The need for greater support and care for people dying at home, and for greater investment in the aged care workforce was highlighted at the 12th Australian Palliative Care Conference in Canberra yesterday.

Experts also called for an end to the funding silos of aged and palliative care, and for more consumer, family and carer engagement in the development of palliative care policies and programs.

As well, experts said that much more needs to be done to prevent aged care residents being taken to hospitals for unwanted invasive treatments.

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Improving the end-of-life experience

Jennifer Doggett writes:

Australia is the second best country in the world to die, according to the Economist’s Quality of Death index. However, we still have a long way to go in ensuring equitable access to quality palliative care, according to panel members at the ‘Palliative Care under a new Government’ session at the 12th Australian Palliative Care Conference yesterday.

Panel members were asked to outline what a new government should do in relation to palliative care in its first 100 days in office.

Moderated by Jean Kittson with Dr Yvonne Luxford (CEO, Palliative Care Australia), the panel included Senator Rachel Siewert (the Greens), Gordon Gregory (National Rural Health Alliance), Rebecca Vassarotti (Consumers Health Forum), Professor Ian Maddocks (palliative care specialist) and Mandy Thorn (Managing Director of a UK Nursing Home).

A key theme was the need for more consumer, family and carer engagement in the development of palliative care policies and programs. Workforce and funding issues also came up several times in the session.

Professor Ian Maddocks focussed on the need to break down the funding silos of aged and palliative care. He argued that currently the system is not set up to support the delivery of palliative care in aged care facilities, despite the fact that it is often the consumer’s preferred location and the most cost effective place to deliver care.

His highest priority for the incoming government’s first 100 days in office would be to ensure aged care residents receive high quality care in their home, rather than being taken to hospitals for unwanted invasive treatments.

Rebecca Vassarotti said two thirds of Australians die in hospital although most people actually want to die at home. She called on the new government to reverse this trend and to provide greater support and care for people dying at home.

She also stressed the need for the health system to be able to differentiate between people who have the potential to get better and people who are terminally ill, as this may affect the treatment choices they are offered. She questioned the cost-effectiveness and the appropriateness of some of the intensive hospital-based treatment provided to people shortly before they die.

Shock over poor staff ratios for aged care residents

Mandy Thorn argued that good quality aged care prevents unnecessary hospitalisation and increased quality of life. She believes that the first priority for the incoming government should be to invest in the people working in the aged care sector to give them support and training they require to provide high quality care.

From her perspective as a manager of a UK nursing home, she said Australia over-invests in aged care capital and under-invests in its aged care workforce.

She said she was shocked at how low care ratios are in Australian aged care facilities. In her nursing home there is 1 nurse for every 10 residents plus five care assistants for every 20 residents. This is much higher than the ratios at similar aged care facilities she has visited in Australia.

Gordon Gregory said that health had been missing-in-action from the front pages of the papers this election, despite it being one of the most important issues to consumers. He argued that there is a case to increase the 10% of GDP that we currently spend on health care but that this should only occur after some major reconstruction of the health sector to increase productivity.

Senator Rachel Siewert supported the call for increased funding to health and aged care but argued that it should be based on evidence, via an independent cost of care study. Yvonne Luxford confirmed that this was supported by the National Aged Care Alliance (NACA), which is lobbying for a similar study.

Senator Siewert said that before significant additional resources can be allocated to aged care we need to have a community debate about harnessing the assets tied up in family homes to fund aged care. She says that neither the ALP nor the Coalition will debate this issue but also neither is prepared to find funding from other sources to fund aged care properly.

The issue of private palliative care was raised by an audience member and discussed by the panel. They described how people with private health insurance (PHI) often assume that they can receive palliative care in the private sector, only to find that it is either not available or not covered by their insurance.

Professor Ian Maddocks said that the PHI funds he deals with are not interested in providing home care support and often will not fund care in smaller facilities and hospices. The experiences of people requiring palliative care in private facilities were described as ‘very random’, with only the lucky receiving adequate care.

The audience was left with a warning that this situation can only get worse, with the health and aged care sector facing what was described as a ‘tidal wave’ of baby boomers.
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