No one to share the load when mum and dad get sick

Unlike in larger families where caregiving load can be spread out, an only child faces immense stress and is more likely to suffer burnout

By Elizabeth Law, Correspondent, The Straits Times, 28 Sep 2024

On a Tuesday afternoon at a coffee shop in Ang Mo Kio, Mr Glenn Poh returns to his waiting mother with two drinks: one hot and one iced. She picks the iced lemon tea.

“All my life she never used to drink cold drinks but now, she always wants something iced. It’s like she’s a small kid again,” he says of his 74-year-old mother, Madam Tan Sow Meng, who has Alzheimer’s disease.

As the only son, Mr Poh took it upon himself to look after her, personally navigating the twists and turns of caring for an ailing parent.

“Whatever needs to be done needs to be done. It’s because I was raised like this,” he says. Having seen how his mother cared for his late father after a stroke, he knew he wanted to do the same for her.

In Singapore, with its rapidly ageing population and cultural norms of filial piety, many adult children find themselves thrust into the role of caregivers.

Life can be put on hold when mum or dad falls ill, and those without siblings or other home help can find themselves shouldering the whole load.

Data shows there were at least 128,800 only children with mothers above the age of 50 in 2023, more than triple the 39,800 in 2003.

In a population of 5.92 million, 1.36 million people have mothers above the age of 50. While the number of only children is just a fraction of that total, researchers and social workers warn that unlike in larger families where the caregiving load can be spread out, only children face immense stress. Among other health challenges, they are more likely to experience burnout.

A stout man with a buzz cut dressed casually in a polo shirt, shorts and sliders, Mr Poh, 44, is unfailingly polite. He says “thank you” or “pai seh” (Hokkien for “sorry to bother”) to anyone he interacts with, and thanks The Straits Times team profusely at each of our three interviews.

He talks about his days in a methodical way, ticking off each activity as if going down a list. He says drawing up lists and “standard operating procedures” helps him find structure amid the uncertainty and constantly evolving nature of his mother’s condition.

But ask him about challenging moments, and his upper lip quivers.

The week before, rather than take her shower at the usual time, his mother fussed around with throwing away rubbish and lighting the oil lamp at the family altar.

“I shouted at her, and I asked her to go and take a bath, which she did. By the time she came out of the bathroom, I apologised but she didn’t remember. I regret it when I lose my temper with her because she cannot remember,” he says, tearing up.

“So it’s not a good feeling. Because you did something wrong, but you’re not able to make up for it.”

He admits this often happened in the initial stages, especially when he had unrealistic expectations about his mother’s condition, and became frustrated that he could not do more to help her.

Conversation on euthanasia should enter end-of-life discussions in Singapore

Assisted dying is a sensitive subject but, with its population ageing, Singapore may need to discuss what we think about it

By Salma Khalik, Senior Health Correspondent, The Straits Times, 29 Jul 2023

As more Singaporeans age, urgent discussions are taking place on how we approach end-of-life issues.

The roles of nursing homes, hospices and home palliative care are part of ongoing discussions on easing and widening different approaches towards how we age, and ultimately pass on.

There is, however, one issue that has gained traction elsewhere but which hardly ever figures in our end-of-life discussions here: assisted dying.

Assisted dying can either take the form of assisted suicide, where the final act is undertaken by the person involved, often with the aid of a medical practitioner; or euthanasia, where another person, again often a doctor, performs the act of terminating life.

Assisted dying is illegal in Singapore.

But given that our population continues to age rapidly, and more older people will increasingly find themselves in continuous pain that even palliative care can do little to help, this is not an issue we should entirely ignore. What could be at stake is the dignity and personal choice of a segment of our population.

Several countries are well ahead of Singapore on this count, both in terms of having mainstream discussions, as well as in having legal frameworks on assisted dying.

Most countries that have legalised assisted dying allow both assisted suicide and euthanasia. Some, like Switzerland, which was the pioneer in allowing assisted suicide in 1942, allow the former but keep euthanasia illegal.

Should one or both options be legalised here, to give those desperate to end their lives a way of doing so with grace?

