The End-of-Life Pathway is a new initiative under the Support at Home program, launching on 1 November. While end-of-life pathways as a concept have long been used in healthcare to guide compassionate care for people in their final months, this specific government-funded model is designed to help older Australians remain at home if they wish. It offers $25,000 in funding over 12 weeks, faster access to services, and coordinated support through My Aged Care.
Here we look at what an End of Life Pathway is, its purpose, key components and the role it plays in aged care decision-making.
Understanding the End of Life Pathway
An End of Life Pathway is a framework or care plan used by healthcare teams to support individuals who are in the last phase of life. It aims to ensure that care addresses the physical, emotional, spiritual, and psychological needs of the patient. The pathway helps staff deliver consistent, high-quality care that respects the wishes and values of the individual and their family.
In other words, this pathway is flexible and adapted according to each person’s health status, prognosis and preferences, rather than following a rigid protocol.
Purpose and Importance of the Pathway
The End-of-Life Pathway serves several important purposes:
- Dignity and Comfort: Ensures that the patient’s pain and other symptoms are effectively managed to maintain comfort.
- Respect for Patient Wishes: Supports shared decision-making, honouring advance care plans and expressed preferences.
- Coordinated Care: Facilitates communication and collaboration among healthcare providers, families, and patients.
- Emotional and Spiritual Support: Provides holistic care addressing emotional, psychological, and spiritual needs.
- Appropriate Care Setting: Helps determine the most suitable care environment, such as home, hospice, or residential care.
Implementing an End-of-Life Pathway can improve the quality of care during what can be a difficult time and provide clarity for families and care teams alike.
Who Can Access the End-of-Life Pathway?
The End-of-Life Pathway is available to older people who have been diagnosed by a medical or nurse practitioner as having three months or less to live.
A completed End-of-Life Pathway form is required. This form, available from 1 November on the My Aged Care website, must be filled out by a medical practitioner or nurse practitioner.
If the person is already on Support at Home:
- Their provider can request a high-priority Support Plan Review to activate the End-of-Life Pathway.
If the person is not on Support at Home:
- A medical or nurse practitioner can complete the form and submit it via the ‘Make a Referral’ tool on My Aged Care (GPs can also use the e-referral option). This will trigger a high-priority aged care assessment.
- Alternatively, a representative can request a high-priority assessment through the My Aged Care website and upload the completed form, or provide it directly to the assessor during the assessment.
The pathway can also be accessed by calling My Aged Care on 1800 200 422 or visiting an Aged Care Specialist Officer at a Services Australia service centre, whether or not the person is already in the Support at Home program.
An aged care assessor will review the submitted form to confirm eligibility before services begin.
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Who Will Provide Care Under the End-of-Life Pathway?
When the Support at Home program begins, people accessing the End-of-Life Pathway will be encouraged to keep the same provider if that provider can meet their needs. This continuity means their existing care team will be able to coordinate end-of-life services without disruption.
Key Components of an End of Life Pathway
An effective pathway typically includes the following stages:
1. Identification of End of Life Phase
Recognising when a person is approaching the final stage of life is crucial. This involves clinical judgment, assessments, and sometimes specific tools to guide timing.
2. Advance Care Planning
Engaging the patient and their family in conversations about preferences for care, treatment limitations, and wishes for end–of–life care. Documentation such as advance directives or care plans helps guide future decisions.
3. Multidisciplinary Care Coordination
A team-based approach brings together nurses, doctors, allied health professionals, and social workers to develop and regularly review the care plan.
4. Symptom Management
Effective control of pain, breathlessness, agitation, nausea, and other distressing symptoms is prioritised.
5. Communication and Family Support
Ongoing, honest, and compassionate communication ensures that families understand the patient’s condition and care plan. Emotional support is offered to both the patient and their loved ones.
6. Last Days of Life Care
When death is imminent, care focuses fully on comfort measures, with minimal clinical interventions. Psychological and spiritual support where relevant is emphasised.
7. Bereavement Support
Following the patient’s death, families and carers are often provided with support and resources to help cope with grief and practical arrangements.
The Role of End of Life Pathways in Aged Care
For aged care providers, the End of Life Pathway provides a practical guide for delivering quality care that aligns with the person’s goals and values. It supports important decisions about treatment options, medication use, and preferred place of care or death.
By using the pathway, aged care teams can:
- Provide clarity and confidence in decision-making.
- Ensure consistent and respectful care delivery.
- Facilitate discussions with families about care priorities.
- Reduce unnecessary hospital transfers or invasive treatments.
- Enhance quality of life in the final phase.
The End of Life Pathway is highly relevant in both home care and residential aged care environments because many people prefer to spend their final days in familiar, comfortable settings rather than hospitals. The pathway helps ensure that quality, compassionate care continues regardless of location.
How Much Funding Will Be Available?
From 1 November, older people accessing the End-of-Life Pathway will receive $25,000 in funding for home care services over a 12-week period.
Will People Need to Make a Contribution?
From 1 November, when the Support at Home program begins, participant contributions will apply to End-of-Life Pathway services in the independence and everyday living categories.
Services in the clinical supports category such as nursing, will be fully funded by the government, with no participant contribution required.
More information is available in the Participant Contributions fact sheet.
What Services Will Be Available on the End-of-Life Pathway?
From 1 November, people on the End-of-Life Pathway will be able to access services from the Support at Home service list, tailored to their needs and based on their high-priority assessment or Support Plan Review. Funding can also be used for assistive technology where required.
What if services are needed beyond 12 weeks?
The End-of-Life Pathway covers up to 12 weeks of support. If the older person still has available funding, this can be extended for an additional 4 weeks (up to 16 weeks total). If they require services beyond this period, they can request a high-priority Support Plan Review to transition to an ongoing Support at Home classification, ensuring continued access to services.
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