Palliative care for people living in residential aged care

In 2020–21, people in permanent residential aged care (PRAC) with an Aged Care Funding Instrument (ACFI) appraisal indicating need for palliative care accounted for 1.9% (4,500) of all residents (243,500), 3.5% (2,400) of all new admissions (67,100), and 6.1% (4,100) of all exits (67,220) from permanent residential aged care. This section provides information on the characteristics of admissions and people using permanent residential aged care, including those appraised as requiring palliative care and other care based on the ACFI.

Note that national reporting on the need for and receipt of palliative care in residential aged care is an underestimate, as available data only reflects those appraised as requiring end of life palliative care and for whom a claim was submitted. Information on actual service provision and that palliative care maybe required for a longer period (not just end of life care) is a considerable gap in the national data. See below and the data sources section for further information on the residential aged care data presented in this report.

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

 

Key points

In 2020–21, people in permanent residential aged care (PRAC) with an ACFI appraisal indicating need for palliative care:

  • Accounted for 1.9% (4,500) of all people in PRAC, 3.5% (2,400) of all new admissions, and 6.1% (4,100) of all exits from PRAC.

  • Almost 3 in 5 (59%) were aged 85 years and over.

  • Almost 1 in 4 (22%) had cancer listed as the first condition on their appraisal, compared with 3.5% for those appraised as requiring other care.

  • 1 in 2 (50%) exited PRAC within 8 weeks of admission, compared with 8.5% for those appraised as requiring other care

  • Overall, remained relatively stable in the 5 years to 2020–21.

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Who was appraised as requiring palliative care?

In 2020–21, there were 4,500 people and 2,400 new admissions appraised as requiring palliative care in PRAC (1.9% of all people and 3.5% of all new admissions).

In 2020–21, among people using PRAC with an ACFI appraisal indicating need for palliative care:

  • Slightly more were women than men –2,400 compared with 2,100. However, as a proportion of all people in PRAC, males were almost twice as likely to be appraised as requiring palliative care as females (2.5% and 1.5%, respectively; see Figure AC.1.).
  • Almost 3 in 5 (59%) were aged 85 years and over, similar to the proportion for those not appraised as requiring palliative care (61%) (Figure AC.1.).
  • Most were living in Major cities (60%) and Inner Regional areas (30%), consistent with the pattern for those not appraised as requiring palliative care (70% and 22%, respectively; Figure AC.1.).
    • As a proportion of the population living in these regional areas, those living in Inner Regional areas had the highest rate with ACFI appraisal indicating need for palliative care (30 per 100,000 population) – 1.6 and 2 times as high as for those living in Outer Regional areas and Major Cities (19 and 15 per 100,000 population, respectively).
    • Those living in Inner Regional areas also had the highest rate for those not appraised as requiring palliative care – 1.3 times as high as for Major cities and Outer Regional areas (1,147 per 100,000 compared with 883 and 900, respectively; Figure AC.1.
  • Rates varied across the states – Tasmania had the highest population rate (34 per 100,000 population) and Northern Territory the lowest (4.5 per 100.000). For those not appraised as requiring palliative care, South Australia had the highest rate and the Northern Territory the lowest.
     

Figure AC.1: Characteristics of people using permanent residential aged care, 2020–21

Figure AC 1.1: This interactive data visualisation shows the number and proportion of people using permanent residential aged care assessed as requiring palliative care, by sex, for 2020–21 financial year. The number of females appraised as requiring palliative care is higher than males, while the proportion of males is higher than females.[MS1] 

 

Figure AC 1.2: This interactive data visualisation shows the number and proportion of people using permanent residential aged care by care type and age, for the 2020–21 financial year. The number of people appraised as requiring palliative care increases with age, with a steep increase between 80–84 and 85 and over. More than half of people using permanent residential aged care for both palliative and other care are aged 85 years and over.

 

Figure AC 1.3: This interactive data visualisation shows the number and rate of people using permanent residential aged care by care type and remoteness, for the 2020–21 financial year. Major cities have the highest number of people using permanent residential aged care while Inner regional have the highest rate (per 100,000 population) of people using permanent residential aged care for those appraised as requiring palliative and other care.

 

Figure AC 1.4: This interactive data visualisation shows the number and rate of people using permanent residential aged care by care type and state and territory, for the 2020–21 financial year. New South Wales had the highest number of people using permanent residential aged care for all care types while Tasmania has the highest rate (per 100,000 population) for those appraised as requiring palliative care and South Australia the highest rate for Other Care type.

