Palliative care services in Australia

Web report

Last updated: 28 Oct 2022

Media release

AIHW

Australian Institute of Health and Welfare (2022) Palliative care services in Australia, AIHW, Australian Government, accessed 25 March 2023.

APA

Australian Institute of Health and Welfare. (2022). Palliative care services in Australia. Retrieved from https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia

MLA

Palliative care services in Australia. Australian Institute of Health and Welfare, 28 October 2022, https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia

Vancouver

Australian Institute of Health and Welfare. Palliative care services in Australia [Internet]. Canberra: Australian Institute of Health and Welfare, 2022 [cited 2023 Mar. 25]. Available from: https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia

Harvard

Australian Institute of Health and Welfare (AIHW) 2022, Palliative care services in Australia, viewed 25 March 2023, https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia

Latest edition

Hospitals – Admitted patient care and specialised facilities for palliative care

In 2019–20, there were 86,900 hospitalisations where palliative care was provided during all or part of the episode of care in Australia. This section provides information related to these hospitalisations and the characteristics of people admitted for palliative care over the period 2015–16 to 2019–20. It also presents establishment-level information on specialist palliative care inpatient units. Further information can be found in the data sources section and the identifying palliative care hospitalisations section.

The information in this section was last updated in May 2022.

Identifying palliative care in hospital data

People with life-limiting illness may require care in a hospital setting, such as a hospital ward (specialist palliative care ward or other areas of the hospital), an emergency department or an outpatient clinic.

Palliative care-related hospitalisations refer to those episodes of admitted patient care where palliative care was a component of the care provided during all or part of the episode. These hospitalisations can be divided into 2 groups depending on the primary clinical purpose:

Palliative care hospitalisation: the primary clinical purpose of care is palliative care and care is provided in a palliative care unit or by a palliative care specialist (hospitalisations with a care type of palliative care).

Other end-of-life care hospitalisation: a diagnosis of palliative care is recorded, but the primary clinical purpose of care is not recorded as palliative care (i.e. care type not recorded as palliative care).

For more information see the Technical Information: Identifying palliative care hospitalisations.

Key points

In 2019–20, among palliative care-related hospitalisations:

49,200 were for palliative care and 37,700 for other end-of-life care (or 86,900 palliative-care related hospitalisations), equating to 19.3 and 14.8 per 10,000 population, respectively.
There was an 18% increase in hospitalisations since 2015–16 – this increase was steeper than that for all hospitalisations over the same period (5.8% increase).
Those aged 75 and over accounted for 1 in 2 (55%) hospitalisations.
1 in 2 (52%) palliative care hospitalisations and 1 in 3 (32%) other end-of-life care hospitalisations had a principal diagnosis of cancer.
Average length of stay was almost twice as long as for all overnight hospitalisations (9.6 days for palliative care and 11.1 days for other end-of-life care compared with 5.5 days for all hospitalisations).
The most common reason for discharge from hospital was death – 63% of palliative care hospitalisations and 40% of other end-of-life care hospitalisations.
110 or 1 in 6 (16%) public acute hospitals (excluding public psychiatric hospitals) in Australia had a specialised palliative care inpatient unit.

Data downloads

PDF version of this section

Latest data tables

Who was hospitalised for palliative and other end-of-life care?

In 2019–20, there were 11.1 million hospitalisations across Australia, including 86,900 hospitalisations where palliative care was provided during all or part of the episode of care (referred to as palliative care-related hospitalisations, see above for further details). The majority of these hospitalisations (57% or 49,200) had care provided in a palliative care unit or by a palliative care specialist (referred to as palliative care hospitalisation), while 37,700 had a diagnosis of palliative care but the type of care delivered was not recorded as palliative care (referred to as other end-of-life care hospitalisation). This equates to 19.3 palliative care hospitalisations per 10,000 population and 14.8 other end-of-life care hospitalisations per 10,000 population (Table APC.1).

Most of the palliative care-related hospitalisations were recorded in public hospitals (84%), a higher proportion than that recorded for all hospitalisations (60%).

