Aged Care, End-of-life And Palliative Care - Queensland Health
Aged care, end-of-life andpalliative careFindings and recommendations(Report No. 33)Health, Communities, Disability Services and Domesticand Family Violence Prevention CommitteePaper No. 4, 56th Parliament, March 2020This paperThis paper provides a summary of the findings and recommendations from Report No. 33 on aged care, end-oflife and palliative care. The report is one of two reports and a volume of additional information from the Inquiryinto aged care, end-of-life and palliative care and voluntary assisted dying.1 Page
Aged care, end-of-life and palliative careFindings and recommendationsInquiry terms of referenceOn 14 November 2018, the Legislative Assembly referred an inquiry to the committee with the following terms ofreference:1.2.3.That the Health, Communities, Disability Services and Domestic and Family Violence PreventionCommittee inquire into aged care, end-of-life and palliative care and report to the LegislativeAssembly on:a.the delivery of aged care, end-of-life and palliative care in Queensland across the health andageing service systems; andb.Queensland community and relevant health practitioners’ views on the desirability ofsupporting voluntary assisted dying, including provisions for it being legislated in Queenslandand any necessary safeguards to protect vulnerable persons.That in undertaking the inquiry, the committee should consider:a.in relation to aged care, the terms of reference and submissions made to the Australianb.Government’s Royal Commission into the Quality and Safety of Aged Care and, in recognisingthe Commission will occur in parallel, how to proactively work with the Commission to ensurean appropriate exchange of information to inform the conduct of the inquiry;c.outcomes of recent reviews and work including Queensland Health’s Palliative Care ServicesReview; andd.the current legal framework, relevant reports and materials in other Australian states andterritories and overseas jurisdictions, including the Victorian Government’s Inquiry into endof-life choices, Voluntary Assisted Dying Act 2017 (Vic) and implementation of the associatedreforms.That the committee report to the Legislative Assembly by 30 November 2019.On 22 August 2019, the Legislative Assembly agreed to a motion that the reporting date for the inquiry beextended from 30 November 2019 to 31 March 2020.2 Page
Aged care, end-of-life and palliative careFindings and recommendationsContentsThis paper .1Inquiry terms of reference.2Contents .3Context for the Inquiry .4Recommendations .6Recommendations from the Earle Haven investigation.14Summary of findings – aged care .16Summary of findings – end-of-life and palliative care.23The committee .34Further information .343 Page
Aged care, end-of-life and palliative careFindings and recommendationsContext for the InquiryAged careThe delivery of aged care across Queensland hasnever been more topical, or its improvement moreurgent. Stories of abuse and neglect of society’s mostfrail in residential aged care facilities, along withsubstantial waits for home care packages that seemany hospitalised, moved into residential aged carefacilities or dying before receiving the package, havebeen shocking.Queensland’s rapidly growing and ageing populationwill present further challenges for aged care andhealth care providers. The incidence of disabilitiesamong the state’s older age groups is significant.Many older Queenslanders depend on informal agedcare rather than government-subsidised aged care.This informal care, while mostly unpaid, is invaluableto those individuals receiving it and to the widercommunity.Most older people (95%) continue to live in their ownhomes – known as ageing in place. Similarly, mostaged care is also delivered to people in private homesor other community settings. The remainder of olderpeople receiving aged care live in careaccommodation such as nursing homes or, in modernterminology, residential aged care facilities. Based onassessments for care, around half of all residents inaged care facilities have dementia.The need for aged care, and the intensity of care thatis required, increases markedly with age. Betweenthe ages of 70 and 85 years, there is a tripling in theproportion of people using home care or residentialaged care. Future expectations of aged care servicesare also evolving. Queenslanders needing aged care,or those supporting them in future, are likely to bemore aware of health issues and more willing to takeadvantages of advances in technology and care. It isalso likely that people will continue to prefer toremain in their own homes as they age.Over the next 16 years, the number of Queenslandersaged over 65 is expected to double, and the number“Over the next 16 years, thenumber of Queenslanders agedover 85 is projected to increaseby 122% to over 200,000.”of Queenslanders aged over 85 is projected toincrease by 122 percent to over 200,000.The state’s population also remains highlydecentralised. More than 40 percent of residentsaged 65 years or older live outside of major cities. Thisincludes over 10,000 people living in remote areasand a further 6,400 living in very remote areas. Thechallenge of providing care to elderly peopledispersed across a large