THE question of whether elderly Australians with serious, life-limiting illness are getting timely access to palliative care has been raised by Palliative Care Australia (PCA).
The ABC’s Four Corners investigation The Waiting Game put the Integrated Assessment Tool (IAT), an automated decision-making system used to assess older Australians seeking government-funded aged care, under a spotlight.
People with serious and life-limiting illness have enormous diversity of needs, and those needs often change very quickly as their condition progresses, according to Dr Hatherly, CEO of PCA, the national peak body for palliative care.
“Whether a decision is informed by an assessment tool, clinical judgement or eligibility criteria, the test should be the same: does it identify what this person needs and help them get the right care at the right time?” he said.
“Any system determining access to aged care must be based on a comprehensive understanding of the needs of the individual.
“Failing to understand this complexity or the trajectory of change during an assessment can mean people aren’t receiving the support they need, or in some cases that they’re approved for the wrong type or level of support.”
A significant gap was the absence of a specific assessment of palliative care needs in the IAT.
The problem is compounded by the eligibility rules for the Support at Home End-of-Life Pathway, which require a doctor or nurse practitioner to estimate that a person has three months or less to live.
“Predicting exactly how long someone has left to live is inherently difficult, particularly for people with dementia, frailty, neurological conditions, heart failure and other illnesses that do not follow a predictable course,” Dr Hatherly added.
PCA wants people with advanced life-limiting illness to receive priority access to Support at Home when their needs are urgent, and is calling for:
– Palliative care needs to be specifically identified through aged care assessment.
– A trial of evidence-based alternatives to eligibility for the End-of-Life Pathway which don’t rely on clinical assessment of life expectancy.
– Priority access to Support at Home for people with advanced life-limiting illness whose needs are urgent.
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