In 2019–20, among palliative care-related hospitalisations:

More were for males than females – 54% compared with 46%, respectively; a different pattern to that for hospitalisations for all reasons where a higher proportion of females were hospitalised (52% compared with 48% for males; see Table APC.2).
Over half (55%) were aged 75 and over – the average age at admission for palliative care-related hospitalisations was 74 years for men and 75 years for women, which was considerably older than that for hospitalisations for all reasons (58 years for men and 54 for women). Around 1 in 10 palliative care-related hospitalisations were for those aged under 55 (Figure APC.1).
For Aboriginal and Torres Strait Islander people there were 1,300 palliative care and 900 other end-of-life care hospitalisations, with the majority occurring in public hospitals (95%) – a higher proportion than that observed for all hospitalisations (88% in public hospitals; see Table APC.5).
Those living in the lowest socioeconomic area had hospitalisation rates in public hospitals twice as high as those in the highest socioeconomic area – 20 compared with 11 per 10,000 for palliative care hospitalisations, and 15 compared with 8.7 per 10,000 for other end-of-life care hospitalisations. Conversely, the rate of palliative care-related hospitalisations in private hospitals was around 3 times as high for those living in the highest compared with the lowest socioeconomic area.
- These same patterns were also observed for hospitalisations for all reasons, although for private hospitals the differences were not as marked, with rates twice as high in the highest compared with the lowest socioeconomic area (Figure APC.1).
Those living in Inner and Outer regional areas had the highest rate of palliative care hospitalisations in public hospitals – 23 per 10,000 each in Inner and Outer Regional areas compared with 14 and 15 in Major Cities and Remote and very remote areas (combined). For other end-of-life care, the rate of public hospitalisations was more similar across remoteness areas, ranging from 12 to 15 per 10,000.
- However, a different pattern was observed for private hospitals where palliative care-related hospitalisations decreased with increasing remoteness. While this pattern was also observed for all hospitalisations in private hospitals, for public hospitals the highest rates were observed in Remote and very remote areas combined (Figure APC.1 and Table APC.6.).

Cancer was the most common principal diagnosis for palliative care-related hospitalisations Expand

How long did patients stay and how was care completed?

In 2019-20, among palliative care-related hospitalisations:

Average length of stay was twice as long as all overnight hospitalisations – 9.6 days for overnight palliative care hospitalisations, 11.1 days for overnight other end-of-life care hospitalisations, and 5.5 days for overnight hospitalisations for all reasons (Figure APC.2).
Patients spent on average longer in private hospitals than public hospitals – 9.1 days in public hospitals compared to 12.4 days in private hospitals for overnight palliative care hospitalisations and 10.6 days compared with 13.6 days, respectively, for overnight other end of life care hospitalisations. In contrast, the average length of stay for overnight hospitalisations for all reasons was similar in public and private hospitals (5.5 and 5.4 days; Figure APC.2).
For public palliative care hospitalisations, the average length of stay declined by 10% over the 5 years to 2019–20, from 10.1 to 9.1 days for overnight stays. Yet the average length of stay remained relatively stable for other end-of-life care and all hospitalisations.

The most common reason for discharge from hospital was death – 63% of palliative care hospitalisations ended in death (64% in public hospitals and 57% in private hospitals). For other end-of-life care hospitalisations, 40% of hospitalisations ended with a patient’s death (38% in public hospitals and 49% in private hospitals). The next most common reason for discharge was to usual residence – 24% for palliative care hospitalisations and 32% for other end-of-life hospitalisations (Table APC.13).

Figure APC.2: Palliative care-related average length of stay, reason for discharge, by sector and states and territories, 2015–16 to 2019–20

Most people who died in hospital had received palliative or other end-of-life care during their final hospitalisation Expand

Palliative care-related hospitalisations varied across the states and territories Expand

Who paid for the care?

In 2019–20:

In public hospitals, public patient funding accounted for a lower proportion of palliative care hospitalisations than for all hospitalisations – 77% for palliative care, 79% for other end-of-life care and 85% for all hospitalisations. In contrast, private health insurance accounted for a higher proportion of funding for palliative care-related hospitalisations – 19% for palliative care and 17% for other end-of-life care, compared with 12% for all hospitalisations (Figure APC.3.).
In private hospitals, private health insurance was the funding source for 59% of palliative care hospitalisations, lower than that for other end-of-life care (85%) and all hospitalisations (82%).

Figure APC.3: Proportion of principle funding source for palliative care-related hospitalisations, by state and territory, and sector, 2019–20

How have hospitalisations changed over time, including during the COVID-19 pandemic?

