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29 August 2019

Supporting palliative and end-of-life care in the home

Professor Deborah Parker, RN, BA, MSocSc, Phd, MACN, University of Technology Sydney writes on changing consumer attitudes to being cared for and dying at home and Home Care Package provider service provision responsibilities.

Supporting palliative and end-of-life care in the home

With more older Australians now choosing to be cared for, and die at home, if possible, and the new Aged Care Quality Standards released in 2019, Level 3 & 4 Home Care Package (HCP) providers need to review their current way they provide services to consumers and their carers. In particular, the palliative and end-of-life care needs of their clients.

Home Care Packages - Total expenditure by the Australian Government on aged care is currently $18.1 billion with 11 per cent spent on Home Care Packages (HCP). Nearly 160,000 people will need a home care package by 2023 [1]. This will have substantial implications for the clinical care needs of consumers, carers and the providers delivering these services. 

End-of-life care is a reality for HCP providers who are involved in providing clinical care. In 2014/15, 21 per cent of people died while receiving a Level 3 Home Care Package, and for Level 4 packages, that figure was 24 percent [2]. Providing quality end-of-life care can be a challenge for some providers, especially those new to the market.

Consumers may not require a high level of clinical care at the beginning of their journey with a HCP provider, but the consumer-directed focus of the health care system now requires that a service provider be prepared to care for the person until death if that person expresses the wish to be cared for, and to die, at home.  

Most consumers who are on a HCP are on a package for over 12 months [1] before they die, so it is important that HCP providers take this into account when planning services, training staff and allocating resources.  Providers need to step into this clinical care space and the caring@home resources are a way for providers to skill their staff around a very natural process of dying at home.

The Aged Care Standards – The eight Aged Care Quality Standards recognise that HCP providers will be involved in providing palliative care. In particular Standards 2, 3, 7 and 8 apply to palliative and end of life care in the home environment:

  • Standard 2: Ongoing Assessment and Planning with Consumers – Ongoing assessment and planning with consumers that includes a clear plan, review of this plan and involvement of external agencies if required. It explicitly identifies that this should include advance care and end-of-life planning, if the consumer wishes.  
  • Standard 3: Personal Care and Clinical Care –Staff need to recognise deterioration in consumers and respond to it in a timely manner with care that reflects the person’s goals and preferences.
  • Standard 7: Human Resources – Providers must have adequately skilled and trained employees to meet client needs.
  • Standard 8: Organisational Governance –Where clinical care is provided a clinical governance framework is required.

With an aging population, and the number of Australians desiring care at home expected to substantially increase in coming years, Level 3 & 4 Home Care Package providers need to upskill their staff in the provision of person-centred, palliative and end-of-life care. The caring@home project has best-practice and standardised resources that can be used by HCP providers. The resources are freely available from www.caringathomeproject.com.au.

References:

  1. Source – Aged Care Pricing Authority – Seventh Report on the Funding and Finance of the Aged Care Industry (2019)
  2. GEN data – Residential aged care and home care data 2014-15
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