Assess Palliative Care Needs

Palliative care is person and family-centred care provided for a person:

with an active, progressive, or advanced disease
who has little or no prospect of cure
who is expected to die, and
for whom the primary goal is to optimise the quality of life.

Palliative care helps people live their life as fully and as comfortably as possible with a life-limiting or terminal illness. It identifies and treats symptoms which may be physical, emotional, spiritual or social. [1]

Assessing palliative care needs in residential aged care is crucial because it ensures that older people with life-limiting illnesses receive comprehensive, person-centred care. This means that all needs are addressed including: Physical, psychological, social, and spiritual needs.

Early detection and correct assessment of palliative care needs is an ongoing process, essential for care planning and continuity of care.

All older people who are identified as being at the end of life by using the SPICT^TM (pdf) screening tool should have a palliative care needs assessment. The holistic life experiences of a person, such as age, culture, religion, ethnicity, or experience should be considered.

How to undertake a palliative care needs assessment
The Palliative Care Needs Assessment Guidance [2] provides a framework across four domains:
- Domain 1 – Physical Wellbeing
- Domain 2 – Social and Occupational Wellbeing
- Domain 3 – Psychological Wellbeing
- Domain 4 – Spiritual Wellbeing. [2]
Check to see whether your service or organisation provides any guidance regarding assessing these domains. Within each of these domains, there are some specific tools or scales that might be useful to understand the needs of the older person and their family and carers.
Each older person will have an individual symptom profile and requires a comprehensive assessment.

Symptom Assessment Scale (SAS)

The SAS can be used as a self-report tool. It provides a report of whether a symptom is present and an indication of the impact of that symptom. The SAS is based on a rating scale of seven common symptoms and has space to add additional symptoms. SAS also allows for rating by proxy when assessing an older person who has cognitive impairment or is non-verbal. The Palliative Care Outcomes Collaboration (PCOC) has a guide explaining the Symptom Assessment Scale (pdf).

Where a symptom has been identified, further assessment using specific tools can provide more details. This might help identify the underlying cause of the symptom or assist with treatment options. The following is a suggested list of tools in addition to the SAS.

Pain Assessment

Modified Resident’s Verbal Brief Pain Inventory (M-RVBPI) (pdf): A comprehensive assessment of pain for older people who are able to communicate.

Abbey Pain Scale (240kb pdf): A simple tool that can be used when an older person is unable to communicate their pain.

Dyspnoea (shortness of breath) Assessment

Modified Borg Scale (mBORG) (pdf). A self-reported measure of the intensity of the sensation of breathlessness. A numeral rating is used that is linked to verbal descriptors.

Delirium Assessment

4AT. A screening tool used as an initial assessment to detect delirium and cognitive impairment.

Nutrition Assessment

The Mini-Nutritional Assessment Short-Form (MNA®-SF) (pdf). A screening tool to identify people over 65 years of age who are malnourished or at risk of malnutrition.

Oral Health Assessment

The Oral Health Assessment Tool (pdf). A clinical assessment of oral health status that can be used to assess older people who are unable to reliably self-report.

Frailty Assessment

Clinical Frailty Scale (Rockwood) (pdf). Used to assess the degree of frailty.

Pressure Ulcer Risk

The Braden Pressure Ulcer Risk Assessment (pdf) evaluates risk for pressure ulcer development.

This domain explores the person’s experience in relation to:

their background

family and carer support

emotional and social support

practical concerns, and

impact on their usual functioning.

For instance, consider the older person’s:

Experience of family/carers and relationships: ‘Do you have any concerns or worries about your family/carers or personal relationships?’

Experience of support: ‘Who is around to support you? What kind of support do they give? Has this been helpful?’

Practical concerns, including any worries about finances, sorting affairs, and advance care planning.

Older people with life-limiting conditions often have psychological concerns. These can include symptoms of anxiety, depression, and past experiences of trauma. Proactive assessment of these concerns is important.

An open question such as ‘Is there anything worrying you?’ can be a helpful place to start.

Depression is common in older people. The Geriatric Depression Scale (GDS(pdf)) is a good screen to indicate depression may be present.

A person’s spiritual care includes faith, cultural background, beliefs, traditions, and any other ways an older person makes sense of their world and experience. Older people have the right to express their spirituality in a way that is meaningful for them. The identification of spiritual needs and offering of basic spiritual care is the responsibility of all who work in aged care, in ways that are appropriate to their role.

If you want to read further, palliAGED provides a summary of spiritual care.

Hope Spiritual Assessment Tool: A Step-by-Step Guide aids in better understanding an older person’s spiritual beliefs and needs. This enables the team to provide meaningful spiritual care.
How to build knowledge, confidence and skills in assessing palliative care needs in residential aged care
- - Gain a better understanding about delivering palliative and end-of-life care by listening to the ELDAC podcast series ‘The What to do, When and How’.
  - Watch the ELDAC Assess Palliative Care Needs educational video that describes the importance of person-centred and holistic assessment. The video identifies the four domains of wellbeing used in a palliative care assessment. It emphasises the use of care planning to support end-of-life care.
  - Use the ELDAC Case Study on Dorothy to build your understanding of how to assess palliative care needs within the four domains in the framework. These include physical, social and occupational, psychological and spiritual needs.
  - The free Equip Aged Care Learning Modules are produced by the Wicking Dementia Research and Education Centre at the University of Tasmania. A range of aged care related topics are covered, including palliative and end-of-life care.
  - The Agency for Clinical Innovation hosts a free palliative care video library. These videos were developed with Australian healthcare specialists to assist in the delivery of appropriate palliative care. There are videos on topics for physical and clinical, psychological, and spiritual and cultural.
  - Learn how to use the Symptom Assessment Scale (SAS) from this short video by the Palliative Care Outcomes Collaboration (PCOC).
  - There is guidance available for assessing specific symptoms:
    - Non-verbal pain assessment. The Agency of Clinical Innovation has a video discussing where to start in a pain assessment and different strategies to use.
    - 4AT. The about the 4AT web page includes the user guide, scoring summary, FAQs and case studies.
    - Braden Scale. Information on pressure injuries and scoring the Braden Scale.

References
1. Australian Government Aged Care Quality and Safety Commission. Draft Glossary of Terms: Guidance material for the strengthened Aged Care Quality Standards for review and discussion (pdf). 2024 [cited 12 Feb 2026].
2. The National Clinical Programme for Palliative Care, HSE Clinical Strategy and Programmes Division. Palliative Care Needs Assessment Guidance. HSE Ireland. 2014 (reviewed 2016). [cited 8 Dec 2025].

How to undertake a palliative care needs assessment

How to build knowledge, confidence and skills in assessing palliative care needs in residential aged care

References