Aim As Australia’s population ages, understanding whether specialist palliative care is accessed equitably across aged care settings is important for integrated care planning. This study addresses a national evidence gap. Methods The study used linked aged care and health data from AIHW’s National Aged Care Data Asset examined people aged 65 years and over who died from predictable causes in 2021–22 (n=132,000). Palliative care-related hospitalisations, outpatient palliative care consultations, and Medicare-subsidised palliative medicine specialist services were assessed in the last year of life, including proximity to death of first service and comparisons by aged care setting. Results Of the study population 56% used at least one aged care service in the last year of life. Overall, 38% received specialist palliative care: 21% of residential aged care [RAC] users; 49% of home care/residential respite [HCR]. First service typically occurred late (median 12 days before death); later for RAC users (8 days) than HCR users (13 days). Unplanned hospital admission occurred for 68% in the last year of life. The study showed variation in place of death: 40% were in hospital and 36% in residential aged care. Conclusion Marked setting-based differences and generally late initiation indicate opportunities to strengthen integrated models and earlier recognition/referral pathways – particularly for people living in residential aged care – to inform policy, service planning and future research. Reference AIHW (Australian Institute of Health and Welfare) (2025) Specialist palliative care use for older people receiving aged care, AIHW, Australian Government, accessed 26/03/2026