‘Positive reform’: $25,000 budget for end-of-life care starts

As part of a suite of changes to home care support, new end-of-life funding will become available from 1 November to help older people with a life expectancy of three months or less.
 
The Support at Home End-of-Life Pathway will provide a one-off budget of $25,000 to fund services such as personal and domestic assistance and nursing care to complement palliative support from state and territory health authorities.
 
The budget, which is federally funded and requires a GP or nurse practitioner to assess life expectancy at three months or less, is designed to help palliative patients who wish to remain at home.
 
The move has been welcomed by Palliative Care Australia (PCA) who labelled it a ‘significant and positive reform, consistent with strong community preference to receive both aged care and palliative care at home for as long as possible’.
 
However, in its position statement, PCA also highlighted some likely implementation challenges.
 
Dr Simon Menelaws, a GP registrar who sits on the PCA board, said the policy reflects an increased understanding of many people’s preference to stay at home as long as possible, as well as a drive to cut expensive hospital admissions.
 
‘Anything that can be done to increase the level of care in the home for a patient who’s choosing to spend their last weeks at home is a really great move for the patient, their families and carers, and for the larger health system,’ he told newsGP.
 
However, he notes that the assessments are likely to pose challenges as the budget is available as a one-off for a maximum of 16 weeks.
 
‘Estimating someone’s life expectancy is notoriously difficult, even for very experienced palliative care physicians,’ he said.
 
‘When you start putting timelines on people’s life expectancy, that is more skewed towards certain disease processes.
 
‘Sometimes people with chronic diseases, such as heart failure, neurodegenerative conditions and dementia – that can be really difficult to determine how long someone has, so that’s going to be probably the big sticking point.
 
‘This 16-week timeline is probably going to raise some concern for people. I think that will be a challenge for carers, patients and GPs.’
 
As well as the life expectancy assessment, patients require an Australia-modified Karnofsky Performance Score (AKPS) of 40 or less to access the support, which will also be means-tested for non-clinical care costs.
 
The funding is part of the new Support at Home Program, which begins on 1 November and replaces the Home Care Packages (HCP) Program and the Short-Term Restorative Care (STRC) Program.
 
The Department of Health, Disability and Ageing (DoHDA) says the End-of-Life Pathway Form to be used by GPs to assess life expectancy will be on its website from 1 November.
 
Guidance for GPs on the overall Support at Home Program can be found on the DoHDA website.
 
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