By Alex Lynch and Josh Fear
The number of Australians aged over 85 is projected to more than double over the next two decades, to more than one million. This presents a challenge for our society if we truly mean to provide dignity and excellent care for all.
The ageing of our population will have enormous consequences—but one issue which is not considered enough is how to ensure our loved ones have access to end-of-life care that tends to their physical, emotional, social and spiritual needs. This is what high-quality palliative care can provide.
Right now, out of approximately 190,000 Australians who die each year from predictable causes, only about 70,000 Australians access specialist palliative care. The number of Australians with terminal illness is set to significantly increase as the baby boomer generation ages.
A national poll by Redbridge Group, commissioned by Catholic Health Australia, found that 87 per cent of Australians believe that palliative care should be universally accessible—but only 38 per cent are confident they could access it in their local community.
The danger, which many have warned about for years, is that with current levels of funding and outdated policy settings, many people will miss out on the care they need.
This is partly because access is often unfairly determined by location. Those in metropolitan areas tend to have greater choice, while many in regional and rural areas struggle to find appropriate inpatient or home-based palliative care services. But even in metropolitan areas, access to palliative care is inconsistent and rationed.
Addressing this inequity requires targeted policy interventions and a commitment to ensuring dignified end-of-life care is a core component of our healthcare, aged care and disability support systems.
Expanding capacity to deliver palliative care
There are several reforms the government could make to strengthen palliative care and improve accessibility nationwide. One option that would make an enormous difference is to reintroduce default benefits (the minimum insurers must pay for a treatment) for “Hospital in the Home” services, including palliative care.
This would ensure that more people who want to spend their final days in the comfort of their own homes—surrounded by loved ones—would be able to make that choice in consultation with their doctors.
Right now, privately insured patients seeking palliative care at home face something of a “postcode lottery.” Most major insurers only fund palliative care at home only in some areas. With the reforms we propose, the government could ensure that private health insurers are required to fund home-based palliative care. This is unlikely to put upward pressure on health insurance premiums, because palliative care at home is generally cheaper than more expensive hospital-based care.
Increasing the default benefit for inpatient palliative care in rural and regional areas is another critical step. This would help ensure that Australians in the bush, where the costs of providing care are higher, are funded by their health insurers to receive the same standard of care as those in the cities.
Of course, it is vital that public patients in public hospitals—where most specialist palliative care is delivered—receive the same standard of and access to healthcare as private patients. By expanding the capacity of the private health system to deliver palliative care, via the default benefits proposed, we hope this will lead to more capacity in the public system to deliver palliative care—something we can all get behind.
Great care exists, but eligibility and access is an issue
There are a range of eligibility issues impacting access to palliative care. In addition to the insurers’ restrictions on palliative care at home, the new End-of-Life Pathway under Support at Home will come with significant restrictions.
The Pathway will provide older Australians with expedited access to home-based palliative care services, offering up to $25,000 in funding for essential care over a 16-week period. This is a great initiative which will bring much needed resources to aged care with a direct focus on palliative care. However some changes to the current design of the Pathway are required to ensure it works effectively.
To ensure that people with uncertain life expectancy are not excluded from essential care, we must shift to a needs-based eligibility model rather than relying on restrictive prognosis-based criteria.
Under the Pathway’s current design, eligibility will be limited to those in their anticipated final three months of life. This restriction excludes many with an uncertain prognosis, particularly those with conditions such as dementia, where symptoms can fluctuate unpredictably and timeframes are difficult to determine. Medical estimation of life expectancy is inherently challenging, especially for frail older Australians.
The restrictions also unfairly prevent access for those with intensive support needs but a life expectancy exceeding 12 weeks, such as individuals with advanced neurodegenerative conditions like Motor Neurone Disease.
Continuity of care is another critical priority. Those who live longer than anticipated—which will inevitably be many people—must not face a decline in access to services once they exceed the 16-week period. Ensuring ongoing support beyond this timeframe is essential to maintaining stability and quality of life for patients and their families.
An easy, practical solution would be to introduce an expedited exemption pathway so that those who live longer than the program envisages receive funding that would ensure continuity of care.
Rural and regional access
Lastly, we must increase the number of services in rural and remote areas, where the need for home care far outstretches the limited services available. This expansion must include culturally appropriate care for Aboriginal and Torres Strait Islander communities.
Governments at all levels must ensure that Australians across the nation have access to high-quality palliative care whether at home, in a hospital, or in a dedicated palliative care facility.
If we achieve this, it will go a long way to ensuring that every Australian receives the dignity and compassion they deserve at the end of their lives.
You can read Palliative Care Australia’s Election Platform and sign PCA’s petition at www.palliativecare.org.au.
You can review Catholic Health Australia’s Election Priorities at https://cha.org.au/federal-election-2025/
Alex Lynch is the Director of Public Health and In-Home Support forCHA
Josh Fear is the National Policy Director for PCA