1. Palliative Care in the Catholic Sector
Dr Ellen Marks
Health Policy Consultant

2. Palliative Care (PC)
“The assumption that everything is fine: no everything is really not fine.
Come and do a ward round with me and see, even in a well-resourced service that really cares about these patients, where all the holes are, where all the resource gaps are, all those people that fall through the cracks and where all the opportunities are for us to do that extra bit.”

3. non-designated inpatient
What is Palliative Care (PC)?
“an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering….. of pain and other problems, physical, psychosocial and spiritual.” (World Health Organisation)
Models of care
non-designated inpatient
primary
community
incl. RACF and home
specialist inpatient
outpatient

4. Why improve PC? Only half of those who would benefit receive it
ABS predicted number of deaths
Only half of those who would benefit receive it
Is cost effective: reduces number of aggressive interventions, hospital associated costs
Choice: most people want to die at home, only 14% achieve this
Voluntary assisted dying only an option for a small number of people

5. Report to be published October 2018
Project background
CHA has undertaken to:
Document the scope of PC activities by CHA members
Examine innovations within PC in the Catholic sector
Highlight gaps, barriers and opportunities for collaboration
Report to be published October 2018

6. Semi-structured interviews
Methods – mixed methods
public and private hospitals, aged care providers
management, clinicians, nurses, pastoral care and researchers
Semi-structured interviews
internal: CNA, public hospitals
Palliative Care Outcomes Collaboration (PCOC)
Australian Institute of Health and Welfare (AIHW)
Data collection
online literature search of PC research performed by members
Literature review

7. Results: Catholic sector is a major provider of PC
of all PC-related hospitalisations
occurred in a CHA hospital
of public PC-related hospitalisations were in a CHA public hospital 6%
of private PC-related hospitalisations were in a
CHA private hospital
53%
73%
CHA members have
of private inpatient beds

8. Private hospital data CHA PC inpatient split
63% private hospital (30% regional)
37% public hospital (18% regional)

9. Private hospitals- source of funds

10. Private hospitals- source of funds CHA
increasing
in metropolitan areas
but decreasing
in regional areas
PHI funded PC hospitalisations are
PHI- private health insurance

11. CHA average length of stay (ALOS) shorter
# data excludes SVHA

12. Findings- fewer PC patients die in CHA private hospitals

13. at home or in the community, but most die in hospital
Findings- PCOC data deaths
community
hospital
Most people want to die
at home or in the community, but most die in hospital

14. Findings- timeliness and responsiveness
CHA tertiary services are timely and responsive
Community PC is timely but struggles to meet responsiveness benchmarks
CHA hospital
non- CHA hospital
CHA community
non- CHA community

15. Community services unable to meet benchmarks
funding
equipment/medications are not available
availably of nursing and medical support 24-7
the ability to respond rapidly to changing needs
symptoms exceed the level of care
choices/preferences regardless of problems
skill of phone assessors
data recording issues off-site

16. Barriers: Funding and Fragmentation Funding
Between sectors (e.g. primary/ community)
Geographical
Multiple clinicians or providers but no continuity
State vs federal
Funding
Medicare Benefits Schedule (MBS)
State vs federal
Private health insurance
Payment models public system
Aged care funding instrument (ACFI)

17. Barriers: Workforce and Knowledge Workforce Knowledge Specialists
Staff training and engagement
Geography
Nursing workforce shortage
Knowledge
Advance care planning
Community perceptions
Research
Staff training and engagement

18. Community empowerment
Enablers
Research
Education programs
Partnerships
Community empowerment
Goodwill
Volunteers

19. Innovations in PC Improving equity of access Enabling at home death
Improving the quality of evidence

20. Non-malignant disease: Indigenous communities and CALD backgrounds:
Innovations- improving equity of access
Improving equity of access
Aged care residents:
- hospice within RACF
- early identification “needs rounds”
Non-malignant disease:
- supportive care clinics
- co-location of services
Indigenous communities and CALD backgrounds:
- partnership, model of care
- case management model

21. PHI funded community PC: Needs identification:
Innovations- enabling at home death
Enabling at home death
Continuum of care:
- tertiary providers delivering continuum
PHI funded community PC:
- Calvary North Adelaide
- St Vincent’s Private Brisbane
- Cabrini
Needs identification:
- Rapid Access Program step-up model
PC networks:
- compassionate communities

22. - with research institutions - carer/patient experience etc.
Innovations- improving the evidence-base
Improving the evidence-base
Collaboration:
- between CHA members
- with research institutions
Research
- clinical trials
- triage tools
- carer/patient experience etc.

23. For further information contact:
Annette Panzera Ellen Marks
Director of Health Policy Health Policy Consultant
Catholic Health Australia