Between 2015–16 and 2019–20, palliative care-related hospitalisations have increased more rapidly than hospitalisations for all reasons – 18% increase (from 73,600 to 86,900) compared with 5.8% increase (from 10.5 to 11.1 million), respectively. Similarly, the national population rate increased from 17.5 to 19.3 per 10,000 for palliative care hospitalisations, and 13.2 to 14.8 for other end-of-life hospitalisations over this period. However, the national population rate for all hospitalisations decreased from 4,389 to 4,364 per 10,000 over the same period (Figure APC.4).

The number of palliative care-related hospitalisations increased in both public and private hospitals across most states and territories in the 5 years to 2019–20, except for Victoria and the Australian Capital Territory which saw a slight decrease in hospitalisations in public hospitals over this period.

The largest increase in palliative care-related hospitalisations between 2015–16 and 2019–20 was for those aged under 20 – 45% increase in hospitalisations over this period (from 800 to 1,200 hospitalisations), compared with 24% increase in those aged 70 years and over (from 47,400 to 58,800; see Table APC.3).

Impacts of the COVID-19 pandemic

Between 2018–19 and 2019–20, the number of palliative care-related hospitalisations increased by 4.2%. While this increase was smaller than that observed in the 12 months to 2018–19 (5.1% increase), it was comparable to increases observed in the 12 months to 2016–17 (4.5% increase) and steeper than increases in the 12 months to 2017–18 (3.3% increase). In contrast, the number of hospitalisations for all reasons declined by 2.8% in the 12 months to 2019–20 and reversed the increasing trend observed over the preceding 4 years (Figure APC.4).

These findings suggest that the public health response and health outcomes associated with the COVID-19 pandemic to June 2020 had a limited impact on palliative-care related hospitalisations but may have contributed to the large fall in hospitalisations for all reasons. Given that the data included in this section captures only the first 3 months of the COVID-19 pandemic outbreak in Australia, more data over a longer time period is required to assess the effects of the COVID-19 pandemic on palliative-care related hospitalisations.

Figure APC.4: Trends in hospitalisations by hospitalisation type and sector, 2015–16 to 2019–20

How many hospitals have specialised palliative care units?

In 2019–20, a total of 110 public acute hospitals reported having a specialist palliative care inpatient unit nationally (see Table APC.15 and Data Sources for further details on this data collection). This represents 1 in 6 (16%) of the 669 public acute hospitals (excluding public psychiatric hospitals) in Australia.

New South Wales and Western Australia had the highest number of public acute hospitals with specialist palliative care inpatient units (32 and 31, respectively), and Western Australia had the highest proportion of public acute hospitals with specialist palliative care units (36%).

Around 1 in 4 (26%) public acute hospitals in Major cities had a specialist palliative care inpatient unit, around twice the rate than in other areas (14% in Inner and Outer Regional areas and 12% in Remote areas).

References Expand

Data sources Expand

National Hospital Morbidity Database (NHMD)

Data on admitted patient palliative care are sourced from the NHMD. These data pertain to admitted patients in public and private hospitals in Australia. Some of these hospitals have hospices affiliated with them.

The NHMD includes administrative data, demographic information on patients, and clinical information including diagnoses and procedures performed. This annual collection is compiled and maintained by the AIHW, using data supplied by state and territory health authorities. Information from almost all hospitals in Australia is included in the database: from public acute and public psychiatric hospitals, private acute and psychiatric hospitals, and from private free-standing day hospital facilities (Appendix A, AIHW 2020). The latest available data at the date of publication of this report was 2019–20.

Episode-based data

The NHMD is episode based, with the term ‘hospitalisation’ used to refer to an episode of admitted patient care; individual patients may have multiple hospitalisations ending in discharge, transfer or statistical discharge with a change in care type and ultimately death. Each record in the NHMD is based on a single episode of treatment for an admitted patient, with such episodes classified in the ‘Care type’ data item as Acute care, Palliative care, Rehabilitation care, Newborn and other types of care. When a patient receives only one type of care during a hospital stay (such as only Acute care or only Palliative care), the length of stay for that hospitalisation is equal to the total length of time the patient spent in hospital during that stay.

