When things feel unmanageable
Most people do not want to spend their final days in hospital, yet many do.
They arrive in crisis. Often late at night, often exhausted. Sometimes frightened, and sometimes because the people caring for them no longer know what to do.
This is not because families have failed. And it is rarely because care teams have done the wrong thing.
It happens because end-of-life care in Australia often begins too late, and because much of what people need at this stage of life is not medical at all.
Crisis is rarely sudden
When people reach crisis at the end of life, it can look abrupt. A rapid decline. A panicked phone call. An ambulance transfer that no one planned for. An emergency department visit that feels unavoidable.
But a crisis usually builds quietly over time.
It grows from unanswered questions and mounting uncertainty. From fear about what is coming next. From carers taking on more responsibility than they ever expected, without enough guidance or reassurance. From not knowing who to call, what is normal, or whether it is acceptable to ask for help.
When there is not enough support at home, hospital can begin to feel like the only safe option left, even when it is not the most appropriate or preferred place to be.
Beyond medical care
Medical and care teams do essential work. They manage symptoms, monitor changes, prescribe treatments and respond when situations escalate. Their role is critical and often life-saving.
But there is a significant gap between clinical care and the lived experience of dying.
This is the space where people wonder what the coming weeks or months might actually look like. Where families worry about how they will cope emotionally and practically. Where conversations about fear, meaning, unfinished business or spiritual concerns sit quietly, waiting for space that rarely appears in busy systems.
When these needs remain unaddressed, stress increases and confidence erodes. Decisions begin to feel reactive rather than considered. Over time, a tipping point is reached.
“Most end-of-life crises are not caused by sudden decline, but by unmet emotional, practical and relational needs that build over time.”
Why earlier support matters
End-of-life support works best when it begins earlier than the final days or weeks.
Earlier support allows people to understand what is happening and what may lie ahead, without being overwhelmed. It creates space for conversations about values, preferences and priorities. It helps people prepare emotionally and practically for change, rather than reacting to it. It also supports carers before they become exhausted or distressed.
Early support is not about predicting death or taking away hope. It is about reducing fear of the unknown and giving people a greater sense of control as circumstances shift.
When people feel informed and supported, fewer decisions are made in panic. Care becomes more intentional. And crisis becomes less likely.
Where End of Life Doulas fit
End-of-life care in Australia is complex, under-funded and under increasing pressure as our population ages. Medical and care teams do essential work, but much of what people and families need at the end of life sits outside the clinical scope of practice. End of Life Doulas offer additional, non-clinical support, focusing on emotional, relational, spiritual and practical needs that health and aged care services often do not have the time or resources to meet. Through consistent presence and continuity of support, End of Life Doulas help people and families feel held, informed and supported across the journey. This support does not replace clinical care – it strengthens the overall care response.
When this kind of support is introduced earlier, it often changes how people experience decline. It also changes how families cope and how decisions are made when pressure increases.
Supporting carers before breaking point
It’s not just medical deterioration that causes end-of-life crises. It’s often due to carer exhaustion.
Family members often step into complex caring roles with little preparation. They manage medications, appointments, household responsibilities and emotional support, while also carrying their own fear and grief. Over time, the load becomes heavy.
When carers feel alone or unsure, hospital can feel like the only remaining option.
Earlier, consistent support helps carers feel less isolated and more confident. It gives them space to ask questions, talk through concerns and understand what is happening. It reassures them that they are doing enough and that support is available before things become unmanageable.
Supporting carers is not separate from end-of-life care. It is central to it.
A different outcome is possible
Getting support early in the end-of-life journey helps to reduce the likelihood of crisis, helps families feel more prepared, and enables decisions to be made with greater confidence.
This does not mean hospital care will never be needed. Sometimes it is absolutely necessary. However, the hospital is used with intention, rather than as a last resort when support elsewhere feels absent.
Getting earlier support changes the tone of the journey. It allows people to remain where they feel safest for longer, often at home, with greater clarity and confidence.
A shared responsibility
There is no single answer to improving end-of-life care in Australia. The system is under strain, and demand will continue to grow.
But when we acknowledge the limits of clinical systems and make space for additional, non-clinical support, we move toward a more realistic and compassionate model of care.
End of Life Doulas are not a standalone solution. They are part of a broader response that recognises dying as both a medical and a deeply human experience. When non-clinical support is valued alongside clinical care, people, families and services are better supported, and the way we die begins to change.
About the Author
Shannon Beresford is the Director of Your Path Guide Pty Ltd, an Adelaide-based practice dedicated to helping people live and die with comfort, meaning and connection. His work brings together End of Life Doula care, sound therapy and compassionate travel experiences that honour each person’s story and choices.
As Chair of HELD Australia Ltd, the national peak body for holistic end-of-life and death-care practitioners, Shannon advocates for stronger recognition of the End-of-Life Doula role across Australia’s health and aged care systems. He also holds a Certificate IV in End-of-Life Doula Services, the only nationally accredited qualification in this field, and volunteers with the Central Adelaide Palliative Care Service (CAPCS), providing practical and emotional support to individuals and families in their final weeks of life.
References
Palliative Care Australia (2025). Australia can relieve hospital ‘bed block’ with palliative care investment.
https://palliativecare.org.au/mediarelease/australia-can-relieve-hospital-bed-block-with-palliative-care-investment/
Australian Institute of Health and Welfare. Palliative care services in Australia.
https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia
World Health Organization. Palliative care.
https://www.who.int/news-room/fact-sheets/detail/palliative-care
Your Path Guide Pty Ltd 