Many terminally ill patients died before they could get admitted
By Rachel Tan, The Sunday Times, 3 Nov 2013
For the terminally ill, death can be a slow and painful journey, yet many patients are struggling to find the necessary support.
Some don't even make it to a bed in a hospice.
Last year, out of 835 people whose referrals were accepted by Dover Park Hospice, 172 died before they could be admitted.
"Our current waiting list is estimated at eight to 10 days," said a spokesman.
And with only 37 beds available at Assisi Hospice in Thomson Road, up to 10 patients can be on its waiting list at any given time.
Besides space constraints, the sector is also facing a manpower problem.
Palliative care combines aggressive pain control with emotional counselling of the terminally ill.
The comfort and ease of these patients depend primarily on the work of doctors, nurses and medical social workers.
While hospices say people are eager to take on such work, not enough are doing so.
Many find the need for home visits and 24-hour support to be too demanding.
"Our annual turnover of health-care workers was 18 per cent during the last year," said Dr R. Akhileswaran, chief executive officer and medical director of HCA Hospice Care, which provides day hospice, live-in hospice and home care services for about 850 patients.
Though the turnover rate at HCA has stabilised in recent years, the voluntary welfare organisation (VWO) told The Sunday Times that it still needs a better patient-to-staff ratio, even with 90 employees.
Dr Akhileswaran said it needs "about 20 per cent more nurses" and a similar amount of medical social workers.
The latter perform psycho-social assessments on patients while educating and counselling their family members.
"Staffing for hospice care has always been a challenge for community-based organisations," said a spokesman for Dover Park Hospice.
Referrals there have been rising in the last three years. Last year there were around 900, almost a 40 per cent increase on 2011.
The hospice finds it difficult to compete with others in terms of remuneration and employee benefits.
"Even though the Health Ministry has been pumping funds into the Intermediate and Long-Term Care (ILTC) sector, it may take years before VWOs can be on a level playing field with restructured hospitals in attracting staff," said the spokesman.
The team at Dover Park Hospice told The Sunday Times that "new rules and increased levies" on foreign workers have also affected the sector.
The situation differs at HCA Hospice Care, but this in turn makes the available talent pool smaller.
"The new rules on foreign labour haven't affected us. We do actually depend on locals," said Dr Akhileswaran.
"If they don't understand the culture and way of life for our patients and caregivers, it's very difficult to carry on. Language is very important. Hokkien is a must."
Non-cancer patient referrals to HCA Hospice Care have increased from 1 per cent to 16 per cent in the last year. It currently has about 5,000 patients under home palliative care.
Dr Akhileswaran has made it a point to match wages at the hospice to those at other health-care institutions to attract more workers.
"We need creative ways to make both inpatient and community hospice work more attractive and meaningful," said a spokesman for Assisi Hospice.
It plans to establish a Centre for Palliative Care Education in the new Assisi Hospice, set to be built by 2016. The centre aims to train all staff and palliative care personnel.
Adequate staff levels will be increasingly important as new trends surface.
"There are more non-cancer patients being referred - like those with advanced dementia, end-stage heart failure, end-stage lung diseases and end-stage renal failure," said Dr Mervyn Koh, head of the Palliative Medicine Department at Tan Tock Seng Hospital.
HANDBOOK FOR PALLIATIVE CARE
Tan Tock Seng Hospital's Palliative Medicine Department has created a new palliative care resource.
Called The Bedside Palliative Medicine Handbook, it is the first palliative medicine handbook in Singapore that contains:
- Information on pain and symptom management;
- Commonly encountered clinical conditions in palliative care;
- How to facilitate a terminal discharge;
- Where to find community hospices;
- How to meet a patient and family's preference when treating their loved one.
About 600 free copies were distributed to, among others, hospices, polyclinics, nursing homes and the Yong Loo Lin School of Medicine at the National University of Singapore.
It is also available for purchase at $22 per book.
Information from Tan Tock Seng Hospital, compiled by Rachel Tan
No comments:
Post a Comment