To die at home or in hospital? Aussies want one but we fund the other via @ConversationEDU

Nikki McCaffrey, Flinders University

Where do you want to die? Provided symptoms can be controlled, most people at the end of life prefer to die at home. However, just over half of Australians who died in 2011-12 died in hospital.

In the same year, about A$2.4 billion was spent on hospital care for people aged 65 or older in their last year of life. But only a small fraction of that amount is spent supporting people to die at home.

Public money is being wasted on ineffective and inefficient treatments and health services which do not meet patients’ and families’ needs and wishes at the end of life.

This money would be better spent on palliative care services. Among other benefits, these more than double the chance of dying at home through the provision of home-based support services such as nursing.

Health funds spent on treatments and health services of negligible and questionable value, such as chemotherapy at the end of life, should be reallocated to palliative care services. This would improve our chances of dying well and in accordance with our wishes.

Palliative care is care provided to people living with a terminal illness where a cure is no longer possible. The aim of palliative care is to achieve the best quality of life possible for patients and their families during the illness and after death by relieving symptoms, addressing emotional, social and spiritual needs and reducing suffering.

This type of care is provided by teams of assorted professionals such as chaplains, doctors, nurses, pharmacists, physiotherapists and social workers. It is provided across all types of settings, including hospitals, hospices, residential care facilities and at home.

A recent report suggested investing A$237 million in providing palliative care services at home rather than in hospital wouldn’t raise the total health care spend but would increase the proportion of Australians dying at home from 14% to 30%.

High-quality palliative care is person-centred and compassionate. Emerging evidence suggests this type of care could even lower health costs, mainly by reducing hospitalisations at the end of life.

Palliative care in hospital

Inevitably, and appropriately, some people will need or desire hospital care at the end of life. The Australian Institute of Health and Welfare’s recent update on palliative care services in Australia showed that over the past ten years there has been a 52% increase in hospitalisations for which the main purpose of care is palliation.

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This trend will continue rising due to our increasing, ageing population and earlier warning of death.

In 2012-13, 42% of people who died in hospital were receiving palliative care. Providing specialised palliative care in hospitals, particularly early on, can reduce hospitalisation costs by shortening the hospital stay and reducing intensive care and laboratory costs, as well as improving quality of life.

What about informal care?

In 2011-12, Australia spent A$140.2 billion on health. Roughly a third of total health costs is associated with people in the last year of life.

But this estimate does not include costs to the individual or their family. Recent research suggests as much as a third of total spending on caring for people at the end of life falls on family and friends.

Without the support of informal carers, home-based care at the end of life would often be unachievable. Smaller, more geographically spread out families, higher divorce rates and changing communities mean these support networks are likely to shrink at a time when the need for them is growing.

When planning health-care services in this setting, it is essential we also think about informal care costs. We need to make sure we avoid over-burdening families who are a vital part of end-of-life care.

Achieving a better death

Without adequate palliative and end-of-life care, people will continue to be cared for and to die in hospitals despite most Australians wishing otherwise. Patients will have a poorer quality of life at the end of life. Families will suffer unnecessarily. Care will not be provided efficiently.

We are all going to die, but how will we die? Investing in palliative care services will improve our chances of dying well and in accordance with our wishes.

The Conversation

Nikki McCaffrey, Health Economist with Palliative Care Clinical Studies Collaborative (PaCCSC), Dept Palliative & Supportive Services & Flinders Health Economics Group (FHEG), Flinders University

This article was originally published on The Conversation. Read the original article.

