Claire Johnson

National Director, Palliative Aged Care Outcomes Programs (PACOP)

The Palliative Aged Care Outcomes Program: A Best Practice Model of Palliative and End-of-Life Care for People Living in Aged Care Homes

Wednesday 12 October 2022

2:30pm – 3:00pm

Speaker Bio

Professor Claire Johnson (RN, PhD) is the national director of the Palliative Aged Care Outcomes Program (PACOP) at the Australian Health Services Research Institute. Claire is leading the development and implementation of PACOP to promote excellence in end of life care in residential aged care. In previous roles, which included the Vivian Bullwinkel Chair of Palliative Care Nursing (Monash University) and Clinical Lead for End of Life Care (Eastern Health, Melbourne), Claire conducted clinical, behavioural and translational research to improve the quality and safety of care for people diagnosed with a life-limiting illness and of their families—irrespective of the setting of care.


More than one-third of all people who die in Australia each year are resident in aged care homes (ACHs), hence there is an imperative to provide palliative care in this setting. The Palliative Aged Care Outcomes Program (PACOP) is a national program, funded by the Australian Government Department of Health. PACOP promotes optimal palliative and end-of-life care for residents in ACHs and their families. It supports ACHs to use routine point of care assessment to inform and improve care.

PACOP is based on the world acclaimed Palliative Care Outcomes Collaboration (PCOC). After a pilot and evaluation of the PCOC Wicking model for residential aged care, extensive refinement was undertaken to ensure the new PACOP program meets the needs of ACHs, residents and their families.

PACOP has developed a model to monitor and respond to all residents’ end of life and palliative care needs. The program involves two modules.

The Profile Collection is the core module and involves the regular, comprehensive, standardised assessment of all residents in the ACH to identify the palliative care concerns of all residents and help identify those who are deteriorating and will benefit from receiving palliative care. Assessments form part of the routine cycle of assessment and care planning in the ACH and helps inform changes needed to the care plan.

The Outcomes Collection allows ACHs to fully implement PACOP. It introduces an assessment and response protocol to guide regular monitoring of symptom severity and distress, and to inform appropriate and timely care. The regular assessments allow the effectiveness of interventions and changes to care to be evaluated.

Participating ACHs receive six monthly outcomes and benchmarking reports which are used to systematically improve the care and outcomes in participating homes.

PACOP is a robust, evidence- based, best practice model of palliative care for aged care. In a person–centred approach, it allows residents and families to communicate their experiences and preferences, and improves communication within the team, and with residents, families and other health professionals. It provides comprehensive documentation for AN-ACC reviews, robust data and support for quality improvement systems, and evidence of compliance with Aged Care Quality Standards for accreditation.

This presentation will describe the PACOP program in detail, its benefits for residents, their families and ACH staff, and its potential for improving palliative and end of life care in the residential aged care setting.