More getting palliative services

MOH aims to make them more affordable, encourage home care
By Janice Tai, The Straits Times, 16 Feb 2017

Since the middle of last year, doctors and nurses have been visiting Mr George S. Pathy, 87, at his one-room rental flat in Punggol to monitor his vital signs and review his medication.

The visits, which take place once every two to three weeks, are free. Low-income individuals like Mr Pathy receive fully subsidised services to fulfil their wishes of being cared for, and hopefully, of dying at home.

Mr Pathy is receiving palliative care, which aims to minimise pain and improve the quality of life for patients who have terminal illnesses. He has end-stage heart failure and lung disease.

To meet the needs of the ageing population, the Ministry of Health (MOH) has been ramping up palliative care services. As of last year, it had built enough capacity for palliative care at home for 5,500 people.

Meanwhile, there are 180 beds available for those who need to be cared for in hospices, nursing homes and community hospitals last year.

"As we face an ageing population, palliative care becomes increasingly important," said Minister of State for Health Chee Hong Tat during a visit to the new Assisi Hospice in Thomson Road yesterday.

"There is a need to increase capacity, to further raise standards, build capabilities and work together with providers. That is what we have been doing in the past three years and will continue to do so," he said.

MOH said it is on track to meet its target of having 6,000 home palliative care places, and 360 beds by 2020. This was a target set in 2014, when MOH released a palliative care plan to meet the demand for and ensure that such services are affordable. The plan includes a new graduate diploma course to train more doctors in palliative care.

In 2015, people were also allowed to use more of their Medisave for advanced care services, with no withdrawal cap for those who are terminally ill.

Government figures show that about one in four deaths in 2015 happened at home, while the bulk were in hospitals. MOH said it hopes to increase the percentage of people who can die at home by promoting greater awareness of palliative care services and advanced care planning.

That is why the bulk of palliative care services currently being offered are home care services.

Mr Pathy's daughter, Joyce, 63, said of his choice: "He loves his independence, so he prefers to be at home. With such services, hopefully his wish to die at home instead of a hospice or hospital can be fulfilled."

Those who opt for a place in a hospice may be put on a waiting list. For instance, a patient who applies for a bed in Assisi Hospice has to wait for about two weeks. On average, patients stay there for 22 days before they die.

The hospice, which has 85 beds, has 200 patients using its home care services. Another 30 people go to its daycare centre for activities and therapy.

Said Dr Angel Lee, who chairs the Singapore Hospice Council: "I believe that the healthcare battlefield is out in the homes right now. We need more workers out in the trenches providing home palliative care."

MOH intends to provide more funding and find ways to attract more Singaporeans to the industry.

Mr Chee said one option to make palliative care more affordable could be to include it under Medishield Life coverage, although that could raise premiums.

Meanwhile, the annual number of Singaporeans dying has risen. In 2015, 19,862 people died, compared with 16,393 deaths in 2006. This means that 4.8 people out of every 1,000 Singapore residents died in 2015, up from 4.4 in 2006.