Thousands of Victorians are missing out on timely palliative care, with a landmark report revealing major gaps as an ageing population puts growing pressure on services.

When a Victorian woman’s mother was diagnosed with advanced cancer, her family thought palliative care meant one thing: giving up. They didn’t know it might have helped her spend more time at home instead of in a hospital ward, and they didn’t know a palliative care nurse could help manage her pain so she could still sit at the kitchen table with her grandchildren.

By the time the family was referred, there were just four days left.

Their experience, recounted anonymously in Victoria’s first comprehensive statewide report into palliative care, illustrates a problem affecting thousands of families: help is often arriving late, and estimated need for care is already far greater than the system’s capacity to provide it.

Thousands missing out on care

The State of Palliative Care in Victoria report, developed by the University of Melbourne’s Palliative Care Economics team for Palliative Care Victoria, estimates 34,457 Victorians could have benefited from palliative care in 2024.

Using specialist workforce capacity and nationally endorsed minimum service benchmarks, researchers estimated unmet need at 22,889 people. That is equivalent to 63 Victorians a day, with current specialist service capacity sufficient to meet only about one-third of estimated need.

There has been some progress. The proportion of Victorians who died after accessing palliative care services rose from 39.1 per cent in 2018 to 44.5 per cent in 2024.

But timing remains a major concern.

Fewer than 11.8 per cent of Victorians who died in 2024 had accessed palliative care more than three months before death.

For people with cancer, fewer than one in three received a timely referral, defined by the report as more than three months before death. For people with heart disease, dementia and Alzheimer’s disease and cerebrovascular conditions, timely access was just 6 per cent.

Palliative care doesn’t mean giving up

For older Australians and their families, understanding what palliative care means can be an important first step.

It is not simply care provided during the final days of someone’s life.

Australian Government health advice says palliative care can be provided at any stage of a life-limiting illness and people can continue receiving treatment for their illness at the same time. It can involve pain and symptom relief, emotional and psychological support, planning future medical care and support for family and friends.

It can also be provided in different settings, including at home, in hospital, in a hospice or in residential aged care.

Palliative Care Victoria Chief Executive Officer Violet Platt said the new report provided an important baseline for understanding where the system stood and what needed to change.

“This report gives Victoria an important baseline for understanding where palliative care is today – and what must change to meet future need,” Platt said.

“Tomorrow’s care starts today, with planning, investment and action.”

Associate Professor Chris Schilling, Head of the Palliative Care Economics Unit at the University of Melbourne, said many Victorians were finding palliative care too late.

“Too many Victorians are finding palliative care too late,” he said.

“For people with conditions other than cancer, only around 6 per cent receive palliative care three months or more before death.

“Yet earlier palliative care can improve quality of life, support families and potentially reduce unnecessary healthcare use.”

Regional families face another hurdle

Where people live can also affect the availability of specialist care.

Victoria has 0.7 clinical specialist palliative care physicians per 100,000 people, below the national average of 1.1 and the minimum service planning benchmark of 2.0.

The shortage is particularly pronounced outside metropolitan areas, where physician supply is only one-quarter of the recommended minimum benchmark.

Community services are also facing financial pressure.

Expenditure among community palliative care providers surveyed reached $50.1 million in 2024-25, while recurrent government funding reached $43.6 million, leaving a reported $6.5 million gap. The report cautions that these figures do not represent the entire Victorian palliative care system and may in fact be conservative because not every provider was captured.

The pressure is only expected to grow

Victoria’s ageing population makes those shortages increasingly significant.

The report projects the number of Victorians requiring palliative care will increase from 34,457 in 2024 to 59,047 by 2045.

Over the same period, the state’s population is projected to grow by 1.3 per cent a year, while deaths – and consequently the report’s estimate of palliative care need – are projected to grow at 2.6 per cent a year.

If current settings continue, estimated unmet need would reach 27,872 people by 2045, equivalent to 76 Victorians each day.

For families, however, one of the report’s most useful messages may have little to do with projections or funding.

Palliative care does not necessarily mean death is imminent. Australian Government guidance says people may receive it for years if needed.

For older people living with a life-limiting illness and those caring for them, having that conversation earlier may mean more support, better symptom management and more choices about how and where that time is spent.