Admitted patient palliative care and other end-of-life care and hospital-based facilities

This section presents information on episodes of admitted patient palliative care and other end-of-life care occurring in Australian hospitals, using data on palliative care-related hospitalisations from the National Hospital Morbidity Database (NHMD). The NHMD is a collation of data about admitted patient care in Australian hospitals, based on the Admitted Patient Care National Minimum Data Set.

Information is presented on hospitalisations for which palliation was provided. A palliative care-related hospitalisation is defined as an episode of admitted patient care for which the principal clinical intent was palliation during all or part of that episode.

For the first time in this section, the analysis has been refined to separate palliative care-related hospitalisations into two groups: palliative care hospitalisations and other end-of-life care hospitalisations, with a greater emphasis on palliative care. The term palliative care as used in this section refers to specialist palliative care. The term other end-of-life care as used in this section refers to hospitalisations where a diagnosis of palliative care was recorded, but that care was not necessarily delivered by a palliative care specialist. Further information can be found in the data sources section and Identifying palliative care hospitalisations section.

Time series data for the period from 2013–14 to 2017–18 are presented to show the changes in hospitalisations for palliative care and other end-of-life care over this period. Wherever possible, corresponding data on all hospitalisations have been provided for comparative purposes.

This section also presents information on public acute and private hospital-based hospice care units.

Data downloads

Admitted patient palliative care and other end-of-life care and hospital-based facilities tables 2017–18 (114KB XLS)

Admitted patient palliative care and other end-of-life care and hospital-based facilities section 2017–18  (443KB PDF)

The information in this section was last updated in June 2020.

Key points

  • 79,932 palliative care-related hospitalisations were reported from public acute and private hospitals in Australia in 2017–18. 57% were for palliative care, and 43% were for other end-of-life care.
  • 52.5% of palliative care hospitalisations and 53.7% of other end-of-life care hospitalisations were for people aged 75 and over.
  • 16.9% increase in palliative care hospitalisations and 48.2% increase in other end-of-life care hospitalisations between 2013–14 and 2017–18, compared to a 16.0% increase in hospitalisations for all reasons over the same period.
  • 35.8% of all hospitalisations in which the patient died, the patient had received palliative care in 2017–18. 18.0% had received other end-of-life care.
  • 54.6% of palliative care and 33.8% of other end-of-life care hospitalisations involved cancer as the principal diagnosis in 2017–18.
  • 133 public acute hospitals reported that they had a hospice care unit in 2016–17, and about a third (31.6%) were located in New South Wales.
  • 1 in 5 (19.8%) of the 673 public acute hospitals (excluding public psychiatric hospitals) in Australia had a hospice care unit in 2016–17.

Admitted patient palliative care and other end-of-life care

In 2017–18, there were 45,561 palliative care and 34,371 other end-of-life care hospitalisations reported from public acute and private hospitals in Australia, totalling 79,932 palliative care-related hospitalisations. This accounted for about 1 in 140 (0.7%) of all hospitalisations (11.3 million). A higher proportion of hospitalisations for palliative care-related were for males (53.8%) than females (46.2%), and the rate was also higher for males than females (20.0 and 16.8 per 10,000 population, respectively). This pattern was similar for other end-of-life care.

People aged 75 and over accounted for over half (52.5%) of palliative care and 53.7% of other end-of-life care hospitalisations in 2017–18. The average patient age was 73.5 for palliative care and 73.8 for other end-of-life care, with little difference between the sexes. This was considerably older than the average age of 55.9 years for hospitalisations for all reasons. Only about 1 in 10 (10.1%) of the total number of palliative care hospitalisations was for patients aged under 55. Findings were similar for other end-of-life care.

Between 2013–14 and 2017–18 the number of palliative care hospitalisations increased by 16.9%, from about 39,000 to almost 45,600. Whilst the number of other end-of-life care hospitalisations increased by 48.2%, from about 23,200 to almost 34,400. The number of all hospitalisations increased by 16.0% over the same period.

The population rate for hospitalisations also trended upward between 2013–14 and 2017–18, from 16.7 to 18.4 per 10,000 population for palliative care and from 10.0 to 13.9 for other end-of-life care. Increases in the rate of admitted patient palliative care were evident across all age groups over this period, with some variability in the degree of increase.

Profile of palliative care and other end-of-life care hospitalisations

Where was palliative care and other end-of-life care provided?

In 2017–18, similar to previous years’ findings, a high proportion of palliative care and other end-of-life care hospitalisations were recorded from public hospitals (85.9% and 84.4%, respectively or about 39,117 and 29,011 hospitalisations, respectively). In contrast, 59.8% of all hospitalisations were recorded from public hospitals. For states and territories where private sector data were able to be published, the proportion of palliative care hospitalisations in public hospitals varied, from 54.0% in Western Australia to 97.5% in New South Wales. A similar pattern of variation by state was also present for other end-of-life care.

