The EOL Pathway is a new funding category within the Support at Home program. It is designed to support people eligible for an aged care package who have been diagnosed with 3 months or less to live, and wish to remain at home, by providing funding to receive in-home aged care services.

A total of $25,000 is available per eligible participant over a 12-week period. This is the highest funding classification an individual can receive under the Support at Home program. Funding can be used to access the participant’s approved services from the Support at Home service list, including care management fees.

An older person is eligible to access the EOL Pathway if they meet the following criteria:

• A doctor or nurse practitioner has estimated they have a life expectancy of 3 months or less to live, and
• they have an Australian-modified Karnofsky Performance Status (AKPS) score (mobility/frailty indicator) of 40 or less.

The EOL Pathway is available to participants already accessing homecare services, as well as older people who are not currently accessing services. Information for new and existing participants can be found in section 15.4 of the Support at Home Program Manual. Homecare providers can refer existing Support at Home participants for a high-priority Support Plan Review to access the EOL Pathway.

An EOL Pathway Form must be completed and submitted before a participant can be assessed as eligible for the EOL Pathway. The participant, their registered supporter or appointed decision-maker, or the provider must download the form and provide this to the appropriate medical practitioner (their GP, non-GP specialist or nurse practitioner) for completion. Upon completion, the form will need to be submitted for consideration by an aged care assessor.

Under the new Support at Home model, participants receiving services under the EOL Pathway must receive care management through a single, registered Support at Home provider known as a Care Partner. Participants already accessing ongoing services will need to consider if their provider is able to deliver the EOL Pathway. While participants have the right to change providers as they wish, it is recommended they remain with their existing providers where possible to ensure continuity of care.

Funding for EOL Pathway care management is taken from the individuals EOL Pathway budget and not care management pooled funds. There is no cap on the amount of care management that can be claimed under the EOL Pathway within this budget. This recognises there may be significant planning and coordination required with medical teams and state and territory support services. However, it is expected that care management claims are proportionate and in the best interests of the participant.

The EOL Pathway provides funding to access in-home aged care services from the Support at Home service list (such as personal care, domestic assistance and general nursing care) to complement services available under state and territory-based palliative care schemes. For example, an older person may access specialist palliative care nursing services, such as medication management, through state and territory services, while using Support at Home funding to access additional meals and personal care. Homecare providers will be required to work as part of a multi-disciplinary team to ensure the mix of services under Support at Home is complementary, coordinated and in the best interests of the care recipient. The standard of care services are required to provide are outlined in Outcome 5.7 of the new Strengthened Quality Standards. 

Consistent with ongoing Support at Home packages, participant contribution arrangements apply for independence and everyday living services accessed under the EOL Pathway. For services in the clinical supports category (for example, general nursing care), no participant contribution is required.

Participants accessing the EOL Pathway may need additional specialist palliative care to support them to stay at home. The Australian Government provides funding to state and territory governments for the delivery of generalist and specialist palliative care services in their jurisdictions. This arrangement enables each state and territory government to make decisions about the provision and delivery of palliative care services in their health systems, to meet the needs of their community. This forms part of their responsibilities through hospital and community service provision.

Care Partners must ensure there is liaison and care coordination with the participant’s doctor, medical team and/or any state or territory palliative care services. It is important that the Care Partner seeks to understand what supports are currently in place and whether additional services or parties should be notified (for example, palliative care services if they are not already engaged). This is essential to ensure the participant is receiving holistic and sufficient care. Care management activities for the EOL Pathway are outlined in Section 8.4 of the Support at Home Program Manual.

The Australian Government provides funding for education, experiential learning and resources in the Palliative Approach to Care. The Program of Experience in the Palliative Approach – PEPA is available to all aged care workers including Homecare staff.

The End of Life Directions for Aged Care (ELDAC) Project, also aims to improve the palliative care skills and advance care planning expertise of aged care providers, and GPs providing health care for recipients of aged care services. ELDAC provides a range of resources to support aged care workers to deliver quality palliative care including toolkits, services to improve connections between aged, primary and palliative care services, and palliative care navigation services.

Another valuable resource available to aged care workers is the website palliAGED, where staff can access palliative care evidence and practice information specific to older people in Australia, their families, and friends. The palliAGED website is managed through the Flinders University CareSearch project.

Additional palliative care resources include: (Links at bottom of page)

• National Palliative Care Standards - Palliative Care Australia
• Palliative care initiatives and programs
• National guidelines for spiritual care in aged care.

Aged care workers are expected to use a palliative approach to care when caring for older people across the three tiers of support for aged care. An aged care worker who has a working knowledge of the palliative approach to care will be able to assess and plan for the palliative care and end-of-life needs of participants.

The Assistive Technology – Home Modification (AT-HM) scheme supports older people to live at home and within their community with increased independence, safety, accessibility and wellbeing. 

Participants under the EOL Pathway may be approved to receive funding for assistive technology, but they are not eligible to receive any funding for home modifications. The only exception to this is if home modifications were already underway for an existing participant prior to entering the EOL Pathway. In these cases, the home modification may be completed.

Assessors consider the older person’s functional ability and home environment when determining whether assistive technology is required and will recommend a funding tier based on an assessment using the Integrated Assessment Tool (IAT). If required, a funding tier and approval for assistive technology will be outlined in a person's Notice of Decision and their support plan.

If approved for assistive technology, dedicated AT-HM funding can also be used to access equipment from the AT-HM List. If eligible, primary supplements (i.e. additional funding allowances) will also apply to participants. Assistive technology includes items, pieces of equipment or products that help a participant to do things more easily or complete activities they can no longer do independently.

Examples of assistive technology include:

• mobility equipment such as walking sticks, walking frames and wheelchairs
• toileting supports such as bedpans and commodes
• bathing devices including shower chairs and bath boards.

Providing assistive technology to a participant may also include services delivered by a suitably qualified health professional such as prescription, advice and wrap-arounds that help to match a person, their goals and their environment with specific products and equipment.

Note: Funding for assistive technology will be separate from a participant’s EOL pathway budget. AT-HM funding is time limited and must be spent, not just committed, within a 12-month period (in most instances).

Exiting from the EOL Pathway may take place for one of the following reasons:

• the older person has died
• the older person no longer wishes to, or is no longer able to, remain at home
• the older person's medical circumstances have changed and services under the EOL Pathway are no longer required
• the period of funding for the EOL Pathway has finished (maximum 16 weeks).

In the event that the older person requires ongoing Support at Home services following the completion of the EOL Pathway, participants who were accessing ongoing Support at Home services prior to accessing the EOL Pathway can be transferred to their previous Support at Home classification via a Support Plan Review. Care recipients who were new to Support at Home when they commenced the EOL Pathway can be transferred to the inactive classification that was assigned at their aged care assessment, via a Support Plan Review. In the event of death or if Support at Home services are no longer required, providers must notify Services Australia.