Palliative care in a hospital or community residential home

Many people receive palliative care at home, but there may be times when you need more care than can be given there, and you may decide to move into a hospital or residential care.

If your condition fluctuates, worsens or becomes complex, you may need care in a hospital or an inpatient specialist palliative care unit. Depending on where you live, the nearest unit may be based in a local hospital. Often you can return home after a period of inpatient care.

Reasons for inpatient care#

You may need care at an inpatient palliative care unit or hospital for one or more of the following reasons:

• Assessment, monitoring and nursing care to manage symptoms such as severe pain and nausea.
• Your medical or other needs become complex, and specialist care is more easily available around the clock in an inpatient facility.
• Respite: you may be admitted for a few days or weeks so that your family or carer can have a break and attend to their own lives. You can return home after respite care.
• You or your carer may decide that it is no longer possible to care for you properly at home as you approach the end of life.

What inpatient units are like#

Inpatient palliative care units (sometimes called “hospices”) are designed to support you when you can no longer get the care you need at home. They aim to be as homely as possible, and you are always free to bring in items from home to make your stay more comfortable.

There are usually no limits on visiting hours, and your family and friends are encouraged to spend time with you and help with your care if they choose. Some units provide space for a family member or friend to stay overnight. Units may include facilities such as lounges and televisions, music players, kitchens, meditation rooms, internet access and gardens. If you have a particular interest or hobby, ask a family or staff member to bring you the things you need to pursue it.

Some palliative care units have a small number of rooms within a hospital complex, while others are attached to residential care facilities. Most offer single rooms, but this is not guaranteed, so talk to the staff about the options available.

A specialist palliative care doctor will manage your medical care, working with other specialist palliative care professionals and your own doctor. If you have been seeing a counselor, nurse or social worker at home, you will usually be able to see similar professionals while in the unit.

Palliative care in hospitals#

Specialist palliative care staff work in many major public hospitals. They work together with your community palliative care service to assess and manage your needs.

You may need medical treatment in a hospital as part of your ongoing palliative care, or you may need palliative care while recovering from surgery. Whether you stay in hospital or go home will depend on your preferences and your immediate needs.

Some private hospitals have dedicated palliative care units or outpatient services. If you have private health insurance, talk with your insurer about your options. Specialist palliative care staff in a private hospital will also work with your community palliative care team.

You may choose to stay in hospital even when you are offered the option of returning home. You might feel safer and more comfortable in hospital, or simply feel like less of a burden on your family. Talk through your options with your family and healthcare team, and with your insurer if relevant.

Palliative care in residential care#

Depending on your needs, your doctor may suggest you move into a residential care home. Moving into a residential aged care home or supported accommodation can give you the longer-term care you need while also managing your end of life care.

Residential care homes sometimes have a doctor or specialist nursing staff, and they can also involve the community palliative care service in your area to provide specialist care. For residential aged care, you may need to be assessed by the relevant aged care assessment service in your area.

Making the decision to move#

Deciding when to move into a residential care home, inpatient palliative care unit or hospital is not always easy. It is a good idea to talk through the possibilities with your family and a trusted health professional.

If your condition deteriorates, or your family or friends are no longer able to care for you, you may need to consider options for inpatient or residential care.

Continuing care from a relative or friend#

If a relative or friend has been caring for you at home, you may want them to continue their caring role to some degree after you move into an inpatient unit or residential care home. Their level of involvement is up to you and them. They can take a hands-on approach if you wish, or provide emotional support and help with day-to-day tasks.

Talk to your loved one about the level of care they can commit to, and share your decision with the staff. It is important that you or your carer tell the staff about any cultural or spiritual wishes that need to be respected. There should be a quiet, private room available for you to talk with staff.

Inpatient palliative care units are designed to support both you and your carer. You may want to bring in special items from home, such as music, photos and books, to make things more comfortable, or ask your carer to help you with this. It is important for those who have cared for you at home to remember that choosing inpatient care is not an admission of failure or giving up. They can continue caring for you, in a different way and in a different place.

Getting a referral#

If you need admission to a specialist palliative care unit or a hospital, you will need a referral from your doctor.

Key points#

• Inpatient palliative care can help with symptom management, complex needs, respite, and care as the end of life approaches.
• Inpatient units aim to feel homely, with flexible visiting and space for family.
• Palliative care can be provided in public hospitals, private hospitals and residential care homes.
• You can record your preferences in an advance care plan, and a relative or friend can continue caring for you in a new setting.
• A referral from your doctor is needed to be admitted to a unit or hospital.

Where to get help#