There was considerable variation by state in the rates of palliative care and other end-of-life care hospitalisations in both public and private hospitals. The Australian Capital Territory reported the highest population rate at 22.0 palliative care hospitalisations per 10,000 population for public hospitals, and Western Australia had the lowest (9.5) (Figure APC.1). In those states where private sector data were able to be published, Western Australia reported the highest rate (8.1 per 10,000 population) for palliative care hospitalisations in private hospitals, and New South Wales reported the lowest (0.5). For those states and territories where all hospitalisations were able to be published, Queensland had the highest rate of palliative care hospitalisations in all hospitals (23.1 per 10,000 population), and Victoria had the lowest overall rate for all hospitals (13.0).

Figure APC.1 -  Palliative care hospitalisations by state and territory, rate per 10,000 population, public and private hospitals 2017-18.

Vertical bar chart showing the rate per 10,000 population of palliative care hospitalisations by jurisdiction. Public hospitals, NSW 20.1, Vic 11.9, Qld 17.9, WA 9.5, SA 12.0, Tas 15.6, ACT 22.0, NT 17.5, Total 15.8. Private hospitals, NSW 0.5, Vic 1.2, Qld 5.1, WA 8.1, SA 1.7, Total 2.6. Refer to Table APC.9.

 Source: Admitted patient palliative care and hospital-based facilities tables (114XLS)

Change over time by sector

The number of admitted patient palliative care-related hospitalisations between 2013–14 and 2017–18 increased in both public and private hospitals. The number of public palliative care and other end-of-life care hospitalisations increased by 20.0% and 49.0%, respectively, with public hospitalisations for all reasons increasing by 17.7% over the same period.

Numbers of palliative care and other end-of-life care hospitalisations in private hospitals also increased, resulting in a net increase of 0.8% and 49.0%, respectively over the same period. The increase in all private hospital hospitalisations, was 13.7% over the same period.

For public hospitals, the rate of palliative care hospitalisations increased from 14.0 in 2013–14 to 15.8 per 10,000 in 2017–18. The rate of palliative care hospitalisations in private hospitals was steady over the same period from 2.7 to 2.6 per 10,000 population. For all hospitals, the rate of palliative hospitalisations increased slightly from 16.7 to 18.4 per 10,000 over the period.

Figure APC.2 Palliative care hospitalisations, rate per 10,000 population, public  and private hospitals, 2013-14 to 2017-18

Line graph with two lines showing the rate per 10,000 population of public and private palliative care hospitalisations from 2013–14 to 2017–18. The rate for public hospitals trended higher over time from 14.0 in 2013–14 to 15.8 in 2017–18. The rate for private hospitals remained steady from 2013–14 to 2017–18. Refer to table APC.9.

Source: Admitted patient palliative care and hospital-based facilities tables (114KB XLS)

Change over time by jurisdiction

For public hospitals, the largest average annual increases in palliative care hospitalisations between 2013–14 and 2017–18 were for the Australian Capital Territory (13.6%) and Western Australia (11.2%), and the largest increases for other end-of-life care were for South Australia (13.5%) and New South Wales (13.4%). The population rate of palliative hospitalisations increased across most states and territories between 2013–14 and 2017–18. The rate for other end-of-life care hospitalisations over the same period varied across states and territories.

Among the states and territories where data could be reported for private hospitals, the number of palliative and other end-of-life care hospitalisations varied over time and across jurisdictions over the period.

For those states and territories where data could be reported for all hospital sectors, there was an increase in the number of palliative care and other end-of-life care hospitalisations between 2013–14 and 2017–18 (2.4% and 8.7% average annual increase, respectively).

How long did patients stay?

Palliative care and other end-of-life care hospitalisations accounted for about 437,466 and 368,553 patient days, respectively with an average length of stay (ALOS) of 9.6 and 10.7 days, respectively. This is approximately 3.5 to 4 times as long as the ALOS of 2.7 days for all hospitalisations. When only those hospitalisations that involved an overnight stay are considered, the difference narrows to 10.0 and 11.1 days for palliative care and other end-of-life care hospitalisations, and 5.3 days for all hospitalisations.

