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Aged care assessments are missing palliative care needs

Palliative Care Australia

Palliative Care Australia (PCA) says questions about aged care assessments highlight a fundamental issue: whether people with serious and life-limiting illness are getting timely access to the care they need.

The ABC’s Four Corners investigation The Waiting Game has put a spotlight on the Integrated Assessment Tool (IAT), an automated decision-making system used to assess older Australians seeking government-funded aged care.

PCA CEO Dr Chris Hatherly said any system determining access to aged care must be based on a comprehensive understanding of the needs of the individual.

“Whether a decision is informed by an assessment tool, clinical judgement or eligibility criteria, the test should be the same: does it identify what this person needs and help them get the right care at the right time?

“People with serious and life-limiting illness have enormous diversity of needs, and those needs often change very quickly as their condition progresses,” Dr Hatherly said.

“Failing to understand this complexity or the trajectory of change during an assessment can mean people aren’t receiving the support they need, or in some cases that they’re approved for the wrong type or level of support.

“This in turn can lead to worsening symptoms, greater pressure on families and carers, and people missing the opportunity to be cared for at home. It is also vastly more expensive if people are admitted to hospital when that might have been avoided.”

PCA National Policy Director Josh Fear said a significant gap was the absence of a specific assessment of palliative care needs in the IAT.

“The Integrated Assessment Tool is designed to identify what support an older person needs, yet it does not specifically assess their palliative care needs,” Mr Fear said.

“That needs to change. Assessors should be equipped to recognise palliative care needs early so they can inform a person’s care and support.”

Mr Fear said the problem was compounded by the eligibility rules for the Support at Home End-of-Life Pathway, which require a doctor or nurse practitioner to estimate that a person has three months or less to live.

“Predicting exactly how long someone has left to live is inherently difficult, particularly for people with dementia, frailty, neurological conditions, heart failure and other illnesses that do not follow a predictable course,” Mr Fear said.

“Someone can have significant and worsening needs but miss out on additional end-of-life support because a clinician cannot confidently predict that they are likely to die within three months.

“PCA has proposed the Government trial a needs-based approach so that access to the End-of-Life Pathway better reflects a person’s actual palliative care needs.”

PCA is also calling for people with advanced life-limiting illness to receive priority access to Support at Home when their needs are urgent.

The Australian Government has announced priority access for people with Motor Neurone Disease, which PCA welcomes, but people with other progressive life-limiting illnesses can also deteriorate rapidly while waiting for support.

“MND is a devastating and rapidly progressive disease where timely access to care is critical, but it is not the only progressive illness where time matters,” Mr Fear said.

“We need an aged care system that responds to people’s needs, not one where timely access depends on having a certain diagnosis or being able to predict precisely when someone will die.”

PCA is calling for:

• palliative care needs to be specifically identified through aged care assessment
• a trial of evidence-based alternatives to eligibility for the End-of-Life Pathway which don’t rely on clinical assessment of life expectancy
• priority access to Support at Home for people with advanced life-limiting illness whose needs are urgent.

“For people approaching the end of life, the goal should be to identify their needs early and get them appropriate care without unnecessary delay,” Mr Fear said.

ENDS

 

Background notes to editors:

PCA’s submission to the Senate inquiry into Support at Home identifies a series of practical reforms to ensure older Australians with palliative care needs can access appropriate care quickly and equitably. PCA recommends that the Government immediately:

1. Trial alternative eligibility criteria for the End-of-Life Pathway to allow people with terminal illness to access necessary care even when prognosis is uncertain. This would consider recent functional decline, unmet need for palliative care, diagnosis and approved access to Voluntary Assisted Dying.
2. Introduce expedited processes for access to equipment and assistive technology for those approaching the end of life, so that people are not left waiting for equipment they need urgently.
3. Revise Support at Home assessment processes to provide greater consistency and transparency in reflecting the palliative care needs of all applicants.

About us:

Palliative Care Australia is the national peak body for palliative care.

Contact details:

Greg Kimball, PCA Acting National Communications Director, E: [email protected], M: 0402 800 649.