A report is calling for the appointment of a Palliative Care Commissioner and $240 million a year to support home based palliative care.
The report says palliative care is treated like an “optional extra” but should be a core health service in the aged care sector.
As well as improving end-of-life for tens of thousands of people, supporting integrated home-based palliative care services would have significant economic benefits, according to the analysis prepared by KPMG for Palliative Care Australia.
It calls for an overall investment of $350 million for palliative care in all settings, saying this will reap annual savings of $450 million across the broader health care system from reduced hospital costs, reduced bereavement costs and increased productivity of families and carers.
KMPG also highlights the need for an expanded palliative care workforce, warning that demand for palliative care will grow faster than both the population and total deaths.
There were just 249 palliative medicine specialists employed in 2017, and 12 full time equivalent nurses with a palliative care job area across Australia per 100,000 population.
“There is limited coordination between the states, territories and the Commonwealth to ensure integrated responsive services which can meet demand and a real need to address inadequacies in specialist numbers,” Palliative Care Australia CEO Rohan Greenland said.
KPMG estimates the cost of delivering home based palliative care would cost an average of $6,508 per person.
“We recommend an increase in funding of AU$240 million per annum for integrated home and community-based services based on models of care that have been shown to be effective,” it says.
It estimates the investment would result in 37,000 more people dying at home, 230,000 fewer hospital bed days, 47,500 fewer ICU days and 225,000 fewer ED presentations.
Desire to die at home
The report says people can live well and die in a place of their choosing, such as their home, instead of institutional settings if they are supported.
However few are actually managing to do this.
“All Australians who need palliative care are simply not having access to services when they need to, particularly at home and in community settings,” Palliative Care Australia Chair Professor Meera Agar said.
“As we prepare for an ageing population and other unexpected stresses to our health care system, like COVID-19, we must look seriously at reforming our system to ensure it can meet people’s needs into the future.”
As few as four per cent of Australians die at home, despite most wanting to spend more time at home in their last months of life.
This compares to countries like the UK and New Zealand where between 23.5 and 30 per cent of deaths occur at home each year.
The report says there are 82,000 deaths in Australia each year that which would benefit directly from palliative care.
But just 2,595 people received a Medicare Benefits Schedule (MBS) funded palliative care home visit in 2017-18, less than two per cent of the deaths in that period.
CHA, which provides 13 per cent of all palliative care-related hospitalisations, last year released a report that identified policy gaps including data, funding and awareness of palliative care.
“Palliative care in Australia is ranked second in the world, with only the UK outperforming Australia, yet just half of the people who would benefit from palliative care actually access it. Referrals to palliative care are absent or late, and only 14 per cent of people die at home, even though studies suggest between 50-70 per cent want to,” CEO Pat Garcia said.
The AMA said the coronavirus crisis had highlighted the work palliative care teams and the challenges of providing care for people in isolation from loved ones.
“Separating patients and families due to the risk of spreading the virus sadly exacerbates an already stressful and emotional time,” AMA presient Tony Bartone said.
“Members of palliative care teams are adapting their approach to do even more for patients when isolation means loved ones may not be present to be with a patient as they approach their final moments of life.”
The release of the report during National Palliative Care Week, came as the federal government announced it would provide $57.2 million to improve palliative care in aged care facilities. That figure is expected to be matched by the states and territories.