Palliative care for people living in residential aged care

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In 2021–22, people in permanent residential aged care (PRAC) with an Aged Care Funding Instrument (ACFI) appraisal indicating need for palliative care accounted for 2.0% (4,800) of all people (246,000), 3.5% (2,400) of all new admissions (69,100), and 6.0% (4,300) of all exits (72,100) from permanent residential aged care. This section provides information on the characteristics of admissions, exits and people using permanent residential aged care, including comparison between those appraised as requiring palliative care and those not appraised as requiring palliative care based on ACFI.

Note that there is limited data on the need for and receipt of palliative care among people accessing home-based and residential aged care services. Available data is based on those in permanent residential aged care appraised as requiring end-of-life palliative care and for whom a claim was submitted. Information on actual service provision and that palliative care maybe required for a longer period (not just end-of-life care) is a considerable gap in the national data. See below and the Data sources section for further information on the residential aged care data presented in this report.

The information in this section was last updated in May 2023.

Key points

In 2021–22, among people in permanent residential aged care (PRAC) with an ACFI appraisal indicating need for palliative care – accounted for 2.0% (4,800) of all people in PRAC, 3.5% (2,400) of all new admissions to PRAC, and 6.0% (4,300) of all exits from PRAC:

  • almost 3 in 5 (59%) were aged 85 years and over
  • 1 in 5 (21%) had cancer listed as the first condition on their appraisal, compared with 3.7% for those not appraised as requiring palliative care
  • 1 in 2 (50%) exited PRAC within 8 weeks of admission, compared with 7.9% for those not appraised as requiring palliative care
  • death was the most common reason for exit from PRAC – 95% compared with 85% for those not appraised as requiring palliative care.

Between 2017–18 and 2021–22, the number of people in PRAC (including those appraised as requiring palliative care) has remained relatively stable; however, the number of new admissions to PRAC has decreased over the same period – by 11% from 2,700 to 2,400 for those appraised as requiring palliative care and by 3.7% from 69,200 to 66,600 for those not appraised as requiring palliative care.

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Who was appraised as requiring palliative care?

In 2021–22, there were 4,800 people and 2,400 new admissions for people appraised as requiring palliative care in PRAC (2.0% of all people and 3.5% of all new admissions). Among people using PRAC with an ACFI appraisal indicating need for palliative care (Table AC.1 and Figure AC.1):

  • More were women (55%) than men – 2,600 compared with 2,200. However, as a proportion of all people in PRAC, men were 1.5 times as likely to be appraised as requiring palliative care as women (2.5% and 1.7%, respectively).
  • Almost 4 in 5 (78%) were aged 80 years and over, same as the proportion for those not appraised as requiring palliative care.
  • 2 in 3 (69%) were born in Australia, similar to the proportion for those not appraised as requiring palliative care (66%).
  • Most were living in Major cities (61%) and Inner regional areas (30%), however as a proportion of the population living in these regional areas, those living in Inner regional areas had the highest rate – 31 per 100,000 population compared with 16 and 19 per 100,000 population for those living in Major cities and Outer regional areas. This is consistent with the pattern observed for those not appraised as requiring palliative care.
  • Rates varied across the states and territories – Tasmania had the highest population rate (31 per 100,000 population) and Northern Territory the lowest (3.6 per 100,000). For those not appraised as requiring palliative care, South Australia had the highest rate (1,200 per 100,000) and Northern Territory the lowest (250 per 100,000).

Figure AC.1: Characteristics of people using permanent residential aged care, 2021–22

Figure AC 1.1: This interactive data visualisation shows the number and rate (per 100,000 population) of people using permanent residential aged care by assessment for requiring palliative care and by sex and age group, in 2021–22. The number and rate (per 100,000 population) of males appraised as requiring palliative care was higher than females in all age groups (except for 85 and over age group that the number of females was higher than males). The number and rate (per 100,000 population) of females not appraised as requiring palliative care were higher than males for 75 and over age groups, while for age groups under 75 males were higher than females.

Figure AC 1.2: This interactive data visualisation shows the number and rate (per 100,000 population) of people using permanent residential aged care by assessment for requiring palliative care and by remoteness areas, in 2021–22. Major cities had the highest number of people using permanent residential aged care, both for those appraised and not appraised as requiring palliative care, while Inner regional had the highest rate (per 100,000 population) of people using permanent residential aged care, both for those appraised and not appraised as requiring palliative care.

Figure AC 1.3: This interactive data visualisation shows the number and rate (per 100,000 population) of people using permanent residential aged care by assessment for requiring palliative care and by states and territories, in 2021–22. New South Wales had the highest number of people using permanent residential aged care, both for those appraised and not appraised as requiring palliative care. While Tasmania had the highest rate (per 100,000 population) of people using permanent residential aged care for those appraised as requiring palliative care and South Australia had the highest rate (per 100,000 population) for those not appraised as requiring palliative care.

Figure AC 1.4: The interactive data visualisation shows the proportion of ten most common principal diagnoses for all diseases, cancers, and mental health and behavioural diagnosis of people using permanent residential aged care by assessment for requiring palliative care in 2021–22. Cancers and circulatory system conditions had the highest proportions for those appraised as requiring palliative care, whereas musculoskeletal conditions and circulatory system conditions had the highest proportion for those not appraised as requiring palliative care. The most common cancer for permanent aged care residents appraised as requiring palliative care was lung cancer and the most common cancer for those not appraised as requiring palliative care was prostate cancer. The most common mental and behavioural diagnosis was Dementia and Alzheimer’s disease for permanent aged care residents, both for those appraised and not appraised as requiring palliative care.