What care and subsidies are available for seniors in Singapore?

By Salma Khalik, Senior Health Correspondent, The Straits Times, 7 Jul 2018

NURSING HOME

The number of nursing home beds has gone up from 9,600 in 2011 to 14,900 last year. More are in the works and there should be 17,000 beds by 2020.

Apart from having more beds, newer nursing homes are designed to be more soothing. Ren Ci's home at Ang Mo Kio, for example, places four people to a room, with shared living and dining areas.

Some high-rise homes have mini gardens or mid-level greenery so residents do not need to leave the homes to enjoy nature.


CARE CLOSE TO HOME (C2H)

Seniors in rental flats in 15 precincts can be cared for while continuing to live in their own homes. People from nearby Senior Activity Centres provide help for daily activities such as bathing and housekeeping, while monitoring the seniors' medical conditions.


HOSPITAL TO HOME (H2H)

Frail patients who have been discharged from hospital are provided with multi-disciplinary care for a short period. This includes caregiver training so family members or helpers know the best way to aid the senior.

Run by the three regional health systems under which all public hospitals are clustered, they also provide phone support as well as medicine reconciliation if the senior is being attended to by different doctors who might prescribe different, and possibly conflicting, medicines. So far, more than 14,000 patients have used this service.


PALLIATIVE CARE

This provides care for people who are dying and in pain, and is especially helpful for terminally-ill patients. The aim is to improve their quality of life.


HOME PALLIATIVE CARE

For patients in the last stages of life, home palliative care supports them till the end of their lives in their own home, instead of in a centre, while offering medical, nursing and psychosocial care.

The number of patients who can receive such care at home has gone up from 3,800 a year in 2011 to 5,900 a year last year. Most charity organisations do not charge for this service. For providers that do charge, the fees are around $1,000 a month. Those who qualify can get subsidies of about $800 a month.





DAY CARE

When caregivers have to work, they worry about leaving the elderly alone at home. Some may even have to give up working to care for the senior.

Day care services give them peace of mind as the senior can be cared for and given proper meals, while still living at home. The centres also give the senior a chance to socialise and engage in activities such as exercise, handicraft and karaoke.

There were 5,000 day care places last year, with at least another 1,200 to be added by 2020. The plan is for 90 per cent of seniors to have such a centre within 1km of their home.


DEMENTIA CARE

These centres try to slow down the progression of dementia by providing cognitive stimulation. They provide activities that try to preserve physical and mental functions. Patients live at home and are taken to the centres daily.

Euthanasia: A good life to the end, or a quick death

The Victorian state of Australia has legalised euthanasia. Concerns about a slippery slope are real. The alternative to euthanasia is palliative care to alleviate suffering.
By Chong Siow Ann, Published The Straits Times, 16 Dec 2017

The Australian state of Victoria recently legalised assisted suicide. This law, when enacted, will enable a resident who has lived in Victoria for at least a year, and who has a terminal, incurable illness with a life expectancy of less than six months, to obtain a lethal drug to commit suicide.

Victoria has now joined the ranks of the Netherlands, Canada, Belgium, Colombia and Luxembourg which have legalised euthanasia. Several states in the United States, including California, Washington, Vermont and Oregon, have passed laws allowing assisted suicide.

In physician-assisted suicide, a physician supplies a lethal drug or suggests a means by which a patient will use it to complete the act that brings about death.



In euthanasia, the physician performs the act of directly injecting the medication to cause death. These terms do not apply to a patient's refusal of life-support measures, or to the request for these life-prolonging measures to be withdrawn.

We would think that it would be terminally ill patients with grievous and irredeemable pain who are most likely to want physician-assisted suicide or euthanasia, but the laws permitting this were mainly motivated by the concerns of the "worried-well" - by healthy people who fear the unknown future and the possibility of dying painfully, and who want that control and assurance that they can have the legalised means to end their lives if things become unbearable.

But empirical studies of physician-assisted suicide and euthanasia in the Netherlands and the United States indicate that pain played a relatively minor role in motivating requests for assisted suicide. These studies showed that in only 11 to 32 per cent of all cases was pain the reason for requests for euthanasia.

