Monday 16 July 2012

More help for dying patients at home

$12m allotted to home visit scheme; caregiver training course to be rolled out
By Poon Chian Hui, The Straits Times, 15 Jul 2012

A programme that helps patients with organ failure live out their last days at home and in as little pain as possible is getting more money so it can expand.

The Ministry of Health (MOH) will spend $12 million, with the bulk of it going into hiring more doctors, nurses and counsellors to conduct home visits so patients do not have to go to hospital for treatment.

The Holistic Care for Medically Advanced Patients Programme (HOME), run by the ministry's Agency for Integrated Care (AIC), has benefited some 600 patients since it was piloted four years ago.

MOH hopes to help 3,000 more by 2016 through the extra funding.

Announcing this at the Singapore Palliative Care Conference at Biopolis yesterday, Health Minister Gan Kim Yong said a structured home care service can help patients avoid hospitalisation.

People who suffer organ failure include those with chronic obstructive pulmonary disease (COPD) and heart disease - the seventh and second most common cause of death here, accounting for 3 per cent and 19 per cent of deaths respectively.

Mr Gan said: 'With the increasing prevalence of chronic diseases, we are extending palliative care beyond traditional cancer care to benefit more non-cancer patients.'

Separately, to boost the number of people capable of caring for those with terminal illnesses, the Singapore Hospice Council will be rolling out a new caregiver training programme by the end of the year.

To be taught by experienced nurses, the initiative aims to increase the pool of caregivers in the community.

'What we are trying to do is to come up with a caregiver training programme that's suitable for anybody - they do not necessarily have to be a caregiver at that point in time,' said the council's chairman, Dr R. Akhileswaran, on the sidelines of the conference yesterday.

Caregiver training for palliative care, to treat the dying and those in pain, is currently conducted in Singapore by HCA Hospice Care and the Metta Welfare Association.

The former is the national agency providing such training. It will be padding up its curriculum and standardising its training methods, Mr Gan said yesterday.

Dr Akhileswaran, who is also chief executive of HCA, said the enhancements will standardise how training is conducted and include the development of a training manual.

Other areas to be strengthened include integration across different health-care providers and better bereavement support in the community, said Mr Gan.

For example, a three-year pilot project involving Dover Park Hospice and Tan Tock Seng Hospital expedites the admission of hospice patients to the hospital if they require a higher level of care. The two institutions share patients' medical records, which cuts down on paperwork.

Started in February last year, the $3 million project has helped about 120 patients, and may be replicated at other health-care institutions.

Said Mr Gan: 'With better palliative home care services, caregiver training and bereavement care, we hope to strengthen palliative care in the community to enable more patients to be cared for in the comfort of their homes.'

Earlier this year, the ministry accepted recommendations for a National Strategy for Palliative Care. End-of-life issues are becoming more crucial as the population ages, with more than one in four citizens aged 65 and above by 2030.


The care of the dying, or palliative care, is gaining importance here and in the region, where the topic of death has traditionally been taboo.

The field was recognised as a medical sub-speciality here in 2007.

At the Singapore Palliative Care Conference 2012 yesterday, participants discussed how to encourage the wider community to talk about death more openly. The two-day conference gathered about 600 people from 18 countries.

In Singapore

A year-old community outreach programme held a concert on palliative care in a school, ITE College East, for the first time last year.

The concert, featuring music and dance performances, was to raise funds and awareness of the field among the young.

The Singapore Hospice Council is also working with grassroots leaders and community centres to spread awareness of what hospices, which deliver palliative care to patients, do. It hopes to cover one constituency every three months.

A Forbes survey in 2010 showed that only 40 per cent of the population here understood what hospice care was.

The council hopes to increase this to 60 per cent by next year.

The chairman of the organising committee, Dr Chong Poh Heng, said that many people still think palliative care is simply 'helping someone to die'.

'They don't realise it's not about dying, but about living before they die.'

In Hong Kong

Some 20,000 elderly people were encouraged to write their wills, and even take field trips to graveyards to be better prepared for death and bereavement.

Project Enable, or the Empowerment Network of Adjustment to Bereavement and Loss in End-of-Life Care, was started by Dr Amy Chow, from the University of Hong Kong, with a colleague in 2007.

Dr Chow said that death is rarely talked about in Hong Kong. As a result, the wishes of the dying are often not made known to families.

'We see a lot of bereaved families that have a lot of arguments,' said Dr Chow.

The project got people thinking and talking about death while the person was still alive and well.

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