The 2024 report of the aged care taskforce (Australian Government, 2024) highlighted that the aggregate demand for residential aged care will continue to grow and has called for an aged care system that is sustainable, facilitates greater innovation in the sector and geared to relationships with the health and hospital systems.
However, what was not mentioned is that approaches to support innovation around end-of-life care will need to include both those focused on the delivery of care, and partnerships with the community, so the sector can meet community expectations.
The number of Australians aged 85 and over will be growing at 60,000 per year by the end of the decade, up from about 20,000 in 2024 and the national demand for palliative care services will increase by 200 per cent.
It is unclear whether the forecast in huge investment, cited in the aged care taskforce report, will cater for this increase in older people: “Investment of $37 billion (in today’s dollars) would be required to build the additional aged care rooms needed by older people in 2050.
Over the next decade to 2030, additional investment of approximately $5.5 billion would be required to refurbish and upgrade existing aged care rooms, increasing to $19 billion by 2050”, according to the taskforce report.
The evidence related to consumer preferences suggests that best practice is defined more by the qualities and values embedded in the care provided, not a particular program structure or setting. The most appropriate model of care is one that can respond flexibly to the variety of needs across the illness trajectory, including at end of life.
Belonging (feeling at home) is of primary importance to residents, as is flexibility in the care routines provided by staff. However, the problem of high staff turnover and the high personal and economic cost work against quality of care.
Thus, an effective model must exist within the challenges of workforce sustainability yet still ensure that residents’ needs are met within the complexities of their life-limiting disease trajectory.
Provision of quality palliative care services for residents of residential aged care homes can facilitate quality of life at end of life and foster a good death for the resident, their family and staff.
To do so, additional training and capacity of staff is required, care should be effectively planned and coordinated, communication between care home staff, residents, families and community-based organisations needs to improve, and the quality of care provided should allow the resident to live and die with dignity.
However, the mostly clinically focused current models of care in aged care are not sustainable neither in cost nor capacity, without incorporating social models of care to provide person-centred meaningful care to residents at end of life.
Current systems are geared to doing tasks (with ever-increasing burdensome administration) rather than facilitating connections between residents and with the wider community, contributing to loneliness, learned helplessness, lack of self-agency and internalised ageism of residents.
Incorporating Compassionate Communities models of care require different perspectives and skills in addition to those gained through clinical training.
Public health perspectives and community development skills need to be added to aged care teams, as well as better death and grief literacy. A combination of behavioural, cultural and systems change is required and resistance to such changes will be encountered along the way.
This change in culture requires commitment, resources and a process which put residents stated needs and aspirations at the centre, so residents are not merely ‘cared for’ but also ‘cared about’.
It is about affirming personhood, the need to be treated with respect, dignity and compassion. The scale and imminent impact of ageing we are facing soon requires a whole-of-community urgent response and collaboration across health and social care is critical.
Ultimately, to achieve an effective, affordable and sustainable end-of-life care system, a public health approach based on a close partnership between clinical services and communities/civic institutions is the optimal practice to be infused in any model of care.
It’s time to stop having our elderly die in a state of anxiety and loneliness. The community needs to be responsible for the outcomes of ageing. It takes time and a concerted effort to recognise that change is needed and desirable.
However, “we never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete” (Buckminster Fuller).
Professor Samar Aoun AM is the Perron Institute Research Chair in Palliative Care at The University of Western Australia and 2023 West Australian of the Year.
Editorial published in the West Australian newspaper on 26 August 2025