Depression, general psychological distress, and fear of a loss of control or dignity, of being a burden, and of being dependent on others, were the common reasons. This prompted oncologist and bioethicist Ezekiel Emanuel to ask (in an article published in The Atlantic) if the wishes of these patients should then be granted. He followed with this riposte: "Our usual approach to people who try to end their lives for reasons of depression and psychological distress is psychiatric intervention - not giving them a syringe and life-ending drugs."



SLIPPERY SLOPE

One of the biggest - and perennial - concerns of legalising physician-assisted suicide and euthanasia is that it will lead to the "slippery slope".

The slippery slope argument contends that even a relatively conservative law like the Victorian model would evolve over time, becoming more permissive and with the right to receive assisted suicide extending to many others: from physician-assisted suicide for the terminally ill and fully consenting adults to euthanasia for patients who cannot give consent - the unconscious, severely disabled children, and the mentally ill.

Volunteers who ensure no one dies alone

NODA members support terminally ill with few or no family members in their final days
By Janice Tai, Social Affairs Correspondent, The Sunday Times, 10 Dec 2017

Mr Tay Cheng Tian, 54, died in a hospice on Nov 4. None of his family members was by his bedside when he took his last breath, but he did not die alone.

In the last few weeks of his life, a bunch of strangers befriended him and committed to spending time with him till the end.

They fulfilled his last wishes and did things such as wheeling him downstairs for smoke breaks.

When Mr Tay started deteriorating rapidly from oesophageal cancer, the volunteers took turns to sit vigil round-the-clock by his bed.

For about two days, they held his hands, whispered to him or played his favourite songs to let him know that someone was there with him.

One saw him take his last breath at 8.30am that Saturday.



"It was a privilege to be with him, knowing that he was comfortable enough with my presence to go at that moment," said Ms Angela Sho, 43, a volunteer with Assisi Hospice's No One Dies Alone (NODA) programme.

It is part of a small but growing movement to support dying people who have few or no family members or friends to accompany them in their final hours. Demand for the service is likely to grow as the number of elderly folk who live alone in Singapore surges.

The General Household Survey, released last year, shows the number of households comprising only residents aged 65 or older stood at 82,600. About half, or 41,200, are made up of residents who live alone. By 2030, the Government estimates the number of seniors who live alone will hit 83,000.

"Given the increasing trends of one-person and two-person households with the head of households over 65 years old, we foresee the number of persons who die alone may increase," said Ms Chee Wai Yee, chairman of the grief and bereavement work group at the Singapore Hospice Council.

Should I help my patients die?

An American doctor grapples with the ethics and practicalities of being asked to help a patient die
By Jessica Nutik Zitter, Published The Sunday Times, 13 Aug 2017

I was leafing through a patient's chart last year when a colleague tapped me on the shoulder. "I have a patient who is asking about the End of Life Option Act," he said in a low voice. "Can we even do that here?"

I practise both critical and palliative care medicine at a public hospital in Oakland, California. In June last year, our state became the fourth in the nation to allow medical aid in dying for patients suffering from terminal illness. Oregon was the pioneer 20 years ago. Washington and Vermont followed suit more recently. (Colorado voters passed a similar law in November.)

Now, five months after the law took effect here in California, I was facing my first request for assistance to shorten the life of a patient.

That week, I was the attending physician on the palliative care service. Since palliative care medicine focuses on the treatment of all forms of suffering in serious illness, my colleague assumed that I would know what to do with this request. I didn't.

I could see my own discomfort mirrored in his face. "Can you help us with it?" he asked me. "Of course," I said. Then I felt my stomach lurch.

California's law permits physicians to prescribe a lethal cocktail to patients who request it and meet certain criteria: They must be adults expected to die within six months who are able to self-administer the drug and retain the mental capacity to make a decision like this.

British couple leave $6 million legacy to charities in Singapore

Assisi Hospice, National Kidney Foundation and the Society for the Prevention of Cruelty to Animals to share gift from Britons who settled here and became citizens
By Toh Wen Li, The Straits Times, 30 Jun 2017

Two Britons met in South Africa during World War II, got married, then eventually decided to make Singapore their home.

