Abstract
The proportion of people over 65 in Australia is predicted to double by 2050 and the number of people moving into residential aged care facilities has increased by 31% (1) with 50% of Australians aged 85 years and over dying in residential aged care facilities (2). Only 18% of people residing in aged care facilities have access to specialist palliative care (2). An expert reference group (ERG) was established in 2020 to guide the Specialist Palliative Care in Aged Care project team to co-design an integrated model of care that brings together, primary, secondary and community care to improve end of life care in residential aged care facilities and increase choice for older people over where they die.
The ERG membership included representatives from specialist palliative care services, a non-government palliative care community service, residential aged care facilities, Queensland Ambulance Service, General Practice, Primary Health Network, consumers, West Moreton Care at End of Life Collaborative and University of Southern Queensland. The ERG utilised clinical redesign methodology to design, implement and monitor the development of the SPACE (Specialist Palliative Care in Aged Care) model. The diagnostics indicated that older people wanted better access to specialist palliative care in their aged care facilities and choice over where they died.
The co-designed model consists of a secondary specialist palliative care service (funded through the Queensland Government) and a non-government community palliative care service (funded through the Primary Health Network) working across organisational boundaries as one service to deliver palliative care consultations, palliative care needs rounds and palliative care education within residential aged care facilities in the West Moreton Region. The model has escalating layers of access to specialist palliative care including a palliative care hospital in the home program allowing residents in aged care facilities to access hospital level palliative care in their home and an after-hours support service. The model relies on partnerships with residential aged care facilities, general practitioners and Queensland Ambulance Service to ensure residents have access to the clinical expertise and medications they need to have a quality death in their preferred place of death.
The model has been implemented in 17 residential aged care facilities since 2020. In this time 97.73% of patients referred to the service have died in their preferred place of death. Patient reported outcomes for residents who are cared for in the Palliative Care Hospital in the Home are comparable to those being cared for in a specialist palliative care unit in a hospital.
The key learnings from the development of this model are that integrated care models require co-design in both design and implementation phases, consumer are central to building models that meet the needs and values of those that will receive the service and flexible delivery of the model ensures scalability.
1.Australian Government Productivity Commission. Report on Government Services 2018 Canberra; 2018.
2.Australian Institute of Health and Welfare. Interfaces between the aged care and health systems in Australia-where do older Australians die? Canberra AIWH; 2021.