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Home Care Clinical Care Assess Your Knowledge Organisational SupportResidential Aged Care Assess Your Knowledge Clinical Care
- Advance Care Planning
- Recognise End of Life
- Assess Palliative Care Needs
- Provide Palliative Care
- Work Together
- Respond to Deterioration
- Manage Dying
- Bereavement
End of Life Law Toolkit Capacity and Consent to Medical Treatment Factsheet: Advance Care Directives Futile or Non-Beneficial Treatment Legal Protection for Administering Pain and Symptom Relief Managing Disputes about Medical Treatment Decision-Making Substitute Decision-Making Urgent Medical Treatment Voluntary Assisted Dying Withholding and Withdrawing Life-Sustaining Medical Treatment Overview of End of Life Law in Australia Advance Care DirectivesHome Care Residential Aged CareAssess Your Knowledge Clinical CareEnd of Life Law Toolkit Dementia Toolkit Education Other ToolkitsAdvance Care Planning Recognise End of Life Assess Palliative Care Needs Provide Palliative Care Work Together Respond to Deterioration Manage Dying BereavementOrganisational SupportRecognise End of Life
An older person may enter into residential aged care for more support managing their increasing care needs over the long term. While living in residential aged care and as the older person continues to age, they probably will experience more health issues. Therefore, they are more likely to die while in residential aged care. In 2019, residential aged care facilities were the second most common place of death after hospital/medical services areas, accounting for 29.5% of all deaths. [1] So it is important for the aged care team to have the ability to quickly recognise the signs that an older person may be approaching the end of their life. This will enable them provide for the person’s end-of-life care needs in a timely manner.
The period of end of life is when a person is living with, and impaired by, a fatal condition. The trajectory of this condition may be ambiguous or unknown [2, p27].
To inform care, the Australian Commission on Safety and Quality in Health Care (ACSQHC) state: “people are ‘approaching the end of life’ when they are likely to die within the next 12 months. This includes people whose death is imminent (expected within a few hours or days) and those with:
- advanced, progressive, incurable conditions
- general frailty and co-existing conditions that mean they are expected to die within 12 months
- existing conditions, if they are at risk of dying from a sudden acute crisis in their condition
- life threatening acute conditions caused by sudden catastrophic events.” [2, p27]
However, the length of the period of end of life can still vary significantly. It may be years where an older person has a chronic or malignant disease, or very brief, where an older person suffers acute and unexpected illnesses or events, such as sepsis, stroke or trauma. [2]
End-of-life care ‘includes physical, spiritual, and psychosocial assessment, and care and treatment delivered by healthcare workers. It also includes support of families and carers and care of the person’s body after their death.’ [2, p27]
Residential aged care services provide the majority of end-of-life care for older people living in this setting. RAC services also support their families and carers. In cases where extra support is needed, referral to a specialist palliative care service may be required. This is explained in more detail in the RAC Toolkit section on Work Together.
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How to recognise end of life in residential aged care
The use of routine and simple trigger tools and questions can provide prompts for health care workers to undertake a holistic assessment of an older person to see if they would benefit from end-of-life care. [2]
What tools can I use to identify that an older person may be approaching the end of life?
The surprise question is suggested as a simple trigger tool to use as the first step. Ask yourself of an older person:
- “Would you be surprised if the older person died in the next 12 months?”
- “Would you be surprised if the older person died in the next days or weeks?
If the answer is ‘no, I would not be surprised’ they may be approaching the end of life.
he Supportive and Palliative Care Indicators Tool (SPICTTM) (pdf) is a screening tool often used in addition to the Surprise Question.
- The SPICTTM helps identify changes early in a person’s health and wellbeing. It can be used to continually monitor a person’s condition. These include any general indicators of poor or worsening health. Also, clinical signs of one or more life-limiting health conditions, and increasing burden of illness. To identify that someone may need end-of-life care, at least one of each of the general and clinical indicators would have a positive response.
- Visit the SPICTTM website for user guidelines and further information about this free tool, including:
- The SPICT-4ALLTM (pdf) is another version using easy to understand language. It is designed to be used by everyone including people with long-term illnesses, family and carers and the healthcare team. The SPICT-4ALLTM makes it easier to identify and discuss the signs that a person’s overall health may be declining. This ensures they receive the care they need in a timely manner. More information is available, including guidance on using this tool on the SPICT-4ALLTM web page.
- The Australia-modified Karnofsky Performance Status (AKPS) (2.69MB pdf)is a measure of an individual’s overall performance status or ability to perform their activities of daily living.
- The AKPS measures performance across the dimensions of activity, work and self-care. An AKPS score of 100 signifies normal physical abilities with no evidence of disease. Decreasing numbers indicate a reduced ability to perform activities of daily living.
Remember, end-of-life care may also be required for an older person who has an acute deterioration. There is more information about this in the Respond to Deterioration section of this Toolkit.
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How to build knowledge, confidence and skills in recognising end of life in residential aged care
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- Gain a better understanding about Recognising the last days and years of life by listening to the ELDAC podcast on this topic.
- Watch the ELDAC Recognise End of Life educational video to help you to recognise the common signs of end of life. The video can assist in understanding the use of end-of-life tools, such as SPICTTM and the Surprise Question.
- Review the SPICTTM user guidelines to learn more about:
- assessing people’s needs and planning care
- talking about future care planning
- starting conversations about changes in health and care planning.
- Gain a better understanding of the clinical indicators used in the SPICTTM:
- palliAGED offer information and resources to help understand comorbidity and multimorbidity.
- palliAGED has practice tips on frailty for Nurses (pdf) and Careworkers (pdf).
- The ELDAC Dementia Toolkit provides information and guidance about people living with dementia at the end of life.
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Information for families and carers
CareSearch
This webpage offers simple information about the signs that an older person may be declining in health over time.
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References
- Australian Bureau of Statistics. Classifying Place of Death in Australian Mortality Statistics: A pilot study applying a framework for the classification of place of death to the Australian mortality dataset. 14 April 2021 [cited 3 April 2025].
- Australian Commission on Safety and Quality in Health Care (ACSQHC). National Consensus Statement: Essential elements for safe and high-quality end-of-life care (pdf). Sydney: ACSQHC. 2023. [cited 3 April 2025].
Page updated 28 September 2026
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