Australia’s leading home care provider Silverchain has warned that the much-anticipated end-of-life care pathway in Support at Home is failing to deliver on its promise, with restrictive eligibility, and an arduous reassessment process locking thousands of Australians out of their preferred place of death.
Despite the expectation that the end-of-life care pathway under the new Support at Home program would provide older Australians with a choice on where they spend their last three months of life, Silverchain Chief Executive Dale Fisher AM says that the reality is a fragmented system that defaults to hospitalisation due to bureaucratic delays.
“As people’s health declines and they approach the very end of life, their needs change rapidly. At the moment, the system requires them to have a reassessment to unlock key services like nursing and allied health support,” Ms Fisher said.
Ms Fisher adds that this rigid process leaves families waiting for help that often arrives too late.
“The long wait times for reassessment means people are hospitalised or die before they can get the support they need.
“When people at the palliative stage end up in hospital unnecessarily and because they don’t have key services approved for the required end-of-life care at home, it costs Australians much more – both economically and socially.
“The system must anticipate for a person’s decline, not react to it. Currently, the process for reassessment is so rigid that it traps families in a state of ‘care-limbo’ at the very moment they need an immediate uplift in support. Once a referral is approved for the end-of-life care pathway, all Support at Home services should automatically be in scope up to the $25,000 limit, to support the person in their last three months of life.
“In end-of-life care, a red tape delay isn’t just an inconvenience – it’s a failure to provide basic care with dignity,” Ms Fisher said.
As the leading provider of in-home palliative care, Silverchain is calling for the Federal Government to adopt the flexible, clinical-first models that have proven to be successful in Western Australia and South Australia, where Silverchain has more than four decades of expertise in delivering palliative care at home.
The disconnect between what people want for end-of-life care and what they can access is just as stark. The Productivity Commission reports that 70 per cent of Australians would prefer to die at home, but only 15 per cent are able to do so. The end-of-life pathway is supposed to change this and provide older people with dignity, choice and compassionate care at home at the end of their lives.
The economic argument is just as compelling. Data from the Australian Health and Welfare Institute^ indicates that the average cost for a hospital-based palliative care bed is approximately $1,660 per day. With the end-of-life care pathway in Support at Home, costs are capped at $25,000 over a 12 week period, equating to a maximum spend of $298 per day.
“It is a rare policy opportunity where the most compassionate outcome, where people’s choices are respected, is also the most cost effective,” Ms Fisher said.
“By sticking to a rigid reassessment process, we are missing a major opportunity to shift more care in the home at a significantly lower cost to the taxpayer and with better psychosocial outcomes for older people and their loved ones.”
As National Palliative Care Week (10-16 May) approaches, Silverchain is calling for an urgent review of the end-of-life care pathway in Support at Home to ensure it meets the rising demand for care in the home with the dignity, choice and flexibility Australians deserve.
^AHIW Palliative Care Services Australia – expenditure web report
