) used linked data to explore services received in the last year of life for people aged 40 and over with life-limiting conditions. It compared people who received specialist palliative care with those who did not, and described differences by age, cause of death and geography. However, the report did not specifically examine the palliative care experience of older people using aged care.

The number of aged care recipients needing and receiving palliative care is a key data gap. In 2021–22, 2.0% (4,800) of people living in residential aged care were appraised as needing palliative care (AIHW 2023). This is based on care needs assessments for people living in residential aged care, rather than whether they received the services. There is no equivalent data source assessing palliative care needs for older people using home care or residential respite care, or whether they received palliative care services.

This report addresses the gap in information about palliative care use by aged care recipients. It uses linked data – aged care, public hospitals, Medicare-subsidised services and mortality – from the National Health Data Hub (NHDH) to examine variations in receipt of specialist palliative care for older people accessing aged care during the last year of life. It compares older people living in residential aged care with older people living in the community and using home care or residential respite care. It also examines end-of-life disease trajectories, given the importance of understanding how different patterns of decline or illness progression influence the timing, type and intensity of palliative care.

This report does not capture all palliative care activity in Australia, due to data limitations. It excludes palliative care provided in residential aged care such as non-specialist palliative care provided by care workers or nurses because these services are not identified in national administrative data collections. It also excludes private hospitals, some community-based palliative care services, and Western Australia and the Northern Territory due to the completeness and quality of these data in the NHDH. For further details see Appendix A for further details.