However, where patients receive different types of care during one hospital stay (for example, a person may be admitted for active cancer treatment but then later reclassified as a palliative care patient), the patient may be statistically discharged from the hospital after the first type of care and then statistically readmitted into a second phase of care. Thus, a single patient may have two or more hospitalisations during any one hospital stay. Since each record within the NHMD is based on an episode of care, the hospitalisation count is a count of episodes, not persons. In cases of more than one care type, length of stay refers to the length of the episode of care, not the total duration of the patient’s hospital stay.

Coverage

For each of the years considered in this report, the coverage of the NHMD has been very good. For example, in 2018–19, coverage for the NHMD was high – data from all public hospitals were included. Most private hospitals also provided data, the exceptions being the private free-standing day hospital facilities and two overnight private hospitals in the Australian Capital Territory. Note that the data for private hospitals in Tasmania, the Australian Capital Territory and the Northern Territory were not published for confidentiality reasons. However, it should be noted that there are no confidentiality concerns about the Tasmanian private hospital data, and that Tasmania would support the release of their private hospital information.

Hospitals may be re-categorised as public or private between or within years (see AIHW 2020 for further information). This should be considered when comparing data by sector over time.

Data on state/territory of hospitalisation should be interpreted with caution because of cross-border flows of patients. This is particularly the case for the Australian Capital Territory. In 2018–19, 17% of hospitalisations in the Australian Capital Territory were for patients who lived in New South Wales.

The AIHW Indigenous identification in hospital separations data: quality report assessed the quality of Indigenous identification in Australian public hospitalisations. The results of this study indicated that data for all jurisdictions should be used in any analyses of Indigenous hospitalisation rates and that the ‘true’ number of Indigenous persons was close to 9% higher than the number indicated in hospital records (AIHW 2013). This should be considered when interpreting the hospital data by Indigenous status. Note, no adjustment has been applied to the Indigenous counts in the hospital data in this report.

Standard admitted patient care data exclusions

As per the standard AIHW practice when analysing admitted patient data in the NHMD, the data presented in this report exclude those records for which the ‘Care type’ data item was reported as newborn (unqualified days only), hospital boarder or organ procurement (posthumous).

Further information

Comprehensive hospital statistics from the NHMD are released by the AIHW on an annual basis in Admitted Patients and further information about the NHMD can be obtained from those publications. Metadata information for the Admitted Patient Care and Local Hospital Networks/Public Hospital Establishments national minimum data sets (NMDSs), that are the basis for the AIHW National Hospital Databases, are published in the AIHW’s online metadata registry – METEOR, and the National Health Data Dictionary.

From 1 July 2013, care types have been reported using revised definitions, with the aim to improve consistency in reporting for the subacute and non-acute care types. Therefore, changes in the care type definitions should be considered when interpreting changes over time.

A complete data quality statement for the NHMD database is available online.

National Public Hospital Establishments Database (NPHED)

The NPHED holds establishment-level data for each public hospital in Australia, including public acute hospitals, psychiatric hospitals, drug and alcohol hospitals, and dental hospitals in all states and territories. The collection covers hospitals within the jurisdiction of the state and territory health authorities only. Hence, public hospitals not administered by the state and territory health authorities (hospitals operated by the Australian Government Department of Health, Department of Defence or correctional authorities, for example, and hospitals located in offshore territories) are not included. The collection does not include data for private hospitals.

For 2019–20, the collection was based on the Local Hospital Networks/Public Hospital Establishments national minimum data set (LHN/PHE NMDS). Information is included on a hospital’s resources, expenditure, average available bed numbers, peer group, and the statistical local area and remoteness area of its location. For more information on the data collection method and other relevant data issues, refer to the 2019–20 NPHED data quality statement.

References

AIHW (Australian Institute of Health and Welfare) (2013) Indigenous identification in hospital separations data: quality report, Cat. no. IHW 90, Canberra: AIHW, accessed 28 March 2022.

AIHW (2020) Admitted patients, Canberra: AIHW, accessed 28 March 2022.

