When someone’s health deteriorates in the final weeks of life, the Support at Home end-of-life care pathway requires a formal reassessment before nursing and allied health services can begin. That reassessment takes time most people don’t have.
Silverchain, Australia’s largest home care provider, warned this week that the pathway isn’t meeting its central promise: that older Australians can choose where they spend their last 3 months of life.
“As people’s health declines and they approach the very end of life, their needs change rapidly,” says Chief Executive Dale Fisher AM. “At the moment, the system requires them to have a reassessment to unlock key services like nursing and allied health support.”
The result is a system that defaults to hospitalisation. People who want to die at home, with providers willing to support that, are ending up in acute care because the administrative process can’t keep pace with clinical reality.
That gap has a scale. More than 450 Australians die each day from a life-limiting illness. ABS data shows most people aged 65 to 84 die in hospital. In 2023-24, there were 107,500 palliative care hospitalisations ending in death. The stated purpose of the end-of-life pathway is to keep people out of that number.
Where the process breaks down
The pathway has dedicated funding for a person’s final 3 months. The break point sits before that funding can be accessed.
The reassessment requirement creates a gap between a deteriorating condition and the care available. Silverchain says too many people are falling in. When families ask why their loved one ended up in hospital, the answer is often a process step: the reassessment that couldn’t be completed in time.
Part of what makes this structurally hard to fix is that clinical decline is difficult to predict. Jennifer Tieman, a professor at Flinders University working in palliative care, has noted the difficulty of establishing a confident 3-month prognosis. People deteriorate faster than expected, or slower. A system that requires a formal reassessment before care can scale has no good answer for the person whose condition changes overnight.
Where the pathway ends too soon
The reassessment barrier creates the most urgent gap. A second structural problem sits further into the pathway.
Even when someone clears the reassessment, funded care ends at 3 months. Palliative Care Australia has said there is no medical or clinical model that supports this time limit. The $25,000 funding cap has no established clinical basis either.
People who live beyond 3 months don’t get better. Their care needs often increase, and carers absorb what the system stops covering.
“We’re at risk of seeing carers break down,” former Palliative Care Australia CEO Camilla Rowland said in 2025. Adrian Morgan, General Manager of Flexi Care Inc., called the policy “heartless.”
Palliative Care Australia launched National Palliative Care Week on Sunday, with a direct statement on equity. Interim CEO Simon Waring said access to quality palliative care “should not depend on postcode, diagnosis, age, background or care setting.” The reassessment requirement and the 3-month cap both produce exactly the kind of variation he’s naming.
