Palliative nursing at home, connected to the treating team
EmpowerLink supports an established palliative plan in the person’s home, with attention to comfort, dignity, preferences, family communication and timely escalation. We work alongside—not in place of—the GP and specialist palliative care service.
What this service involves
EmpowerLink supports an established palliative plan in the person’s home, with attention to comfort, dignity, preferences, family communication and timely escalation. We work alongside—not in place of—the GP and specialist palliative care service.
Information for referrers
Referrals should include current goals of care, medication and symptom plans, advance care information, expected nursing tasks, equipment, family contacts and clear instructions for deterioration and after-hours escalation.
Who this service may suit
- NDIS participants seeking disability-related nursing supports that align with their approved plan
- Support at Home participants whose registered provider is seeking to arrange an agreed nursing service through a documented third-party delivery arrangement
- Private clients and families seeking self-funded nursing care after a written scope and fees are confirmed
- People living with a life-limiting illness who want planned nursing support at home
- Families and carers implementing an agreed palliative care plan
- Hospitals, GPs and specialist palliative services arranging community support
Eligibility and funding
- A current treating team and palliative care plan are required; service scope is agreed with the person and authorised decision-makers.
- Health-system, disability and aged-care funding responsibilities must be confirmed before service.
- For a Support at Home participant, service can begin only if their registered provider formally engages EmpowerLink for the agreed service under a documented third-party delivery arrangement. The registered provider remains responsible for care management, the service agreement and program obligations. EmpowerLink does not claim direct Support at Home provider approval.
- Private clients can request a written scope and quote. Care begins only after clinical fit, service capacity, fees, products or consumables, and the service agreement are confirmed.
Care that may be included after intake
The final scope is documented for the individual person after clinical, operational and funding review.
- Nursing assessment and observations defined by the goals-of-care plan
- Medication and symptom-support tasks covered by current prescriber instructions
- Skin, continence, nutrition, comfort and personal-care coordination within scope
- Education for the person and family about the documented plan and escalation contacts
- Communication with the GP, specialist team, pharmacy and authorised family
- Recognition and escalation of changing symptoms or carer support needs
From referral to planned visits
- 01
Understand what matters
Intake records the person’s goals, communication needs, cultural and spiritual preferences, decision-makers and desired place of care.
- 02
Connect the care plan
We confirm roles, medication orders, symptom actions, equipment, pharmacy, GP and specialist palliative care contacts.
- 03
Provide planned support
Visits focus on the agreed nursing tasks, comfort observations, education, documentation and family communication.
- 04
Escalate early
New or uncontrolled symptoms and carer strain are raised through the documented clinical and after-hours pathways.
Safety and clinical governance
- Current goals of care, medication orders and escalation contacts must remain accessible in the home.
- Uncontrolled symptoms require prompt contact with the treating or specialist palliative team; immediate danger requires Triple Zero (000).
- Advance care directives and substitute decision-makers are respected according to the documented legal and clinical plan.
- Statements about likely course, prognosis or medication changes remain the responsibility of the authorised treating clinicians.
Service boundaries
- EmpowerLink complements the medical and specialist palliative team; it does not replace them.
- A home death cannot be promised and must be supported by an appropriate clinical and legal plan.
- Funding and round-the-clock availability are never assumed from an enquiry.
Palliative care FAQs
Is palliative care only for the final days of life?
No. Palliative care can be introduced while a person continues other treatment and may support comfort and quality of life over time. The person’s treating team determines the appropriate clinical pathway.
Can EmpowerLink manage symptoms without a GP?
No. Nurses implement current authorised plans and communicate observations; prescribing and medical management remain with the appropriate doctor, nurse practitioner or specialist service.
Can you support a person who wants to remain at home?
We can assess the nursing component of an agreed home-care plan. Feasibility depends on clinical needs, family and community supports, equipment, funding, workforce and access to medical and specialist palliative care.
What information is needed to assess a palliative care referral?
Provide the current goals of care, medication and symptom plans, treating and after-hours contacts, advance care information where applicable, requested nursing tasks, equipment needs and preferred communication arrangements. Intake may require further clinical handover before confirming service.
Can family members and carers be included in visits and updates?
Yes, according to the person’s consent, communication preferences and any documented substitute decision-making arrangements. Intake records who may receive routine information and who should be contacted when needs change.
What happens if symptoms become uncontrolled between planned visits?
Use the documented GP, specialist palliative care or after-hours pathway promptly rather than waiting for the next visit. Call Triple Zero (000) for an immediate threat to life or another emergency, in keeping with the person’s current goals-of-care and emergency plan.
Does a referral guarantee 24-hour or after-hours care?
No. The accepted visit schedule and any after-hours arrangements depend on the care plan, funding, clinical scope and available workforce. Nothing is confirmed until it is documented in the service agreement.
Discuss a palliative referral
Share the goals of care, treating contacts and requested nursing support.