state is exacerbated by theincreasing prevalence of disabilities, dementia, frailtyand chronic disease among older Queenslanders.These conditions are expected to increase demandfor a more diverse range of aged care and health careservices in the future.End-of-life and palliative careAccess to quality palliative care and end-of-life care isas important as health care at any other stage of life,yet for many it is not readily available. There is astrong expectation that all Queenslanders and allcommunities can access services 24 hours a day sevendays a week, if and when they need to. Sadly, accessto services at a local level is often problematic,particularly for Queenslanders in regional, rural andremote communities.Mortality data indicates that between 41 percent and76 percent of people living with life-limiting illnesswould require palliative care services. It is estimatedthat between 51,000 to 71,000 of Queensland’s totalpopulation, and between 52,000 and 57,000 peopleaged over 65 would require palliative care services.Between 2,700 to 4,900 children in the Queenslandpopulation under 19 years old could require palliativecare services. As Queensland’s population continuesto increase and people live longer, the need for endof-life and palliative care will only increase.4 Page
Aged care, end-of-life and palliative careFindings and recommendationsCaloundra public hearing, 3 May 2019.Inquiry processThe committee undertook a range of activities to raise awareness of the inquiry and to assist groupsand individuals contribute their views, including distributing an issues paper, providing informationabout the inquiry to over 4,000 groups and individuals registered to receive regular email updatesabout the committee’s work, advertising the inquiry and calling for submissions in major newspapers,along with further advertising to raise awareness of each of the public hearings and forums for theinquiry.In total, the committee accepted 4,719 written submissions for the inquiry. The committee conducted34 public and private hearings and briefings for the inquiry across the state, and heard evidence from502 invited witnesses. These included public hearings across regional centres along the east coast ofQueensland as well as in Mount Isa, Longreach, Mossman and Palm Island. The committee also visiteda cross section of residential aged care facilities, hospices and palliative care facilities during theinquiry.The committee held an additional seven hearings and briefings and accepted 10 submissions for theEarle Haven investigation, with 33 witnesses appearing.41 hearings – 535 witnesses – 4,729 submissions5 Page
Aged care, end-of-life and palliative careFindings and recommendationsRecommendationsFor further information please refer to comments by committee members in the full report.1. Trial of nurse practitionersThe committee recommends that the AustralianGovernment allocate funding through the PrimaryHealth Networks in Queensland to trial the use ofnurse practitioners in residential aged care facilities.The trial could include expanding their scope ofpractice to prescribe certain medications and ordercertain pathology testing for residents in consultationwith general practitioners.2. Consistency of access to health serviceswhile in residential aged careThe committee recommends that the AustralianGovernment in consultation with individual providersensure that residents in residential aged care facilitiesenjoy the same level of access to health serviceproviders as other elderly in their local communityliving outside of those facilities.3. Review of item numbers for visits bygeneral practitioners to residential careThe committee recommends that the AustralianGovernment review the schedule of item numbersthat general practitioners, specialists and other alliedhealth professionals can access to claim the costs ofcare they provide for patients, and their travel to andfrom residential aged care facilities or patients’homes and the formula used for calculating paymentamounts. In reviewing the formula, the governmentshould ensure the formula provides reasonablecompensation for doctors and other healthprofessionals for their time whilst removingincentives for practitioners to bulk visit facilities.4. Care for frail elderly residents in agedcare facilitiesThe committee recommends that Queensland Healthexamine opportunities to expand programs such asthe Comprehensive Aged Residents Emergency andPartners in Assessment Care and Treatment programthat focus on streamlining the care pathway for thefrail elderly residents of aged care facilities.5. Utilisation of nurse navigators in agedcare to improve access to primary careThe committee recommends that the QueenslandGovernment explore opportunities to better utilisenurse navigators in aged care to improve access toprimary care for older people and supplement thecare provided by general practitioners.6. Sharing of electronic patient/residentrecordsThe committee recommends that the QueenslandGovernment, through Queensland Health, explorethe feasibility of improving access to The Viewer toenhance the sharing of electronic patient/residentrecords between residential aged care facilities,hospitals, ambulance service staff, generalpractitioners and other health