Palliative care for older people can work alongside aged care and Support at Home to provide comfort, symptom support and guidance for families at end of life.
Palliative care is about getting the right care, in the right place, at the right time for a person with a life-limiting illness. This means an illness or condition that is expected to shorten a person’s life, such as advanced cancer, heart failure, lung disease, kidney disease, dementia, neurological conditions or increasing frailty.
Across Australia, public specialist palliative care services are government funded for people with a Medicare card.
For older people, this support can sit alongside aged care services, including Support at Home and care in a residential aged care home. Specialist palliative care services bring expertise that can help with symptoms, comfort, family conversations, planning and decisions about where and how care should be provided.
What is palliative care?
Palliative care is care and support for people living with a life-limiting illness. It focuses on comfort, dignity, symptom management, quality of life, planning and support for the person’s family and carers.
Palliative care can be helpful earlier than many people realise, especially when symptoms, care needs or decisions are becoming more complex. It can support a person at home, in hospital, in a palliative care unit, or in residential aged care.
What does palliative care cost?
Public palliative care services are usually funded by government and provided at no cost for people with a Medicare card.
Some associated costs may still apply, depending on individual needs. These can include medications, equipment, dressings, private services, private hospital care or aged care costs.
Advance care planning and family conversations
Palliative care can create the opportunity for important conversations about what matters most to the person. This may include where they would prefer to be cared for, who they want involved in decisions, what treatments they would or would not want, and what comfort, dignity and quality of life mean to them.
Advance care planning can help families, GPs, aged care providers and palliative care teams understand the person’s wishes before decisions become urgent. It can reduce uncertainty for families and help guide care if the person becomes too unwell to speak for themselves.
What can palliative care services provide?
Specialist palliative care teams may include doctors, nurses, nurse practitioners, occupational therapists, physiotherapists, pharmacists, social workers, counsellors, psychologists, pastoral care workers, cultural support workers, volunteers and bereavement support staff.
They may assist with pain and symptom management, breathlessness, nausea, fatigue, agitation, confusion or delirium, swallowing changes, wound care, anxiety and distress, medication review, comfort care planning, family meetings, carer support, grief and bereavement support, and cultural or spiritual care. They can also help identify and arrange appropriate equipment such as hospital beds, pressure-relieving mattresses, wheelchairs and other aids, and can help families understand what is needed and how to access it.
The GP’s role in palliative care
Specialist palliative care services provide expert clinical advice and support, while the GP usually remains the central point for ongoing medical care.
For people living at home, the GP may initiate referrals to palliative care, prescribe and review medications, manage symptoms, and support advance care planning in partnership with the person and their family. In residential aged care, the GP continues this central role, working closely with nursing staff, pharmacists, families and specialist palliative care teams.
Palliative care and Support at Home
For older people living at home, palliative care and aged care services can work together.
Support at Home assists with practical daily needs such as personal care, meals, transport, domestic assistance, nursing, allied health, respite and equipment, depending on assessed needs.
Palliative care adds specialist clinical and emotional support, helping manage symptoms, medications, comfort care planning and changing care needs. Together, these services can make home care safer, better coordinated and more responsive.
The Support at Home End-of-Life Pathway
The Support at Home program includes an End-of-Life Pathway for eligible older people who wish to remain at home during the final months of life.
This pathway is for people who have been assessed as being in the last three months of life. It provides additional short-term funding for in-home aged care services and is designed to work alongside local palliative care services.
Through the End-of-Life Pathway, eligible individuals can access approximately $25,000 over a 12-week period, with flexibility to extend up to 16 weeks if funds remain available. This funding replaces other My Aged Care funding during the pathway period.
Services may include nursing care, personal care, allied health, medication support, transport, respite and domestic assistance. Those already receiving Support at Home can request an urgent Support Plan Review to transition to the pathway.
It is important to understand that the End-of-Life Pathway provides aged care funding, not specialist palliative care funding. Palliative care services may provide clinical
expertise around pain, symptoms, medication planning and end-of-life care. The End of-Life Pathway can help fund the practical in-home supports that make it more possible for a person to remain at home.
Palliative care in residential aged care
Residential aged care homes can provide palliative and end-of-life care.
Many aged care providers have staff with experience and training in this area. They may be supported by education services, clinical guidance, expert resources and palliative care programs designed to build end-of-life care capability in home care and residential aged care settings. For example, palliAGED provides evidence-based guidance, tools and training to support aged care professionals, older people and families.
Specialist palliative care can add another layer of support when symptoms are difficult to manage, decisions are complex, family members are worried, or extra clinical advice is needed.
In residential aged care, palliative care services may provide advice to the GP and aged care team, support pain and symptom management, guide medication planning, help with family meetings, provide comfort care advice and support advance care planning.
Some local services provide in-reach to aged care homes. In southeast Melbourne, Calvary Health Care Bethlehem is an example of a specialist palliative care service offering a team approach that supports patients, families and residential care staff, coordinates with other services, helps avoid unnecessary transfer to hospital and provides support during illness, grief and loss.
When home care is no longer enough
Many people want to remain at home for as long as possible, and with the right mix of family care, GP support, aged care services and palliative care, this may be possible. But sometimes symptoms become too complex, family carers become exhausted, or the person needs more intensive care than can safely be provided at home.
Palliative care teams can help families understand whether care can continue at home or whether a palliative care unit or hospital admission may be needed for symptom control, respite, medication changes or more intensive end-of-life care.
In summary
Palliative care can add an extra layer of expertise around an older person and their family. It can help with pain and symptom management, medication planning, equipment, emotional and spiritual support, family meetings, carer support, advance care planning and decisions about whether care should continue at home, in hospital, in a palliative care unit or in residential aged care. For older people and families, palliative care works alongside aged care to help the person remain as comfortable, supported and well cared for as possible.
If someone you love is becoming more unwell and you are unsure how palliative care, Support at Home, residential aged care or other aged care supports fit together, Aged Care Conversations can help you understand the options, ask the right questions and plan the next steps with more confidence.