Palliative Care

Palliative care helps people with a life-limiting illness to live comfortably at home, hospital, hospice or aged care facility. It involves a range of general and specialist care services to improve overall quality-of-life for patients and their families through holistic management of disease and symptoms as well as any associated needs including psychological, spiritual and social wellness.

Key Points

• Ageing population with high burden of life-limiting conditions requiring palliative care

• Populations with unique care considerations

• Major data gaps in palliative care service delivery and access

Identified Needs

1. Access to health care services and preventative care

2. Reduce potentially preventable hospitalisations

3. Integrated and coordinated care across the health system

4. Older persons are supported to stay healthy and well in their place of residence

The Country SA PHN region has an ageing population experiencing a high rate of chronic and long-term health conditions. Further, there is a high burden of conditions associated with palliative care needs, including cancer, dementia and heart disease (8).

It was recently estimated that up to 72% of persons who die from a life-limiting illness in SA could benefit from palliative care services (100) In the Country SA PHN region, this would account for over 2,800 persons every year (2, 101). Of these, around 9 in 10 palliative care encounters are predicted to be persons aged 65+ (102).

The demand for palliative care services is projected to increase further over time and requires coordination of multidisciplinary care teams to accommodate individual needs of patients and their families. Several population factors are associated with increased complexity of needs relative to palliative care. Persons who are Aboriginal, CALD, or living with a severe or profound disability may have additional care considerations based on cultural or other diversities. Similarly, people living in rural and remote areas have a high rate of disease and risk factors leading to increased complexity of care (refer to Aboriginal Health and Populations of Special Interest sections of this report) (100)

Further, Aboriginal persons and those living in regions classified as having the lowest relative socioeconomic status are at increased risk of palliative care-related hospitalisation. Aboriginal persons in South Australia have double the rate of palliative care-related hospitalisations than non-Indigenous persons (45.6 vs 23.3 per 10,000 persons) (100). The same trend exists for those living in the lowest socioeconomic areas compared to those in the highest socioeconomic areas of Australia (102).

Persons considered frail are at increased risk of adverse clinical events and outcomes including falls, unplanned hospitalisation and acute health complications. Consequently, the anticipation of decline and palliative care planning is an important consideration for frail patients (103) While there is no standard measure for frailty, it has been estimated that around 21% of persons aged 65+ are frail in Australia, with prevalence increasing with age (104) Similarly, unpaid care provision is an indicator of demand for health care services including palliative care. Over 12% of persons (age 14+) in the Country SA PHN region currently provide unpaid care to someone due to disability or a long-term illness (8)

Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Service Needs

Despite major national reforms of palliative care, data on service delivery and access is poor both on a national and local level (105) Access to services to facilitate palliative care is reduced in regional SA relative to service availability in metropolitan Adelaide, including specialist end-of-life care, 24/7 clinical and nursing care, equipment and medication (100) Multidisciplinary care delivery incorporating regional palliative care, general practitioner, community nursing, home support and allied health services including pharmacy are pivotal to provision of palliative care in regional and remote areas. Limitations in workforce impact service capacity and capability (refer to Health Workforce section of this report).

Consultation with palliative care general and specialist services, peak bodies and service providers across 2022 identified the following key themes relative to service need:

• Limited services in most regional areas to deliver palliative care in the home including:

- clinical care - medication administration

- equipment provision - care in the after hours

• Lack of electronic and coordinated information sharing across care providers, including care goals, medication and clinical needs

• Lack of early stage goal planning with person, carers and family (106).

Country SA PHN continue to build on existing knowledge, resources and relationships by partnering with local stakeholders, service providers, consumers and carers in a multi-phased approach focussed on improving components of the local palliative care experience including; pathways, models of care, workforce capacity, engagement and datadriven quality improvement.

Country SA PHN Needs Assessment Report 2022-2025 (November 2021)