service providers toimprove the continuity of care for residents/patients.7. Redesign of the My Aged Care websiteThe committee recommends that the AustralianGovernment redesign the My Aged Care website tomake it easier for all to use.8. Information on aged careThe committee recommends that the AustralianGovernment provide information on aged care in aform that meets the information needs of all usersand is targeted at potential recipients of aged careservices and their families, including Aboriginalpeople, Torres Strait Islander people and people fromculturally and linguistically diverse communities.9. Performance targets for assessmentsand reassessmentsThe committee recommends that the AustralianGovernment reassess performance targets for thecompletion of assessments and reassessments as partof My Aged Care to minimise delays.6 Page
Aged care, end-of-life and palliative careFindings and recommendations10. Increased funding for the Home CarePackages Program16. Qualifications and training for personalcarers providing in-home aged careThe committee recommends that the AustralianGovernment significantly increase the level of fundingit provides to the Home Care Packages Program toensure packages are sufficient to meet the costs ofthe required hours of care required for each levelpackage, to clear the current backlog of packages thathaven’t been provided.The committee recommends that the AustralianGovernment consider whether there should bemandatory minimum qualifications and training forpersonal carers providing in-home aged care.11. Removal of caps on Home CarePackagesThe committee recommends that the AustralianGovernment remove its cap on the number ofpackages available, at all levels, and provides as manypackages as are needed.12. Clearing of backlog in Home CarePackages that have not providedThe committee recommends that the AustralianGovernment clear the current backlog of packagesthat haven’t been provided.13. Maximum waiting times for Home CarePackagesThe committee recommends that the AustralianGovernment ensure wait times for packages arereduced to a maximum of three months for deliveryof all packages across all levels from the date ofapproval.14. Access to interim care while waiting forHome Care PackagesThe committee recommends that the AustralianGovernment commit to provide interim carearrangements, close to the approved package level,for applicants for home care packages while waitingfor their package to be provided.15. Mandatory reporting by home carestaff of elder abuseThe committee recommends that the AustralianGovernment requires that the reporting of elderabuse is a mandatory requirement for all staffworking in home care.17. Controls on physical and chemicalrestraintsThe committee recommends that the AustralianGovernment continues to examine and reformpractices regarding physical and chemical restraintsto discourage providers from using restraints assubstitutes for appropriate levels of care andsupervision.18. Better nutritionThe committee recommends that the AustralianGovernment require that meals provided inresidential aged care facilities meets the nutritionalguidelines for older people provided by the NationalHealth and Medical Research Council’s AustralianDietary Guidelines.19. Funding for activities to increaseresidents’ social connectednessThe committee recommends that the AustralianGovernment consider providing funding for activitiesto increase residents’ social connectedness as well asphysical and mental engagement in residential agedcare facilities.20. Disclosure of staff to resident ratios atresidential aged care facilitiesThe committee recommends that the AustralianGovernment require providers to display in a publiccommon area at each residential aged care facility thestaff to resident ratios at that facility across each shift,for the information of residents, prospectiveresidents and their representatives.21. Publication of staff to resident ratios onthe My Aged Care websiteThe committee recommends that the AustralianGovernment require that information aboutresidential aged care facilities that is published in theSchedule to the My Aged Care website includes staffto resident ratios at each of those facilities.7 Page
Aged care, end-of-life and palliative careFindings and recommendations22. Advance Health Directives in residentialaged care facilitiesThe committee recommends that the AustralianGovernment require residential aged care facilities toprovide information and encourage residents tocomplete an Advance Health Directive as soon aspossible after entry to the facility. This informationshould be readily available for relevant health careworkers.23. Establishment of a funded aged carecommunity visitor schemeThe committee recommends that the AustralianGovernment consider establishing a funded aged carecommunity visitor scheme to help address risks ofelder abuse for older people receiving aged care.24. Training and resources about specialneeds clientsThe committee recommends that the AustralianGovernment consider requiring aged care providersto ensure all aged care staff have access to trainingand resources to promote awareness andunderstanding of the special needs of clients who arefrom groups with special needs such as clients:27. Reducing the number