Palliative care for an ageing population: a rural based model? Or, “For whom the bell tolls” \ud

Statistics show that Australia has an ageing population which will experience radical changes over the next 50 years due to the progression into retirement of generations born in the ‘baby boom’ years (1945-1965). Statistics also show that the proportion of Australian people over 65 is increasing and, as the majority of deaths occur in this age group the demand for palliative care, or care of the dying, is also likely to increase. Many retiring baby boomers looking for a sea change, gravitate towards coastal and rural areas may well be contributing to Foskey’s (1998) notion of ‘Aged Care Ghettos’ where these areas may not have the desired infrastructure to deal with an increased demand for health services including palliative care services. An increasing focus on, and public interest in palliative care research will likely emerge in keeping with the changing needs of an ageing population. It will become particularly important that relevant research undertakings are initiated to establish a clearer understanding of the issues and problems surrounding palliative care. At the present time there exists a limited research base in relation to palliative care and related services in Australia. While there has been a concentration of palliative support services in urban settings this has not been the case in rural based settings. Palliative Care Australia (2000) reported that half of the people receiving palliative care in Victoria in 1997 died in rural and regional areas, which may be attributed to harsher living environments, poor access to health services, specialists, and health professionals, lower socio-economic status and employment levels, and exposure to occupational hazards. This thesis is concerned with examining palliative care services and related needs in a selected rural area within the Australian state of Victoria. The overall aim of this research was to investigate the availability of palliative care services, trends in ageing and to examine the relationship between the two. Methodology used in this research incorporated a sequential mixed methods approach of quantitative and then qualitative methodology to determine the relationship between the needs of an ageing population and rural palliative care service delivery in Australia. The data collection included demographic statistics from the Australian Bureau of Census and Statistics and Palliative Care Australia, and were used for descriptive purposes to inform and support this research. Other ordinal data were obtained using a questionnaire. These data were analysed in the context of the research. Qualitative data were obtained through interviews with focus groups. The Gippsland area provided an excellent area for this research and the findings of this research would appear to be consistent with the literature relating to access and equity issues faced in rural areas. Other rural areas may replicate the data gathering used in this research. A number of conclusions are able to be drawn from this research based on the review of literature and examination of the emerging issues, results and findings. Statistical projections into ageing indicate that the health of all Australians will have significant consequences for our society as we generally live longer and healthier lives. Health and ageing predictions and projections should prompt key stakeholders including baby boomers, the aged cohorts of the future, to plan and prepare, perhaps redefining ageing in the attempt. Findings further show that planning should include preparations for the expected rise of dementia related diseases and the implications of gender on health which will have ramifications for an ageing population, and in particular for women as carers in our society. As a result of this research recommendations are made for a model for the delivery of palliative care services in rural areas, which is specific to the needs of an ageing population. These recommendations are made in acknowledgement and with respect and consideration for the concerns of the rural community where feedback from focus group participants suggests that rather than another ‘model’, a hospice is what is needed to meet the current and future needs of rural communities. “Another ‘Model’ is the last thing we need, it’s not the how we are doing things, it’s the where – we desperately need a hospice down here” and, “It’s bricks and mortar we want down here, not more theories”. Evidence collected from this research also suggests that a ‘rural attitude’ to death and dying may prevail. In its simplest form, this attitude emerges in statements such as: ‘it’s the country you expect to get less’ and ‘we just look after our own when we can’. It is also apparent that while people in rural areas have the same medical and palliative care needs as those in metropolitan areas, this research shows that they are differentially disadvantaged when it comes to accessing palliative care services. This research has found that a negative relationship exists between ageing trends in a selected rural area of Australia chosen for this study and the availability of palliative care services. \ud \ud \ud \u