Tuesday 8 November 2011

Singapore's palliative care sector to get boost

National plan for palliative care to come, says Health Minister
By Janice Tai, The Straits Times, 8 Nov 2011

MORE will be done to ensure Singaporeans nearing the end of their lives are well cared for, Health Minister Gan Kim Yong said last night.

A national strategy for palliative care is being formulated and it will, among other things, help determine the resources that are needed in this area.

Details will be announced soon, he said at the 42nd anniversary dinner of Assisi Hospice, one of Singapore's oldest and most established hospices.

Mr Gan noted that with people living longer and the rise in chronic diseases, the medical care that people require at the end of their lives will change significantly.

For example, while in the past, people often died of acute illnesses such as infections or heart attacks, people today increasingly die after a period of progressive disability due to an incurable condition, such as advanced cancer, progressive organ failure or advanced dementia.

Although palliative care historically focused on patients with advanced cancer, there is increasing recognition that patients with non-cancer conditions can also benefit from palliative care, he said.

Addressing about 600 people, including Temasek Holdings' chief executive Ho Ching, the patron of Assisi Hospice, he said Singapore has made good progress in developing palliative care services.

While they began as home hospice services and inpatient hospices, such services are now available in acute hospitals and piloted in a few nursing homes.

Currently, there are seven inpatient and home hospice providers which serve about 5,000 palliative care patients yearly.

The number of health-care professionals trained in palliative care is also on the rise, with the number of nurses trained in palliative care increasing by about 14 per cent over the past year to 294 this year, from 257 last year.

He noted that the Lien Centre for Palliative Care had been asked by the Ministry of Health to work out the national strategy for palliative care, with input from the palliative-care community.

Former health minister Khaw Boon Wan revealed last year that a code of ethics may be included in the national strategy.

Mr Gan also encouraged Singaporeans to actively make choices on end-of-life care before they are struck by a debilitating illness.

'While death is inevitable, it need not be filled with agony and helplessness,' he said at the dinner at the Pan Pacific Hotel.

Through advance care planning, patients, families and health-care professionals are encouraged to talk more about end-of-life care and treatment decisions before palliative care is required.

This is already taking place in some hospitals and nursing homes today.

Under the Project CARE pilot, seven nursing homes in the central region are working with Tan Tock Seng Hospital to improve their palliative care and advance care planning capabilities.

Early results have been encouraging and the ministry will have more such projects in the coming few years.

The ministry will also continue to work with the palliative care community to raise awareness of end-of-life issues, as many continue to have misconceptions about this subject.

Mr Gan said some hospice care workers had told him that patients and family members who are referred for palliative care sometimes decline the referral as they see it as 'futile care'.

'I thought it was a lost opportunity for the patient and family to make the patient's final journey as meaningful and comfortable as possible, and avoid inflicting unnecessary pain and suffering to the natural process of dying,' he said.

Bigger Assisi Hospice by 2014
By Janice Tai, The Straits Times, 8 Nov 2011

THE Assisi Hospice in Thomson Road will be redeveloped to meet the increasing palliative care needs of Singapore.

The new hospice will be built on a 0.55ha site next to its current premises at Mount Alvernia Hospital. It will double its current inpatient, day care as well as home hospice care capacities, and should be ready not later than end-2014.

The hospice, which started as a home for the chronically ill in 1969, currently provides palliative care services to more than 1,000 patients a year, including those on home care and day care, and has a total of 36 beds.

Mr Ronny Tan, chairman of the hospice, said hospice care is fast becoming an urgent area of concern.

The hospice also intends to set aside space to train and educate caregivers and other health-care professionals.

'It is our dream to be a centre of excellence for palliative care research and training,' said Mr Tan.

A Catholic charity founded in 1969, Assisi was set up by the same nuns who started Mount Alvernia Hospital. The hospice receives subsidies from the Health Ministry, but before last night's fund-raiser, it was still $1.4 million short of the $4 million it needs to meet its annual operating expenditure of $6 million.

In his speech, Health Minister Gan Kim Yong paid tribute to how the hospice has helped patients and their families. He noted how, during a recent visit, he was touched by the dedication of the care staff and volunteers in helping patients maximise their quality of life in the face of terminal illness.

'The environment of the hospice also facilitated patient privacy and respect for patients from various religious backgrounds,' he said.

Pilot scheme to ease end-of-life pain
Project Care sends doctors to attend to participating patients
By Melissa Pang, The Straits Times, 10 Nov 2011

PATIENTS nearing the end of their lives are having their suffering reduced by a palliative care pilot scheme.

Project Care sends doctors to the nursing home whenever a member of the programme becomes seriously ill.

This avoids patients having to go to hospital, where they could be given further treatment that may cause them more pain. Instead, the doctor from the project will focus on reducing suffering.

It is just one example of the palliative care programmes that are in place at hospitals and nursing homes today. More are expected as the Ministry of Health shifts its focus onto this form of care.

Earlier this week, Health Minister Gan Kim Yong announced that a national palliative care strategy is being formulated to examine issues such as the resources that should be devoted to this area. More details will be released later.

Those who have been helped by Project Care include the family of Mrs Belinda Charles, dean of the Academy of Principals. When her 88-year-old bedridden mother caught an infection, the nursing home she was staying in immediately sent her to Tan Tock Seng Hospital (TTSH) for treatment.

After she was discharged and sent back to Ling Kwang Home For Senior Citizens, Mrs Charles received a call from the hospital telling her that her mother was eligible for the project. A meeting was set up between Mrs Charles, her sister, and representatives from Project Care and the home.

During the almost hour-long meeting, Project Care's doctor explained in detail the condition of Mrs Charles' mother and asked questions about the type of care she would prefer. Once her mother was a participant, nursing staff began calling the project if she needed medical attention, instead of the hospital. Mrs Charles, whose mother has since died, said: 'Not knowing what to expect, they helped us a lot.'

The Project Care team has two permanent doctors - Dr Ian Leong, head of TTSH's department of continuing and community care, and Dr Siew Chee Weng, a consultant family physician at the hospital.

There are also two doctors on rotation, four nurses, and a medical social worker. Since it started in 2009, the scheme has screened 1,600 residents from seven nursing homes around TTSH. About 400 have entered the project.

Ms Gladys Heng, nurse manager at Ling Kwang Home for Senior Citizens, said that in the past, in the case of old and frail residents 'whom we know would not make it past the next month or next week, the question was do we send them back to the hospital? With Project Care, we know the way to go'.

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