of young peoplein aged care facilitiesThe committee recommends that the AustralianGovernment act immediately to reduce the numberof young people with health issues enteringresidential aged care facilities, and to provide themalternative housing arrangements that meet theirrequirements.28. Expanded criteria for audits ofresidential aged care facilitiesThe committee recommends that the AustralianGovernment require that the criteria covered byaudits of residential aged care facilities be expandedto cover internal processes, resident safety, capacityto meet residents’ needs and the standard ofaccommodation.29. Graded scale for compliance with agedcare standardsThe committee recommends that the AustralianGovernment require that the current system ofpass/fail for compliance with standards be replacedwith a graded system.30. Separation of accreditation andcompliance systems suffering from mental health issues from culturally and linguistically diversebackgrounds from Aboriginal and Torres Strait Islandercommunities, andThe committee recommends that the AustralianGovernment require that the accreditation system isseparated from the regulatory system. from LGBTIQ communities.31. No prior notice of audits of facilities25. Training opportunities for Aboriginaland Torres Strait Islander peopleThe committee recommends that the AustralianGovernment fund trainee positions for Aboriginal andTorres Strait Islander people to work in rolesproviding aged care and health care for Aboriginaland Torres Strait Islander people.26. Mandatory dementia care training forall aged care workersThe committee recommends that the AustralianGovernment mandate that accredited dementia caretraining is undertaken by all aged care workers.The committee recommends that the AustralianGovernment cease the practice of providing priornotice to providers of compliance audits of residentialaged care facilities.32. Ground truthing of audit findings byresidentsThe committee recommends that the AustralianGovernment require that, as part of the auditprocess, residents and their representatives areprovided with the opportunity to contribute to theaudit process and audit findings are shared withresidents and their representatives for commentbefore finalising the audits.8 Page
Aged care, end-of-life and palliative careFindings and recommendations33. Publication of compliance monitoringreportsskills and competencies to perform the tasks requiredof them.The committee recommends that the AustralianGovernment require the Aged Care Quality and SafetyCommission to publish all compliance monitoringupdate reports.39. Aged caredevelopment34. Publication of accreditation reportsafter a change of providerThe committee recommends that the AustralianGovernment require the Aged Care Quality and SafetyCommission to explain the commission’s practices inrelation to the removal from publication ofaccreditation reports of facilities after any change ofapproved provider occurs.35. More accessible complaints systemThe committee recommends that the AustralianGovernment require that the Aged Care Quality andSafety Commission’s complaints system for aged carebe made more accessible and responsive tocomplaints.36. Process for medical practitioners toreport problemsThe committee recommends that the AustralianGovernment require that the Aged Care Quality andSafety Commission’s complaints system promotemechanisms to encourage medical practitioners andallied health professionals to report problems theyobserve with the potential to compromise the safetyand welfare of residents and other clients, on aconfidential basis if necessary.37. Disclosure of staff qualifications andexperienceThe committee recommends that the AustralianGovernment require that providers of residentialaged care services disclose to residents, prospectiveresidents and their representatives the qualifications,training and experience of their staff at the facility.38. Audit of accredited aged care trainingcoursesThe committee recommends that the AustralianGovernment ensure accredited training courses foraged care are producing graduates with the requiredstafftrainingandThe committee recommends that the AustralianGovernment call on providers to promote a culture inthe aged care industry of ongoing staff training anddevelopment.40. Certificate 3 qualifications for personalcarersThe committee recommends that the AustralianGovernment consider requiring that trainingequivalent to Certificate 3 in aged care is mandatoryfor all personal care workers in the aged care sector.For existing employees with certificate 2qualifications, there should be recognition ofexperience on the job in lieu of undertakingadditional training.41. Better pay and conditions for aged careworkersThe committee recommends that the AustralianGovernment raise the minimum pay and conditionsof employment for personal carers, nurses,administrators and other workers in the aged careindustry to levels equivalent to their peers in thehealth sectors.42. Workforce strategy for aged careThe committee recommends that the QueenslandGovernment, in conjunction with the AustralianGovernment, unions representing aged care workers,peak bodies representing the aged care providers andtraining providers devise a strategy to recruit andtrain workers for Queensland’s aged care providers tomeet future staffing requirements, to meet theincreasing aging population, and demand for servicesin Queensland.43. National strategy implementation planand monitoring and evaluation planThe committee recommends that the AustralianGovernment finalise and publish the ImplementationPlan and the Monitoring and Evaluation Plan for theNational Palliative Care Strategy 2018 as soon aspossible.9 Page
