1. Rural end-of-life care in New Zealand, Australia and South East Asia Rod MacLeod Department of General Practice and Primary Health Care University of Auckland and North Shore Hospice, Takapuna rd.macleod@auckland.ac.nz

2. The overall trends – not really different ‘down under’ An aging population Increasing life expectancy Rising numbers of the oldest old [Growing burden of non-communicable disease] Changing family structure Shifting patterns of work and retirement Evolving social insurance systems Department of State and the Department of Health and Human Services. 2007. Why Population Aging Matters: A Global Perspective. Washington DC: National Institutes of Health

3. Asia Pacific Hospice Palliative Care Network 600 services throughout the region Vary from comprehensive urban programs to rudimentary rural ones Over 1000 members from 29 countries Split into 5 regions East Asia; central Asia; south-east Asia; south Asia; Pacific www.aphn.org

4. Malaysia Perhaps up to 40% of deaths not registered in Malaysia Penang General Hospital 1999-2001 Place of death Home 94 (60%) Penang General Hospital 41 (26%) Nursing homes 13 (8%) Unknown 8 (5%)

5. Malaysia Penang Hospice at home 1992-2005 Place of death Home 1999 (79%) Hospital 515 (20%) Nursing homes 27 (1%)

6. Michael Wright with Ednin Hamzah, Temsak Phungrassami and Agnes Bausa-Claudio Oxford University Press Hospice and Palliative Care in Southeast Asia

7. Australia Foreman LM, Hunt RW, Luke CG, Roder DM. Factors predictive of preferred place of death in the general population of South Australia. Palliative Medicine 2006; 20: 447-453 2652 respondents aged 15+ if dying of ‘a terminal illness such as cancer or emphysema’ Predictors of preference of preferred home death include younger age, male, born in UK/Ireland or Italy/Greece, better physical health, poorer mental health

8. Australia Place of death 2000-2002 % deaths ActualPreference Hospital56.4%28% Hospice17.7%12.2% Nursing home11.7%1.8% Home14.1%58.1%

9. Australia Currow DC, Burns CM, Abernethy AP Place of death for people with noncancer and cancer illness in South Australia: a population-based survey. Journal of Palliative Care 2008; 24,3, 144-150 9,500 households – 31% had someone close die of a terminal illness in the preceding five years 62% of deceased had accessed palliative care Palliative care involvement did not reduce institutional deaths

10. Australia

12. McNamara B, Rosenwax L Factors affecting place of death in Western Australia Health & Place 2007; 356-367 Almost half of Western Australians died in hospital With increasing age there is a tendency to die in your place of residence People accessing specialist palliative care had a seven times higher chance of dying in their usual place of residence

13. Australia 26,882 people died in WA in 2.5 year study 48.6% died in hospital 35.8% died in place of residence (private 20.2%; RAC 15.6%) 5.5% died in hospice 6.3% died in some ‘other’ place McNamara B, Rosenwax L. Factors affecting place of death in Western Australia. Health & Place 2007; 356-367

15. Hospice care in NZ Patients (total) In-patient admissions Community visits (nursing etc) Average length of stay 200911,9634,47989,299 200813,3505,073128,9938.2 days 200710,7484,586118,3009.7 days

16. Hospice care in NZ Place of death Residential aged care HomeHospitalHospiceTotal 20091390 (20%) 2261 (33%) 1363 (20%) 1792 (26%) 6916 20081926 (24%) 3852 (46%) 1207 (15%) 2044 (25%) 8150 20071079 (17%) 2744 (43%) 905 (14%) 1573 (25%) 6301

17. Palliative Care Partnership Stewart B, Allan S, Keane B et al (2006) Palliative Care Partnership: a successful model of primary/secondary integration New Zealand Medical Journal 119(1242) http://www.nzma.org.nz/journal/119-1242/2235/ McKinlay E, McBain L (2007) Evaluation of the Palliative Care Partnership: a New Zealand solution to the provision of integrated palliative care New Zealand Medical Journal 120(1263) http://www.nzma.org.nz/journal/120-1263/2745/