Key concepts Expand

Key concept	Description
Additional diagnosis	Conditions or complaints either coexisting with the principal diagnosis or arising during the episode of care. Additional diagnoses are recorded in accordance with ICD-10-AM Australian Coding Standards.
Admitted patients	Patients who undergo a hospital’s formal admission process to receive treatment and/or care.
Average length of stay	The length of stay for an overnight patient is calculated by subtracting the date the patient is admitted from the date of separation and deducting any days the patient was ‘on leave’. Average length of stay refers to the average number of patient days for admitted patient episodes. Patients admitted and separated on the same day are allocated a length of stay of 1 day.
Care type	Care type refers to the overall nature of a clinical service provided to an admitted patient during an episode of care. Examples of care types are Acute care, Rehabilitation care, Palliative care and Geriatric evaluation and management.
Funding source	The principal source of funds for an admitted patient episode (hospitalisation).
Specialist palliative care inpatient unit	A type of specialist unit delivering palliative care services and can include both free-standing hospices and/or palliative care wards within a hospital.
Hospitalisation	Hospitalisation (or separation) refers to the episode of admitted patient care, which can be a total hospital stay (from admission to discharge, transfer or death) or a portion of a hospital stay (beginning or ending in a change of type of care; for example, from Acute care to Rehabilitation ).
Index of Relative Socio-Economic Disadvantage (IRSD)	One of four Socio-Economic Indexes for Areas (SEIFA) developed by the ABS (ABS 2008). The IRSD represents the socioeconomic position of Australian communities by measuring aspects of disadvantage, such as low income, low educational attainment, high unemployment, and jobs in relatively unskilled occupations. Areas are then ranked according to their level of disadvantage. When the IRSD is used in this report, people living in the 20% of areas with the greatest overall level of disadvantage are described as living in the ‘lowest socioeconomic areas’. The 20% of people at the other end of the scale—those living in areas with the least overall level of disadvantage—are described as living in the ‘highest socioeconomic areas’. It is important to note that the IRSD reflects the overall or average socioeconomic position of the population of an area; it does not show how individuals living in the same area might differ from each other in their socioeconomic position. See Classifications for further information.
Other end-of-life care hospitalisations	Defined, for the purposes of this report, as hospitalisations where a diagnosis of palliative care is recorded, but the primary clinical purpose of care is not palliation (care type not defined as palliative care). Further information can be found in the Identifying palliative care hospitalisations section.
Palliative care hospitalisations	Defined, for the purposes of this report, as hospitalisations where the primary clinical purpose of care is palliative care and care is provided in a palliative care unit or by a palliative care specialist (hospitalisations with a care type of palliative care). Further information can be found in the Identifying palliative care hospitalisations section.
Palliative care-related hospitalisations	Defined, for the purposes of this report, as those hospitalisations (episodes of admitted patient care) where palliative care was a component of the care provided during all or part of the episode, as evidenced by a code of palliative care for the ‘Care type’ and/or principal or additional diagnosis. Palliative care-related hospitalisations are separated into two groups: palliative care and other end-of-life care. palliative care hospitalisation: primary clinical purpose of care is palliative care and care is provided in a palliative care unit or by a palliative care specialist. other end-of-life care hospitalisation: a diagnosis of palliative care is recorded, but the primary clinical purpose of care is not palliative care (care type not recorded as palliative care). Further information can be found in the Identifying palliative care hospitalisations section.
Patient day	The occupancy of a hospital bed (or chair in the case of some same day patients) by an admitted patient for all or part of a day.
Principal diagnosis	The diagnosis established after study to be chiefly responsible for occasioning the patient’s episode of admitted patient care.

Palliative care services in Australia

Citation

AIHW

APA

MLA

Vancouver

Harvard

Hospitals – Admitted patient care and specialised facilities for palliative care

Identifying palliative care in hospital data

Key points

Data downloads

Who was hospitalised for palliative and other end-of-life care?

Figure APC.1: Characteristics of those hospitalised for palliative-related care, 2015–16 to 2019–20

How long did patients stay and how was care completed?

Figure APC.2: Palliative care-related average length of stay, reason for discharge, by sector and states and territories, 2015–16 to 2019–20

Who paid for the care?

Figure APC.3: Proportion of principle funding source for palliative care-related hospitalisations, by state and territory, and sector, 2019–20

How have hospitalisations changed over time, including during the COVID-19 pandemic?

Impacts of the COVID-19 pandemic

Figure APC.4: Trends in hospitalisations by hospitalisation type and sector, 2015–16 to 2019–20

How many hospitals have specialised palliative care units?

National Hospital Morbidity Database (NHMD)

Episode-based data

Coverage

Further information

National Public Hospital Establishments Database (NPHED)

References

AIHW

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