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.

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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.).

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

Figure 1.1: The interactive data visualisation shows the age distribution of palliative care-related hospitalisations, by hospitalisation type. For the 2019-20 financial year, the number of hospitalisations generally increased with age, with the highest number and rate for  those aged 85 years or older.

 

Figure 1.2: The interactive data visualisation shows the remoteness distribution of palliative care-related hospitalisations, by hospitalisation type.  For the 2019-20 financial year, the highest number of palliative-care related hospitalisations were in Major Cities, while the highest rate of hospitalisations per 10,000 population was in Inner Regional areas

 

Figure 1.3: The interactive data visualisation shows differences by socioeconomic areas (using the SEIFA quintile distribution) of palliative care-related hospitalisations, by hospital type and sector. For the 2019-20 financial year, the number of palliative-care related hospitalisations in public hospitals increased by increasing disadvantage (highest in quintile 1 and lowest in quintile 5), while the reverse was observed in private hospitals (lowest in quintile 1 and highest in quintile 5).

 

Figure 1.4: The interactive data visualisation shows the ten most common principal diagnoses of palliative care-related hospitalisations, by hospitalisation type and diagnosis type (cancer or diseases other than cancer) for the 2019-20 financial year. The most common cancer diagnosis for palliative care hospitalisations was cancer of an unknown site. The most common disease other than cancer was cerebrovascular disease.

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

Figure 2.1: The interactive data visualisation shows the average length stay of overnight palliative care-related hospitalisations, by hospital sector and hospitalisation type for the 2019-20 financial year. The average length of stay for palliative care hospitalisations has gradually trended downwards from 2016-17 to 2019-20.

Figure 2.2: The interactive data visualisation shows the proportion of hospitalisations by  mode of completing hospitalisations by hospitalisation type and for the 2019–20 financial year The most common reason for discharge for palliative care- related hospitalisations in both public and private hospitals was death, followed by to usual residence.

 

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

Figure 3: The interactive data visualisation shows the proportion of funding type by jurisdiction, hospitalisation type and sector for the 2019–20 financial year. Public patients contributed the largest proportion of funding across all hospitals and jurisdictions for palliative-related care hospitalisations.

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

Figure 4: The interactive data visualisation shows trends in the number of palliative care-related hospitalisations by hospitalisation type and sector between 2015–16 and 2019–20. It shows that the number of palliative-care related hospitalisations in public hospitals have been increasing over the 5-year period.

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).