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How long did people stay and how was care completed?

In 2021–22, among people using PRAC with an ACFI appraisal indicating need for palliative care:

  • 1 in 2 (50%) exited PRAC within 8 weeks of admission (including 30% within 4 weeks), 69% within one year, and 22% after 2 years. For those not appraised as requiring palliative care, 2 in 3 (67%) exited after 1 year – 31% within 1–3 years and 36% after 3 years, while 7.9% exited within 8 weeks (Figure AC.2).

The shorter stays for people appraised as requiring palliative care are consistent with the purpose of the funding for palliative care under ACFI that is provided specifically for ‘end-of-life’ care (see ‘Aged care service provision and context for interpreting residential aged care data’ above for further details).

In 2021–22:

  • Death was the most common reason for exit from PRAC – 95% and 85% of exits for those appraised as requiring palliative care and for those not appraised as requiring palliative care, respectively. Further, return to the community and to other residential care was far more common among those not appraised as requiring palliative care (3.7% and 7.8% of exits, respectively) than those appraised as requiring palliative care (0.6% and 2.2% of exits, respectively; see Figure AC.2).
  • Over 1 in 4 people in PRAC required hospital leave from PRAC – 29% and 27%, respectively for those appraised as requiring palliative care and for those not appraised as requiring palliative care (see Table AC.5).

Figure AC.2: Exits from permanent residential aged care, 2020–21

Figure AC 2.1: This bar graph shows proportion of exits from permanent residential aged care, by length of stay and assessment for requiring palliative care in 2021–22. Exits within 1 year was the highest among permanent aged care residents appraised as requiring palliative care, while permanent aged care residents not appraised as requiring palliative care had the highest proportion of exits after 1 year.

Figure AC 2.2: This bar graph shows the proportion of people leaving permanent residential aged care, by reason for leaving and assessment for requiring palliative care in 2021–22. Death was the most common reason for people leaving permanent residential aged care among permanent aged care residents, both for those appraised and not appraised as requiring palliative care.

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Have there been changes over time?

Overall, the number of people appraised as requiring palliative care using PRAC in 2021–22 was relatively similar to 2017–18, driven by large annual fluctuations over the preceding 5 years, as shown in Figure AC.3. In contrast, the number of people using PRAC not appraised as requiring palliative care generally increased slightly each year (2% increase overall between 2017–18 and 2021–22).

The number of new admissions to PRAC appraised as requiring palliative care also experienced some fluctuations over this period, but overall declined by 11% between 2017–18 and 2021–22. This rate of decline was steeper than for those not appraised as requiring palliative care (overall decline of 3.7% over this same period).

Between 2019–20 and 2020–21, there was a decline in the number of people and new admissions to PRAC for people assessed as requiring palliative care (by 3.4% and 5.0%, respectively), and a subsequent increase in the following 12 months (by 6.8% and 1.6%, respectively).

These patterns likely reflect the introduction and easing of public health measures introduced to manage the spread of the COVID-19 pandemic during 2020 and 2022. In particular, the various falls in new admissions and rises in exists coincided with lockdowns and the tightening and easing of restrictions in response to the waves of the COVID-19 and new strains of the coronavirus. For example, compared with corresponding months in 2018–19, the number of new admissions to PRAC for people assessed as requiring palliative care fell by 19% in May 2020, 25% in October 2020, 21% in October 2021 and 17% in January 2022 but increased by 20% in March 2022 – similar to the patterns observed for new admissions to PRAC for people not assessed as needing palliative care. Exits from PRAC for those appraised as requiring palliative care also followed a similar pattern – 28% higher in April 2020, 22% higher in May 2020, and 15–18% higher in September 2020, May 2021, September 2021, December 2021, and May 2022 (compared with corresponding months in 2018–19). This report did not explore the reasons for these PRAC exits (such as death or to another setting).

These fluctuations in new admissions and exists may reflect a number of factors that not related to the COVID-19 pandemic (see 2022 edition of this report for further details on the impacts of COVID pandemic). Further, ACFI reviews were undertaken from the Department of Health's offices since 2020 to minimise COVID­19 transmission risks (DoH 2020).

Figure AC.3: Trend in new admissions, exits and people using permanent residential aged care, 2017–18 to 2021–22

Figure AC 3.1: This interactive data visualisation shows new admissions, exits, and people using permanent residential aged care, by assessment for requiring palliative care for each year from 2017–18 to 2021–22. The number of new admissions, exits and people appraised as requiring palliative care had fluctuated over this period, with a dip in 2018–19 and 2020–21. The number of people using permanent residential aged care not appraised as requiring palliative care remained relatively stable over the same period, while the number of new admissions and exits for these people remained stable with a slight decrease each year between 2017–18 and 2020–21 and then increased between 2020–21 and 2021–22.

Figure AC 3.2: This interactive data visualisation shows new admissions and exits for people using permanent residential aged care, by assessment for requiring palliative care for each month from July 2018 to June 2022. The number of new admissions and exits fluctuated for permanent aged care residents, both for those appraised and not appraised as requiring palliative care over this period.

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