Aged care, end-of-life and palliative careFindings and recommendations44. Revision of the 2015 End-of Life-46.Increasedtransparencyandaccountability for palliative care servicesThe committee recommends that the QueenslandGovernment revise and update the StatewideStrategy for End-of-Life Care 2015 in conjunction withthe Australian Government, Primary HealthNetworks, Palliative Care Queensland and other peakbodies, consistent with the Clinical Services CapabilityFramework, to:The committee recommends that the ability of palliative care services, bymandating reporting of data and setting clearperformance standards.Strategy specify what palliative care services and endof-life care services are to be provided and inwhat form by government and nongovernment providers, including: specialistcare services, telephone support, access topharmacy services, grief and bereavementsupport, the delivery of awareness programsfor health professionals and the general public,and interactions with aged careprovide clear, meaningful targets foraccessibility to, and the delivery and timelinessof, palliative care and end-of-life care servicesto all Queenslanders regardless of theirlocation, including communities with specialcultural and other needs, who are located inregional, rural and remote areasrequire that Queensland Health is responsiblefor coordinating and implementing thestrategy across all Hospital and Health Services,and that department report annually on theperformance by all Hospital and HealthServices against the accessibility, delivery andtimeliness targets for palliative care and endof-life care servicesprovide goals and actions related to thedelivery of training and education for palliativecare and end-of-life workers link to other strategies and plans for therecruitment and retention of staff, and acknowledge that a key principle of palliativeand end-of-life care is person-centred care.45. Person-centred care47. Assistance for people wishing to die athomeThe committee recommends that the QueenslandGovernment and Primary Health Networks exploreways to fund and provide further assistance tocommunities and families to enable people to die athome supported by end-of-life care through:expansion of community and in-home nursingservices; expansion of community care programs;supporting community-based medical aids andequipment loan schemes; and increased resourcesfor the Hospital in the Home program which provideshigh-level care in the home when patients require it.48. Assistance for regional hospicesThe committee recommends that the QueenslandGovernment with assistance from Primary HealthNetworks examine ways to help establish viablehospices outside of South East Queensland.49. Pediatric palliative careThe committee recommends that all levels ofgovernment explore the opportunity to establish apaediatric palliative care hospice outside of SouthEast Queensland.50. After hours palliative careThe committee recommends that the QueenslandGovernment explore options to improve after-hoursaccess to palliative care services, to ensure allQueensland palliative care patients have access toafter-hours palliative care regardless of whether theyare at home or in a residential aged care facility,hospice or hospital.The committee recommends that any changes to thedelivery of and access to palliative care services inQueensland promote person-centred care.10 P a g e
Aged care, end-of-life and palliative careFindings and recommendations51. Centralised 24/7 telehealth serviceThe committee recommends that priority funding beallocated to establish a centralised 24-hour, sevenday telehealth service available to practitionerscaring directly for palliative patients throughoutQueensland, and to develop a statewide supportiveinformation system to allow practitioners to accessreal-time patient information for rapid response andappropriate treatment recommendations.52. Capacity building for telehealth servicesThe committee recommends further developmentand capacity building of telehealth or other digitalservices for patient consultations to enable people inregional, rural and remote areas to access healthservices not locally available.53. Increased Australian Governmentfunding for palliative careThe committee recommends that the AustralianGovernment increase the amount available throughthe subacute funding for the delivery of palliative careto address the unmet need for services.54. Increased Queensland Governmentfunding for palliative careThe committee recommends that the QueenslandGovernment increase its funding for palliative care inQueensland.55. Options to prevent palliative carefunding being divertedFunding Instrument to incorporate funding forpalliative and end-of-life care.57. Clinical capability framework forpalliative careThe committee recommends that the QueenslandGovernment, as