Home Care Package providers are well placed to deliver clinical services for a person who chooses to be looked after at home in the last weeks of life. An important part of this role is to help manage pain and other symptoms.
Two policy changes from the Australian Government will support palliative and end-of-life care and can be offered by Home Care Package providers.
- The draft Strengthened Aged Care Quality Standards now include Outcome 5.7: Palliative care and end-of-life care requiring aged care providers to, amongst many actions, actively manage an older person’s pain and other symptoms with access to specialist palliative and end-of-life care when required.
- On 1 July 2025, the Australian Government will introduce a new End-of-Life Pathway that will give participants who have three months or less to live access to a higher level of in-home aged care services. Funding of up to $25,000 will be available, with 16 weeks to use the funds. The additional funding aims to help people to stay at home for as long as possible.
People near the end of life are clinically unstable and severe symptoms can emerge rapidly at any time. If these symptoms are not managed quickly, unnecessary suffering and unwanted transfers to hospital can result.
Despite the degree of unpredictability, there are some things which clinical services can anticipate. For instance, in the terminal phase of a life-limiting illness, a standard set of symptoms is documented, including pain, shortness of breath, nausea, restlessness, anxiety, and rattly breathing. Additionally, the person loses the ability to swallow, necessitating giving medicines under the skin to manage symptoms at this point of their illness.
Home Care Package providers can work in partnership with a GP, Nurse Practitioner or Medical Officer (upon discharge or transfer from inpatient facilities) for the management of palliative care medicines. Community pharmacy also plays an important role in the dispensing and supply of medicines in a timely fashion to facilitate optimal palliative care symptom management.
While using the patient's regular pharmacy may appear to be the best choice, evidence suggests that it may be difficult to quickly access palliative care medicines as some pharmacies may not stock these medicines. This can create additional stress for families and carers. They may need to ring around to find a pharmacy that stocks the medicines prescribed by a doctor or a nurse practitioner or there may be a delay while the pharmacy sources a particular medicine.
To improve timely access to palliative care medicines for urgent symptom relief, caring@home has developed a National Core Community Palliative Care Medicines List (the List). The four medicines on the List fulfil these requirements:
- evidence-based efficacy in management of common symptoms
- cost considerations (including PBS subsidy)
- common use across Australia
- efficacy in multiple symptoms
- community-friendly formulation for administration
- easy transport and storage.
The List guides prescribers on what medicines to prescribe and pharmacists on what medicines to stock. It also provides a foundation for communication and collaboration across the disciplines to enable a person to remain at home with good and responsive symptom management. The List will help community pharmacies anticipate the most likely medicines that will be prescribed and enable GPs and NPs to predict which medicines will be readily available in the pharmacies.
Home Care Package providers, prescribers and community pharmacists, by considering this List, can assist in providing timely access to medicines for people with palliative care needs and facilitate them remaining at home for end-of-life care.
caring@home is a National Palliative Care Project, funded by the Australian Government and led by the Brisbane South Palliative Care Collaborative.
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