With an ageing population and growing demand for palliative care, the iGEM unit at Blacktown Hospital is showing what’s possible when hospitals and aged care services work together to support older people to return home sooner.
As Australia’s population ages, more people are living in residential aged care. Ensuring their care aligns with their values, goals, and clinical needs is essential. There is growing recognition that introducing palliative care earlier, not just in the final days of life, leads to better outcomes for older people.
At Blacktown Hospital in Western Sydney, a new model of care is helping to make this vision a reality. The Integrated Geriatric Emergency Medicine (iGEM) unit is a specially designed hospital unit for older patients, ensuring they receive timely care that meets their complex needs. The model of care at iGEM supports the patients to return home, reducing unnecessary hospital admissions and aligning with end-of-life goals of people living in residential aged care facilities (RACF). At the same time, iGEM staff help identify patients and families who may benefit from connection to palliative care support services.
The iGEM unit operates within the emergency department at Blacktown Hospital. It offers a quieter, calmer, and more tailored environment for older patients. With low noise levels, calming lighting, and dementia-sensitive design, the unit provides a supportive space for patients with complex health needs, including those living with life-limiting illness.
But the real innovation lies in the clinical approach. In true patient centred care, the iGEM team assesses a patient’s acute medical condition as well as identifying care and services that may best help them safely return home in alignment with their care goals. The team works closely with the Community Aged Care Rapid Evaluation (CARE) team, Hospital in the Home, palliative care clinicians, and the person’s GP to ensure a care plan is in place. This helps make the transition back to their RACF safer and smoother, and means hospital-level care and support continues after discharge when needed.
Originally established as a three-month trial in 2024, the unit is now a permanent part of Blacktown Hospital’s care model, following strong outcomes and positive feedback. Between July 2024 and January 2025, more than 600 patients accessed care through the iGEM unit. Previously, patients in this group might have remained in hospital for an average of 7 to 10 days. Now, around 90% return to their RACF within 24 hours, where integrated care continues under the guidance of RAC staff, GPs, and community-based health teams.
Advance care planning plays a key role in making models like iGEM effective. When a person’s values and preferences are discussed and documented early, through an Advance Care Plan or Advance Care Directive, clinicians, families, RAC staff can make decisions that truly reflect what matters most to each individual. For people living in RACFs, this can be the difference between an unwanted hospital admission and end-of-life care in familiar surroundings at home.
While formal evaluation is still underway, early outcomes from the iGEM unit are promising. They point to reduced hospital stays, improved experiences for patients, families and carers, and a clearer pathway for introducing palliative care support at the appropriate time. Above all, the investment in this iGEM unit shows how a thoughtful, well-designed model of care can ensure that patients are supported to receive the care they need in familiar surroundings, and if appropriate, to die well at home.
Importantly, this model can reshape how and when we talk about palliative and end-of-life care goals. By providing a setting and opportunity for these conversations earlier, we can ensure that older people as well as their families and carers are empowered to make informed choices about their care.
Written by Sarah Whiteley.