a matter of urgency, mandate theapplication of the Clinical Services CapabilityFramework for Public and Licensed Private HealthFacilities for palliative care planning and delivery byall Hospital and Health Services as part of theirfunding agreement, and monitor Hospital and HealthService performance in meeting this framework withexplicit use of performance metrics and reporting.58. Funding for specialist palliative careThe committee recommends that the QueenslandGovernment consider as part of any broader reviewwhether to develop a needs-based funding model forspecialist palliative care which includes packages ofcare instead of time-limited funding models.59. Develop a palliative care workforcestrategyThe committee recommends that the QueenslandGovernment, in conjunction with the peak bodies andunions representing the palliative care workers,model current and future workforce needs anddevelop a palliative care workforce strategy thataligns with the national strategy and that it includesstrategies for:The committee recommends that the QueenslandGovernment examine options to ensure thatpalliative care funding is not diverted to othersubacute areas.56. Palliative and end-of-life care forresidential aged care residentsThe committee recommends that the AustralianGovernment properly fund palliative care and end-oflife care services provided to residents living inprivate homes or in residential aged care facilities soresidents can access the clinical care, nursing andspecialist palliative care services they require. Thiswill involve providing greater flexibility in the homecare package system and a redesign of the Aged Care11 P a g e increasing the number of palliative carespecialists, nurse practitioners, and palliativecare nurses via specialised palliative caretraining and education professional development training for allproviders of palliative care within the medical,nursing and allied health professions educating health workers who may need toprovide palliative care as part of their normalhealth care delivery, for example, generalpractitioners, nurses and residential aged carefacility workers, so they have a basicunderstanding of palliative care recruiting and retainin
End-of-life and palliative care Access to quality palliative care and end -of-life care is as important as health care at any other stage of life, yet for many it is not readily available. There is a strong expectation that all Queenslanders and all communities can access services 24 hour s a day seven days a week, if and when they need to.
Indirect employment in aged care 3 Contents 1. About this study 4 Defining key concepts and the study's scope 8 2. Current employment arrangements in aged care 12 The aged care workforce: an overview 12 Indirect employment in aged care 15 Regulation of indirect employment in aged care 19 3. Impacts of indirect employment in aged care 22
3.1 Population ageing 14 3.2 The need for care 15 3.3 Aged care provision 16 3.4 Aged care workforce needs 17 3.5 Care quality 19 3.6 Government funding 20 4 A package of reform for high quality care 22 4.1 Reforms considered 22 4.2 Projected care recipients 26 4.3 Aged care workforce requirements 27 4.4 Education and training 30
3. Other—youths aged 16 to 18 who completed high school or a GED, youths aged 16 to 18 in 11th grade or lower, and youths aged 16 who were not considered 12th grade aged (based on criteria discussed in group 2) This issue of The CBHSQ Report focuses on the first two of these groups, which are collectively referred to as 12th grade aged youths;
(Aged Care Assessment Program) is an important part of Australia’s aged care system. The Commonwealth engages each state and territory government to manage the day-to-day operations of the ACAP and Aged Care Assessment Teams (ACATs or in Vi
Safety Commission from 1 January 2019. The Commission will bring together the functions of the Australian Aged Care Quality Agency, the Aged Care Complaints Commissioner, and, from 1 January 2020, the aged care regulatory functions of the Department of Health. This 2018-19 Corporate Plan takes account of this changed operating environment and
Palliative care vs end-of-life care -End-of-life care is used to describe the support and medical care given during the time surrounding death (What is End-of-Life Care, 2017). -Happens in the days, weeks, or months leading to death.-Usually associated with hospice: -Each state decides the length of the life expectancy a patient must have to receive hospice care under
Palliative and End of Life Care Palliative care is an approach to care focusing on promoting comfort through relieving pain and other symptoms. The aim of palliative care is to enhance the quality of life of those living with life limiting progressive conditions and their families. End of Life Care refers to all aspects of the care relating to .
Accounting Paper 1 You do not need any other materials. Pearson Edexcel International GCSE Turn over . 2 *P48370A0220* SECTION A Answer ALL questions. Some questions must be answered with a cross in a box . If you change your mind about an answer, put a line through the box and then mark your new answer with a cross . 1 A business sells goods for cash. What are the entries in the books of the .
