Support for caregivers frees up hospital beds

Chronic patients cared for at home, thanks to help from hospital staff
By Salma Khalik, The Straits Times, 7 Oct 2014

MS ROSE Kong cares for her 88-year-old mother who has had a fractured leg, suffers from dementia, and needs to be tube-fed five to six times a day.

The National University Hospital (NUH) helped her get a hospital bed for her mother at their Hillview home, so she can be raised easily to sit at a 45 degree angle for feeding.

And Ms Kong, who is retired and in her 60s, has called senior geriatric staff nurse Sharifah Beebi several times for advice.

When her mother developed a rash, for instance, nurse Sharifah told her what to do and the cream to apply, saving her a trip to the doctor.

Another time, when her mother developed a fever and a swollen leg, the nurse said she needed to be hospitalised.

"Instead of taking her to the emergency department and waiting a few hours for a bed, she arranged for a bed so my mother could go straight to the ward," recalled Ms Kong. "It is a real benefit. I don't feel so lost when something happens."

Public hospitals have been able to free up hundreds of much-needed beds by helping family members like Ms Kong to care for chronic patients in their homes. This means they are less likely to have to rush to hospital, and the effort has been lauded by patients and their families alike.

Associate Professor Reshma Merchant, a geriatric specialist at NUH, said the scheme started earlier this year with 30 patients who had been hospitalised at least twice in the previous three months. A nurse would visit their homes the day after discharge, to make sure that the caregiver was doing things right, medicine was stored properly and any fall risks were identified and removed, she explained. The caregiver was also given the nurse's phone number, which she could call any time, day or night.

In the three months before they went on the scheme, the 30 patients had a total of 87 admissions, said Prof Merchant.

But in the same period afterwards, this was slashed to five admissions. "It has proven to be really effective," she said. "It has reduced the number of long-staying patients by half."

Not only are readmissions down, but the scheme has also reduced the demand for nursing home care, as patients' families feel they are able to cope with the hospital's help which is only a phone call away, she added.

In March, the scheme was extended from the two pilot wards to 11 wards in the hospital.

Tan Tock Seng Hospital (TTSH) has a similar scheme, where it works with voluntary welfare organisations, and has managed to cut hospital readmissions by one-third.

Geriatric specialist John Abisheganaden noted that even when patients do have to be admitted, their stay is generally two to three days shorter.

About 160 TTSH patients have benefited from the scheme, and Associate Professor Abisheganaden hopes to see it expanded to about 2,000 patients.

Such efforts are still in their infancy, however, and whether they are here to stay will depend on changes to government funding.

Today, hospitals are paid to look after patients in the hospital, but to enhance such home care schemes, more funds will have to be extended to discharged patients, said doctors.

Responding to queries from The Straits Times, a Ministry of Health (MOH) spokesman said: "MOH is working closely with our health-care clusters to monitor the total cost of care per patient, as well as care outcomes under pilot programmes, and the evaluation will then advise future reviews of our funding model for health-care services."

Singapore's hospital readmission rates comparable to the US: MOH
Last year, readmission rates ranged from 13.4% at SGH to 15.1% at Alexandra.
Channel NewsAsia, 7 Oct 2014

The overall public hospital or institution readmission rate in Singapore is comparable to that of the United States, but higher than some countries, such as Britain, according to the Ministry of Health (MOH) said on Tuesday (Oct 7).

Minister of Health Gan Kim Yong said this in a written reply to three questions by Aljunied GRC MP Chen Show Mao.

Mr Gan said the readmission rate for patients within 30 days after discharge from public hospitals was 11.7 per cent in 2011 and 12.2 per cent in both 2012 and 2013. In 2013, the readmission rate was 6.2 per cent for KK Women’s and Children’s Hospital, while the readmission rates for the other hospitals were similar, ranging from 13.4 per cent at Singapore General Hospital and National University Hospital to 15.1 per cent at Alexandra Hospital.

The readmission rates for patients aged 65 years and older had remained stable at around 19 per cent from 2011 to 2013, said Mr Gan. In 2013, the readmission rates for patients aged 65 years and older ranged from 18.5 per cent at Tan Tock Seng Hospital to 21.1 per cent at Khoo Teck Puat Hospital.

Attributing readmissions to several factors including the patient's conditions and disease type, quality of inpatient care, the transitions to primary and community care, and the follow-up care including rehabilitation care, Mr Gan added that the home environment and family support is an important contributing factor while readmission rates also vary across hospitals due to the different mix of cases.

Mr Gan said that the MOH will study Mr Chen's request to publish the rates of readmission annually, adding that they share the results with public hospitals annually for the hospitals' consideration in implementing measures to reduce readmissions. 

The Health Minister cited how hospitals have implemented various programmes to reduce readmission rates. For example, Tan Tock Seng Hospital’s Virtual Hospital programme involves assigning a care manager to monitor patients who have a history of multiple admissions.

Such coordinated care and monitoring ensures that these patients receive adequate support, and thus minimises the risk of readmission, said Mr Gan.