The average length of stay for palliative care hospitalisations in 2017–18 was longer in private than public hospitals for all jurisdictions where private hospitals data can be reported, with the exception of Victoria. The greatest difference was in Queensland, with a 7.1 day longer ALOS in private compared to public hospitals (Figure APC.3) in 2017–18. Nationally, ALOS was higher in private (12.9 days) than public hospitals (9.5 days) for overnight palliative care hospitalisations. The ALOS in public hospitals for overnight hospitalisations was highest in Victoria (11.3 days), and lowest in Queensland (7.8 days). For private hospitals, South Australia recorded the highest overnight ALOS, at 16.4 days.

Figure APC.3: Palliative care hospitalisations, average length of stay, public and private hospitals, states and territories, 2017-18

Vertical bar chart showing the average length of stay for palliative care hospitalisations by jurisdiction for public and private hospitals. Average length of stay in public hospitals ranged from 7.3 days in Qld to 11.0 days in Vic. In private hospitals, average length of stay ranged from 10.7 days in WA to 15.5 days in SA. Refer to Table APC.11.

Visualisation not available for printing

Source: Admitted patient palliative care and hospital-based facilities tables (114KB XLS)

Change over time in length of stay

The number of patient days for palliative care hospitalisations in admitted patient settings increased by 5.3% between 2013–14 and 2017–18, to a total of 437,466 patient days. The ALOS for palliative care hospitalisations trended downwards over the same period (Figure APC.5). Patient days for other end-of-life care increased by 41.5% over the same period, from 260,376 to 368,553 days, and ALOS for other end-of-life care was fairly stable.

Figure APC.3: Palliative care hospitalisations, paitent days and ALOS, public and private hospitals 2013-14 to 2017-18

 A combined bar and line graph showing patient days (bars) and average length of stay (line) for palliative care hospitalisations from 2013–14 to 2017–18. Patient days showed an increasing trend over time from 415,368 in 2013–14 to 437,466 in 2017–18. Average length of stay showed a decreasing trend from 10.7 days in 2013–14 to 9.6 in 2017–18. Refer to table APC.1.

Visualisation not available for printing

Source: Admitted patient palliative care and hospital-based facilities tables (114KB XLS)

Who paid for the care?

In 2017–18, public patient funding accounted for 76.0% of palliative care hospitalisations in public hospitals; private health insurance was the next most common funding source (20.0%). Results for other end-of-life care hospitalisations were similar. By comparison, public patient funding for all hospitalisations in public hospitals was 83.4% and private health insurance 13.5%.

In private hospitals, private health insurance was the funding source for 57.8% of palliative care hospitalisations, compared with 83.2% of all hospitalisations. Public patient funding was more likely for palliative care hospitalisations in private hospitals (28.3%) than all hospitalisations (4.3%).

The funding pattern for public and private hospitals combined differed across jurisdictions. There were also substantial differences by state for other end-of-life care.

How was the care completed?

The ‘mode of completing a hospitalisation’ indicates the status of a patient at the end of the hospitalisation; for example, whether the person died, or their destination on discharge from hospital.

Six in ten palliative care hospitalisations ended with the patient’s death (61.9%), compared with 4 in 10 (41.2%) for other end-of-life care and less than 1 in a hundred (0.7%) for all hospitalisations. The next most common reason for completing hospitalisation for palliative care was discharge to usual residence (25.7%), followed by transfer to another hospital (5.9%). The pattern for other end-of-life care was slightly different with 31.6% of hospitalisations ending in discharge to usual residence, and 10.5% in transfer to another hospital.

Patterns of completed palliative care hospitalisations were similar across both public and private hospitals. However, jurisdictional differences were evident within and across sectors. The proportion of palliative care hospitalisations in public hospitals ending with the patient’s death was lowest in Western Australia (55.1%) and highest in Tasmania (72.4%). For private hospitals, the national average for the sector was 56.1%. Palliative care patients from private hospitals were more likely to be transferred to another hospital in Victoria compared with other jurisdictions reported. Jurisdictional variation was also seen for other end-of-life care.

Characteristics of admitted palliative care and other end-of-life care patients

This section presents information on the number and proportion of palliative care and other end-of-life care hospitalisations for various demographic groups.

Socioeconomic status

Socioeconomic status generally refers to the level of economic and social resources of an individual (such as income, education and employment) and it is well established that it is associated with health outcomes (AIHW 2016). The Index of Relative Socio Economic Disadvantage (IRSD) is used here to indicate socioeconomic status of the area in which the individual lives.

In 2017–18, people living in areas classified as having the lowest socioeconomic status (Quintiles 1 and 2) accounted for a higher proportion of palliative care hospitalisations (25.0% and 24.8%, respectively) in public hospitals than those living in other areas. The rate of palliative care public hospitalisations was also highest for those living in these areas (19.8 and 19.6 per 10,000 population, respectively). Conversely, the rate of public palliative care hospitalisations was lowest for those living in the highest socioeconomic status areas (11.0 per 10,000). These patterns are similar to those for other end-of-life-care and for all hospitalisations.

