Conditions of funding for palliative care

These are the conditions of funding for admitted, community and consultancy under the Policy and Funding Guidelines.

Conditions of funding for admitted palliative care

Admitted palliative care services provide end of life care (in the last 12 months or so of life), and respite care, for people with life-limiting illness who require an interdisciplinary and comprehensive approach to challenging physical, emotional, social and spiritual issues. In Victoria, this activity is funded through Subacute Weighted Inlier Equivalent Separation (SWIES). For information on SWIES, see Policy and Funding Guidelines.

Admitted palliative care is provided in designated palliative care units and in other ward configurations that contain dedicated palliative care beds. In Victoria, these units are located within acute hospitals as part of purpose-built subacute units and as stand-alone services. In some health services, palliative care beds may be incorporated into other wards/units such as medical or subacute wards.

Palliative care beds can be used in a variety of ways. These include:

• In coordination with designated community palliative care services to stabilise a person’s condition/circumstances and to enable them to return home for ongoing care.
• When families caring for someone at home require assistance with care, particularly during the person’s last days of life.
• Other clinical specialties may refer their client to a designated palliative care unit when it has been identified the person requires specialist palliative care.

All designated admitted palliative care units must:

• provide palliative care under the clinical supervision of a specialist palliative medicine physician with an interdisciplinary team
• provide palliative care in accordance with evidence-based best practice standards
• have a palliative care policy that guides care from admission to discharge for both acute and respite care
• provide bereavement care in line with the Bereavement support standards for specialist palliative care services
• report activity to the department against the Australian National Subacute and Non-acute Patient (AN-SNAP) (PDF, 1,399 KB) classification system for palliative care
• report prescribed performance measures and audit data (for example Clinical Indicators for Pain) to the Department of Health and Human Services (the department) as outlined in Victoria’s Policy and Funding Guidelines
• participate in the department’s Victorian Health Experience Survey – palliative care module.

A palliative care admitted episode is defined as an episode of admitted care for which the principle clinical intent is palliation during all or part of that episode. Two National Health Data Collection data items Care Type and Additional diagnosis are used to capture information on admitted palliative care.

Conditions of funding for community (home-based) palliative care

Community palliative care services provide end of life care (in the last 12 months or so of life), and respite care (in-home during the day or night and provided by health professionals or volunteers), for people with life-limiting illness who require an interdisciplinary and comprehensive approach to challenging physical, emotional, social and spiritual issues.

Community palliative care services provide holistic care based on impeccable assessment of the client and their family and carers. Support must include complex symptom management, access to medical review, nursing care, allied health, respite, and practical support such as information and equipment.

It is expected that services will provide care to clients in residential aged care facilities and disability group homes. These facilities are the clients’ homes.

In Victoria, community palliative care is provided by:

• 22 acute hospitals
• 8 non-government organisations; and
• 4 community health services.

A designated community palliative care service is assigned to each Victorian Local Government Area. Each service has a prescribed catchment area.

All designated community palliative care providers must:

• provide interdisciplinary palliative care in accordance with evidence-based best practice standards. This includes:
  • some nursing staff with post graduate palliative care qualifications
  • palliative medicine physician advice/guidance/consultation and or direct employment as part of the interdisciplinary team
  • allied health staff with relevant post graduate qualifications and palliative care experience for advice/guidance/consultation and/or direct employment as part of the interdisciplinary team. Examples include occupational or physiotherapy, social work, counselling and bereavement care
  • access to after-hours phone triage, support and visits. A designated palliative care provider must provide after-hours phone triage and support. This excludes Nurse-on-Call and Bolton Clarke (previously RDNS). A primary (generalist) provider may provide visits under the guidance of a designated palliative care provider.
• have policies and procedures that guide care from admission to discharge for all clients, their families and carers, including respite care
• provide bereavement care in line with the Victorian Bereavement support standards for specialist palliative care services.
• report activity to the Department of Health and Human Services (the department) against the Australian National Subacute and Non-acute Patient (AN-SNAP) (PDF, 1,399 KB) classification system for palliative care via the Victorian Integrated Non-Admitted Health dataset.
• report prescribed performance measures and audit data (for example Clinical Indicators for Pain) to the department as outlined in Victoria’s Policy and Funding Guidelines and, where applicable, the department/funded agency Service Level Agreement.
• participate in the department’s Victorian Health Experience Survey – palliative care module.

A palliative care community (home-based) episode is defined as an episode of care for which the principle clinical intent is palliation during all or part of that episode.

Conditions of funding for regional palliative care consultancy

Regional palliative care consultancy services provide clinical advice and support to treating teams in hospitals and in the community within their designated geographical region (or sub-region).

Regional consultancy services provide assessment, direct clinical care and advice for clients and carers with complex needs. This supports the treating team to maintain care of the person with a life-limiting illness and to address their pain, symptoms and psychological, social and spiritual concerns.

Consultancy services work across all health care settings. They provide specialist advice and support to services in the community, including community palliative care services, general medical practices, district and bush nursing services and residential facilities.They address complex issues that otherwise would necessitate admission of the client to hospital.

Consultancy services also provide education and training about palliative care to other clinicians and provide palliative care input for cancer streams and at chronic disease management meetings.

A regional palliative care consultancy service must:

• have an interdisciplinary team including a medical practitioner with specialist qualifications in palliative medicine, nursing staff with postgraduate qualifications and experience in palliative care (may include a nurse practitioner in palliative care) and allied health staff with specialist qualifications and experience in palliative care
• provide ‘in-reach’ consultancy advice and support to hospital-based staff
• provide ‘outreach’ consultancy advice and support to primary (generalist) community-based healthcare professionals and designated community palliative care services within their designated geographical region (or sub-region)
• provide palliative care in accordance with evidence-based best practice standards
• have a palliative care policy that guides care from admission to discharge for both acute and respite care
• provide bereavement care in line with the Bereavement support standards for specialist palliative care services
• report prescribed activity data, performance measures and audit data as required to the Department of Health and Human Services (the department) as outlined in Victoria’s Policy and Funding Guidelines.