Providing end-of-life support through home care is critical, but it can come with its own challenges

Earlier this month, the Government announced significant changes to aged care in Australia, including an A$4.3 billion investment in home care.

In addition to the changes to the home care packages, the home support programme will include an critical addition – the end of life path for older Australians.

This path will give you access to higher level home care services for older people to assist Australians stay at home as they approach the end of their life. Specifically, it will provide an additional A$25,000 for palliative support where a person has three months or less to live.

This is a positive change. But there may be some challenges in implementing it.

Why is this critical?

Older people have clearly expressed their wish to remain in their homes as they age. most peoplehome is where they want to be in the last months of their lives. The space is personal, familiar, and comforting.

However, the data from Australian Bureau of Statistics shows that most people who die between the ages of 65 and 84 die in hospital, while most people aged 85 and over die in residential care homes.

This apparent gap may reflect a lack of appropriate services. Both palliative care services and family doctors play an critical role in providing medical care to people living at home with terminal illness. However, the possibility die at home is based on the availability of ongoing support, including direct care and assistance with daily living.

Family members and friends often provide this support, but it is not always possible. Even when it is possible, caregivers can lack of self-confidence and skills provide the necessary care and may lack sufficient support and respite from their carer role.

Palliative care funding offered by Support at Home should assist an older person to remain at home and die at home if they wish.

Unless someone dies suddenly, care needs are likely to escalate towards the end of a person’s life. Support at home may include assistance with showering and toileting, assessing and treating symptoms, developing care plans, managing medications, dressing wounds, housework, preparing meals, and communicating with the person’s family.

Occupational therapists and physical therapists can assist select equipment and suggest at-home modifications.

End-of-life support may also include explaining goals of care, contacting services such as pharmacists to obtain medications or equipment, liaising with organisations on financial matters, respite care or funeral planning, as well as accepting grief and offering spiritual care.

However, we do not yet know what exact services this amount will be allocated to.

What do we know about this program so far?

The in-home support program, including an end-of-life pathway, is scheduled to begin on July 1, 2025.

We know that funding is linked to a survival prognosis of three months or less, which will be determined by a doctor.

Further information indicates that the elderly person may be referred to high priority assessment to access the end-of-life pathway. We don’t know what that means yet, but they don’t have to be current Support at Home participants to be eligible.

The recent path will allow the funds to be used over a 16-week period, which is likely to provide some margin of safety with a three-month timeline.

Although more and more details are coming to airy, some issues still remain unclear.

Home care providers will want detailed information about what may be covered by this funding and how they will work with primary care providers and community health settings.

Older people and their families will want to know what the procedures are for applying for this funding and how long it will take to process applications.

Everyone will want to know what happens if a person doesn’t die within three months.

Some challenges

The willingness to access appropriate supports and services will be crucial for older people using this pathway. Home care providers will therefore need to assess how the end-of-life pathway fits into their operations and how they can build the necessary skills and capabilities.

The demand for nurses with palliative care skills and allied health workers is likely to escalate. Providing end-of-life care can be particularly burdensome It will therefore be necessary to develop strategies to prevent employee burnout and encourage them to take care of themselves.

It will be necessary to monitor how pathways are implemented in rural and remote areas and across different cultural and social groups to ensure they benefit all older people.

Effective coordination and communication between home care, primary care and specialist palliative care providers will be key. Digital health systems that connect sectors can assist. Family involvement will also be very critical.

Escalation and referral pathways should be established to enable appropriate response to emergencies, unexpected deterioration or family distress.

At last, specifying exactly when someone dies can be challenging. Knowing when the last three months of life begin can be challenging, especially when frailty, cognitive issues, and multiple health problems may be present.

This may mean that some people are not perceived as ready for this path. Others may not be willing to accept this prognosis. The older person may also be expected to live with a terminal illness for many months or years. Their palliative care needs will not be met by this path.

Despite these challenges, the announcement of the Home Care End of Life Pathway is timely and welcome. As a population, we are living longer and dying older. More detail will assist us better prepare for the implementation of this program.