3rd Australian Palliative Care Research Colloquium

Prof Patsy Yates sharing her reflections on setting up a NHMRC Centre of Research Excellence in end-of-life care at the PCRNV Breakfast Forum

Prof Patsy Yates sharing her reflections on setting up a NHMRC Centre of Research Excellence in End of Life Care at the PCRNV Breakfast Forum

For the third year in a row, the Australian Palliative Care Research Colloquium was held at the Rendezvous Grand Hotel in Melbourne on October 22-23. The meeting was once again preceded by a breakfast forum hosted by Palliative Care Research Network Victoria (PCRNV), which served as a tempting entrée to the two-day main course of fantastic presentations and workshops exploring a diverse range of topics pertaining to palliative care research. Conversations about research continued over tea and meal breaks, next to quality poster presentations, and during the convivial conference dinner on the banks of the Yarra.  Continue reading

#PallANZ tweet chat

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And we’re back for another round!

Following on from the highly successful inaugural #PallANZ tweet chat last month, we are delighted to announce that we will be hosting another tweet chat in November! Join team Palliverse (@Palliverse) and Liz Callaghan, CEO of Palliative Care Australia (@PCACEO), and “Let’s talk about death, baby!” Share your stories and reflections on having THE conversation with your family, friends, patient, doctor, nurse, spiritual counsellor…

Date: November 5th 2015

  • 7pm AEDT (Canberra, Sydney, Melbourne, Hobart)
  • 6:30pm ACDT (Adelaide)
  • 6pm AEST (Brisbane)
  • 5:30pm ACST (Darwin)
  • 4pm AWST (Perth)
  • 9pm NZDT (Wellington, Auckland, Christchurch)
  • Other time zones 8am GMT, Hong Kong/Singapore 4pm

Hope to see you all there!

How badly do we want to solve this $32bn dollar persistent pain problem? | via @ConversationEDU

It’s National Pain Week in Australia and I wanted to share this excellent article by Pain Specialist Dr Michael Vagg, first published in The Conversation. I have huge respect for my colleagues caring for people with persistent pain. It is a challenging specialty, often dealing with complex physical, psychological, social and existential challenges, in the setting of limited resources. We often call upon their services to help manage palliative care patients (particularly with interventions like intrathecal catheters or nerve blocks). Also, as the palliative care approach is being taken earlier in the trajectory of many diseases, we are increasingly caring for patients with persistent pain. – Elissa


How badly do we want to solve this $32bn dollar persistent pain problem?

Michael Vagg, Barwon Health

This week is National Pain Week so it’s only fitting that I should climb onto the soapbox again in support of people with persistent pain, their employers, workmates, friends, and families. The economic burden of persistent pain in our country is enormous, and the arguments in favour of a co-ordinated national response are compelling. The lack of such a political and economic imperative puzzles me. If you don’t believe me, perhaps this will convince you. Continue reading

Posters from the 11th Asia Pacific Hospice Conference

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Here is a collection of posters from the recent Asia Pacific Hospice Conference in Taipei – primarily by researchers and clinicians from Australia and New Zealand. Enjoy!

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Palace of Care/I think therefore I am? – Announcement

Head in HandsPhoto by Alex Proimos under Flicker Creative Commons

To my Palliverse team-mates and our internet friends,

I just wanted to say that it has been a real pleasure working with you all on our Palliverse adventure.

I think we all deserve to give ourselves pats on our backs as we have achieved a lot in our limited collected spare time.

Unfortunately I will have to leave the team, and I apologize in advance for doing it in such a public fashion.

I have thought long and hard about it and with much regret I have to make the right decision for myself and my young family, at this stage in our lives.

It is with a heavy heart that I must bid you all farewell for now. It has been fun while it has lasted and I’ve been very fortunate to have you all in my Palliative Care life. Continue reading

National Palliative Care Projects: call for applications

Funding of up to $52 million is being provided by the Australian Government over three years from 2014-15 to 2016-17 under the Chronic Disease Prevention and Service Improvement Fund (CDPSIF) for National Palliative Care Projects that focus on enhancing the quality of service delivery in the palliative care sector. The objective of the National Palliative Care Projects is to deliver nationally focused projects that: improve palliative care education and training of health and aged care workforce; and identify quality improvements that can assist in improving the delivery of palliative care services across Australia.  Click here for the invitation to apply for funding.