PCOC Aged Care Assessment Forms

Four forms are used in PCOC’s residential aged care palliative care outcomes program. Using these forms as part of routine practice is key to driving improvements in outcomes.

  1. Download the PCOC resident details form (pdf) - used when a resident requires palliative care. It captures key information about the resident, for example diagnosis and preferred language.
  2. Download the PCOC care details form (pdf)) - captures information when a resident starts, changes or stops palliative care.
  3. Download the PCOC palliative assessment and clinical response form for RAC (pdf)- contains PCOC’s validated measures. It captures information to help the resident and their carers receive the care they need.
  4. Download the PCOC Symptom Assessment Scale (SAS) form for RAC (docx) - contains the PCOC SAS, a measure of distress related to common symptoms.

PCOC provides free education and training to help use these forms. There are also instructions on how to use these forms in PCOC’s Palliative care routine assessment and response protocol for residential aged care. PCOC can provide software (free of charge) to help manage your data. Access to a network of palliative care providers is also part of the program.

Residential aged care providers in Australia are welcome to contact us to participate in PCOC’s residential aged care palliative care outcomes program.


PCOC Aged Care Assessment Tools

PCOC’s model relies on the use of five tools. These five tools help assess the characteristics and needs of residents. All of the tools are validated. They perform well in terms of their measurement properties. They perform well within the clinical settings. They are easy to use as part of routine care. Each tool has been used with hundreds of thousands of patients over the last decade.

  1. Palliative Care Phase
  2. PCOC Symptom Assessment Scale (SAS)
  3. Palliative Care Problem Severity Scale (PCPSS)
  4. Australia-modified Karnofsky Performance Status (AKPS) scale
  5. Resource Utilisation Group - Activities of Daily Living (RUG-ADL)

The Palliative Care Phase identifies a clinically meaningful period in a resident’s condition. Phase is determined by a holistic assessment, which considers the needs of the resident and their family and carers. A change in phase represents a change in the resident’s clinical condition and/or a change in the resident’s carers or family. These changes lead to a change in the resident’s care plan. Five palliative care phases (pdf) are possible. A resident may move back and forth between phases. A structured phase algorithm (pdf) can help guide healthcare professionals to determine the correct phase. Palliative care phase has a long history of development (pdf). Its development commenced in the 1990s. The palliative care community has described phase as an important tool. This is because it can help develop a common palliative care language across countries. Phase is used in Australia, Germany, Great Britain, Ireland, Taiwan and Singapore.


Key resources:

The PCOC SAS is a resident-rated tool that staff can use to measure the amount of distress caused by seven of the most common symptoms in palliative care. Staff need to know how bothered, worried or distressed patients are by each of the symptoms in order to effectively manage symptoms and what matters to residents. The measure is easy to use and brief. Staff ask residents to rate their distress relating to each of the seven symptoms on a scale from 0 to 10, 0 being distress-free and 10 being severe distress.


Key resources:

The PCPSS is completed by clinicians. PCPSS measures the severity of symptoms. The tool can be used for initial screening, symptom management and ongoing coordination of palliative care. Four palliative care domains are assessed through PCPSS: pain, psychological/spiritual, other symptoms and family/carer. Each domain is rated on a four-point scale with 0=absent, 1=mild, 2=moderate and 3=severe.


Key resources:

The RUG-ADL is a four-item scale. RUG-ADL measures functional status. It measures motor function in relation to activities of daily living (ADL). Four ADLs are examined: bed mobility, toileting, transfers and eating. RUG-ADL helps identify the assistance a resident needs to carry out these ADLs. RUG-ADL helps identify the resources that the resident needs. When assessments are completed, the assessment is based on what the resident does, not what they are capable of doing.

Functional status is different to performance in functional measures examine what the resident does, not how they perform. Compared to other tools that measure function, the RUG-ADL is a measure particularly useful in palliative care. This is because ADLs are hierarchical. The RUG-ADL items (e.g., toileting, transfer) are the four items that a resident will lose last as they deteriorate and approach death.


Key resources:

The AKPS scale is a measure of the resident’s performance across the dimensions of activity, work and self-care. The AKPS results in a single score between 0 and 100. For PCOC, the scores from 10 through to 100 are reported. The AKPS is completed by a clinician. It is based on observations of a resident’s ability to perform common tasks relating to activity, work and self-care.


Key resources:

Frequently asked questions about the PCOC Aged Care Assessment and Clinical Response Form

For ease of use, the PCOC tools are collated into one, easy-to-use form. This means the form includes the five essential, brief, validated clinical assessment tools.

The five tools within the form help identify and manage common symptoms. Using the form helps ensure that assessments are routinely completed as a suite of measures at each occasion of assessment. The form helps guarantee that the assessment scores are documented or recorded at point of care.

PCOC’s five tools form a package of measures. Each tool performs a specific function to help improve outcomes in residnets and their families (carers). You are able to use a selection of PCOC measures, and not all. However using the five measures together may mean that outcomes in your service are more likely to improve more quickly. Also, the information you receive from your PCOC reports will be more useful in driving improvements in outcomes. Completing the five measures will allow you to benchmark with other like services. Completing the five tools together will also help provide a more comprehensive picture of the needs of each resident.

A free program of education is available for services registered with PCOC. This program is designed to help services implement the measures and drive quality improvements. A range of useful resources are also available free of charge to PCOC's community of practice. Guidance on embedding the assessments into routine practice is available. The use of this guidance helps ensure that these measures become part of routine care. PCOC improvement facilitators are also available and ready to help with using the form and the measures within your service. Contact us for more information.

© PCOC UOW 2020. The intellectual property associated with a suite of resources on this website is owned by the Palliative Care Outcomes Collaboration (PCOC), University of Wollongong. PCOC has placed resources in the public domain and is happy for others to use them without charge, modification or development. These resources cannot be modified or developed without the consent of the University.

PCOC is a national palliative care project funded by the Australian Government Department of Health.