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How long did people stay and how was care completed?

In 2020–21, among people using PRAC with an ACFI appraisal indicating need for palliative care:

  • 1 in 2 exited PRAC within 8 weeks of admission – 32% within 4 weeks, 50% within 8 weeks, 69% within one year, and 21% after 2 years. For those appraised as requiring other care, 2 in 3 exited after 1 year – 32% within 1–3 years and 34% after 3 years, while less than 9% exited within 8 weeks (Figure AC.2.).

The shorter stays for people appraised as requiring palliative care are consistent with purpose of the funding for palliative care under the ACFI that is provided specifically for ‘end of life’ care (see above for further details).

In 2020–21:

  • Death was the most common reason for exit from PRAC – 95% and 82% of exits for people using PRAC with a palliative care and other care appraisal, respectively. Further, return to the community and to other residential care was far more common among those appraised as requiring other care (4.4% and 9.3% of exits, respectively) than for those appraised for palliative care (0.8% and 2.2%, respectively; see Figure AC.2.).
  • Over 1 in 4 people in PRAC required hospital leave from PRAC – 31% and 28%, respectively for those appraised as requiring palliative care and other care (see Table AC.12.)

Figure AC.2. Exits from permanent residential aged care, by length of stay, 2020–21

Figure AC 2.1: Bar graph showing proportion of exits from permanent residential aged care, by length of stay and care type, for the 2020–21 financial year. Exits within 8 weeks is highest among those who have been appraised as requiring palliative care, while people who were admitted for other reasons have the highest proportion of exits after 2+ years.

Figure AC 2.2: Bar graph showing the proportion of people leaving permanent residential aged care, by reason for leaving and care type, for the 2020–21 financial year. For both care types, death was the most common reason for people leaving permanent residential aged care.

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Have there been changes over time, including during the COVID-19 pandemic?

In the 5 years to 2020–21, the number of people using PRAC appraised as requiring palliative care and other care has remained relatively stable, with slight fluctuations over this period (see Figure AC.3.). However, the number of new admissions each year has been falling slightly between 2017–18 and 2020–21 (from 2,700 to 2,400 for palliative care appraisals and from 69,200 to 64,800 for other appraisals).

These declines in palliative care admissions are unlikely to be due to a fall in the need for palliative care, but rather may reflect the application of the ACFI in recent years (see above and Inquiry Report, Section 3; Productivity Commission, 2017 for further details). Further, in 2020, ACFI reviews were undertaken from the Department of Health's offices since 2020 to minimise COVID­­­­­-19 transmission risks (DoH 2020).

Residential aged care and COVID-19

The COVID-19 pandemic, commencing in Australia from March 2020, has had a significant impact on the aged-care sector and those receiving aged care. People living in PRAC are at an increased risk of COVID-19 due to a high proportion who are aged 70 and over (94% of people using PRAC), and/or who are immunocompromised due to conditions such as cancer and other chronic diseases (DoH 2021a).

By looking at monthly PRAC data it may provide insights on the impact of the COVID-19 pandemic on palliative care in the PRAC setting. These data highlight that there was a large drop in the number of new admissions for PRAC between March and May 2020 – 28% and 24% decline for people appraised as requiring palliative and other care, respectively – reaching its lowest level in May 2020 over the 3 year period (July 2018 to June 2021). Another dip was also observed in October 2020 and January 2021 for palliative care admissions and in August 2020 and January 2021 for other care.

These declines may in part be due to the stricter public health restrictions during these months, however fluctuations in admissions may reflect a number of factors that may or may not be related to the COVID-19 pandemic. By February 2021, number of admissions had largely recovered to similar levels observed prior to the COVID-19 pandemic in March 2020.

In terms of exits from PRAC and reasons for exit no clear patterns were observed during 2020 and 2021, with various fluctuations observed between March 2020 and June 2021. 

Figure AC.3: Admissions and people using permanent residential aged care appraised as requiring palliative and other care, 2016–17 to 2020–21

Figure AC 3.1: This interactive data visualisation shows admissions and people using permanent residential aged care appraised as requiring palliative and other care for each year between 2016-17 to 2020-21. The number of people appraised as requiring palliative care has remained relatively stable, except for a dip in 2018–19, while the number of admissions are gradually declined over this period. 

Figure AC 3.2: This interactive data visualisation shows admissions and exits for people using permanent residential aged care for each month between July 2018 to June 2021. The number of admissions for people appraised as requiring palliative care dropped between March and May 2020 and also in October 2020 and January 2021.

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