A contrasting pattern is apparent for palliative care hospitalisations in private hospitals, where the rate was highest for those living in the highest socioeconomic status areas (3.9 per 10,000 population). This pattern was also seen for other end-of-life care for this socioeconomic group (3.1 per 10,000 population) and for all private hospitalisations (2,599.7 per 10,000 population). In addition to accessing private hospitals for palliative care, higher socioeconomic status individuals may also be accessing other types of non-admitted patient palliative care e.g. from private, freestanding hospice care facilities or community based palliative care services.

Indigenous status

Aboriginal and Torres Strait Islander people are disadvantaged relative to other Australians across a range of health-related and socioeconomic indicators (AIHW 2015a). This may affect their use of, and access to, admitted patient palliative care and other end-of-life care.

A total of 1,113 palliative care and 682 other end-of-life care hospitalisations for Indigenous Australians were reported in 2017–18, with the majority occurring in public hospitals (93.6% and 99.3%, respectively). This compares to 89.4% of all hospitalisations among Indigenous Australians that occurred in public hospitals.

Remoteness of patient’s usual residence

Most palliative care hospitalisations in 2017–18 across both public and private hospital sectors were for patients whose usual residence was in Major cities (63.0%), with the proportion of palliative care hospitalisations decreasing as remoteness increased. The rate of public hospital hospitalisations for palliative care was lowest in Major cities and Remote and Very remote areas (of 13.6 and 13.7 per 10,000 population, respectively). The rate was highest for Inner regional (21.5 per 10,000) and Outer regional areas (23.7 per 10,000). In contrast, the rate of public hospital hospitalisations for other end-of-life care was similar across all remoteness areas.

Diagnosis

The principal diagnosis recorded for a hospitalisation is ‘the diagnosis established after study to be chiefly responsible for occasioning an episode of admitted patient care’ (AIHW 2015b; ACCD 2015). Additional diagnoses are those ‘conditions or complaints either coexisting with the principal diagnosis or arising during the episode of admitted patient care’. One or more additional diagnoses can be assigned to the care episode (AIHW 2018; ACCD 2015).

About half of all palliative care (54.6%) and one third of other end-of-life care (33.8%) hospitalisations recorded a principal diagnosis of cancer in 2017–18. Of these, a principal diagnosis of secondary site cancer (that is, a malignant tumour originating from a cancer elsewhere in the body) was assigned to about 1 in 5 (21.7%) for palliative care, and 1 in 3 (32.2%) for other end-of-life care. The next most common principal diagnosis of cancer was lung cancer, for both palliative care and other end-of-life care (16.3% and 13.7%, respectively).

For palliative care hospitalisations, the most frequently reported principal diagnoses other than cancer were cerebrovascular disease and heart failure and complications (4.1% and 3.1%, respectively). For other end-of-life care, the most frequently reported principal diagnoses other than cancer were influenza and pneumonia and septicaemia (4.9% and 4.8%, respectively).

Palliative care and other end-of-life care deaths in hospital

This section presents data on a subset of palliative care and other end-of-life care hospitalisations—those that ended with the patient’s death. Some admitted patients who died in hospital but were not identified as being ‘palliative care patients’ or ‘other end-of-life care patients’ may also have received some palliation during the hospitalisation that ended with their death. However, as elsewhere in this section, the focus is on those hospitalisations for which palliation was a substantial component of the care provided.

Place of death

In 2017–18, about 161,600 people died in Australia (ABS 2019). According to data from the NHMD, 78,800 (48.8%) of these people died as an admitted patient in hospital.

Most states and territories operate hospital-in-the-home (HITH) programs, under which patients are provided with hospital-type care, are categorised as an admitted patient, but receive this care in their home as a substitute for hospital accommodation (AIHW 2012). Admitted patients receiving HITH may have their final hospitalisation in their home; although it is also possible for HITH patients to return to hospital during their final hospitalisation.

Palliative care and other end-of-life care patients and death

In 2013–14, 32.1% of admitted patients had been a palliative care patient during the hospitalisation that ended with their death, and 11.9% had received other end-of-life care. This proportion has steadily increased such that by 2017–18, 35.8% of people who died as an admitted patient had been a palliative care patient during their final hospitalisation, and 18.0% had received other end-of-life care. Although it is difficult to be definitive about the reasons for this increase over time, the growth and ageing of Australia’s population, and the corresponding increase in the prevalence of chronic, progressive and generally incurable illnesses has broadened the type of patient groups requiring palliative care (AIHW 2014; Murtagh et al. 2013).