Monday 24 June 2013

More patients living out final days at home

About 5,000 now receive palliative care at home, up from 1,700 in 2009
By Melissa Pang, The Sunday Times, 23 Jun 2013

Many more people are living out their final days in the comfort of home, according to Ministry of Health figures.

Currently, about 5,000 people are being cared for in their own homes. In contrast, 1,700 people were able to have this care for the whole of 2009.

The numbers are set to rise as more become aware of the benefits of end-of-life care, along with efforts by the Government and care providers to increase accessibility to such services.

Palliative care is crucial in ensuring good quality of life for not just patients, but caregivers too, said HCA Hospice Care's chief executive and medical director R. Akhileswaran.

It means relieving patients of pain and other debilitating symptoms like breathlessness. For caregivers, it provides "the necessary physical and psychological support", whether through palliative caregiver training or a listening ear, said Dr Akhileswaran.

Increasingly, palliative care programmes are focused on making sure patients are looked after at home.

In March last year, Dover Park Hospice piloted a home programme for patients living in the central region of Singapore, which has seen enrolment steadily increasing to about 300 patients to date.

Under this scheme, dying patients at home who need more medical attention are "seamlessly transferred" to the hospital or hospice. It eliminates the need for duplicate tests that may cause financial strain, or even delays in diagnosis and treatment.

It may be made available to those in other parts of Singapore in a few years.

Children, too, are not excluded. Last October, HCA Hospice Care began a dedicated home care service for children and young adults who are dying of cancer, as well as those who suffer from serious disabilities.

The Star Pals (Paediatric Advanced Life Support) programme has helped about 70 to 80 children so far.

Madam Chua Ah Toh, 65, is a beneficiary of one of the earliest home palliative care initiatives. The end-stage renal failure patient used to be admitted to hospital as often as twice a month for fluid overload caused by her kidney problem.

Since enrolling in the Agency for Integrated Care (AIC) Holistic Care for Medically Advanced Patients (Home) programme early last year, she has reduced that to just a few times a year.

Regular visits by a nurse help to keep her condition in check. From weighing just 30kg at one point, she is now a healthy 47kg.

About 750 patients diagnosed with heart, respiratory, or renal failure have benefited from Home. More than six in 10 of them were able to live out their last days in familiar surroundings, said a Health Ministry spokesman.

Home care would take the pressure off a shortage of beds in hospitals, nursing homes, and hospices, brought about by an ageing population.

The National Strategy for Palliative Care report, which was accepted by the Health Ministry last year, estimated that by 2020, more than 10,000 people would need palliative care annually.

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