Now, the late Mr Gerry Essery and Mrs Jo Essery are giving back to their adopted home, with a $6 million legacy donation.

The sum will be divided equally between the Assisi Hospice, National Kidney Foundation (NKF) and the Society for the Prevention of Cruelty to Animals (SPCA).



Details of the donation were announced at the NKF Building in Kim Keat Road yesterday.

Mrs Essery was born in Singapore and lived here before leaving for South Africa at the start of World War II.

Mr Essery, on the other hand, was born in Britain and came to Singapore in 1931, as his father was working as an engineer here. His father sent him to Australia when the Japanese invaded Singapore in 1942.

A few months later, he travelled to South Africa, where he was reunited with his family - and met his future wife. They got married in South Africa in 1945.

The couple then moved to Australia in the 1950s, where Mr Essery worked for multinational confectionery company Cadbury. He then got a job in a glass production firm in Singapore, and the couple decided to make Singapore their home.

Palliative care for dementia patients at Assisi Hospice

At Assisi Hospice's new ward, they can live out their last days in comfort and dignity
By Janice Tai, The Straits Times, 11 Apr 2017

Madam Liow Ah Tay, 87, has struggled with dementia for the last decade. Now as her health declines further, she had been admitted into the first hospice ward here for dementia patients.

In 2007, the former vegetable seller started displaying strange behaviour. At 3am every day, she would wake up to prepare to go to the market to open her stall, even though by then she had long retired from the trade.

Her children refused to let her go out at that hour and she would force open the door with a pair of scissors or a knife. They discovered then that she had mild dementia.

Five years later, her condition deteriorated further. She accused people of stealing her things. Whenever her children - those who did not live with her - went to visit her, she treated them as guests and entertained them.

Today, Madam Liow has advanced dementia - the feisty woman has become quiet and no longer recognises her daughters.

On some days, she even has trouble sitting up.

Her two daughters who look after her are relieved that she is among the pioneer batch of patients to be cared for in the first hospice ward here dedicated to people with advanced dementia. She was admitted in January.

Dr Shirlynn Ho from Assisi Hospice said not many people know that dementia does kill and that palliative care could be needed.

"People don't usually recognise dementia as a terminal illness that one can die from because it is a long and progressive disease," she said.

The hospice opened a dementia ward which has a capacity of 16 beds in January. It provides palliative care that specially caters to people with severe dementia so that they can spend their last days in comfort and dignity.

New 500-bed Tan Tock Seng Hospital rehab complex to open in 2022 at HealthCity Novena

Integrated Care Hub to be built next to TTSH; opens in five years
As part of HealthCity Novena, it will add to growing facilities for ageing population

By Linette Lai, The Straits Times, 22 Mar 2017

Tan Tock Seng Hospital's (TTSH) new 500-bed rehabilitation complex, right next to the main hospital in Novena, opens in five years and will add to the growing number of healthcare facilities that cater to the needs of an ageing population.

The new Integrated Care Hub will be part of HealthCity Novena - a mega health complex scheduled for completion by 2030 that will include a hospital, medical school and step-down facilities, as well as the National Centre for Infectious Diseases.

TTSH's hub will take in patients who have complex rehabilitation needs, such as those who have suffered spinal cord injuries or lost their limbs, and also care for those who no longer need the acute services of a general hospital but still require a degree of medical care.

In doing so, it will provide what Senior Minister of State for Health Amy Khor described as "the crucial link between the acute hospital and community care".

Speaking at the hub's ground-breaking ceremony yesterday, she noted that TTSH will also move its current rehabilitation services - including those in Ang Mo Kio - into the new centre when it is ready.

A fifth of the beds at the hub will be used by the Dover Park Hospice, located nearby in Jalan Tan Tock Seng, to care for the terminally ill. The rest of the beds - managed by TTSH - will be for those who need rehabilitation and sub-acute care.

"The Integrated Care Hub is part of our efforts to move beyond hospital-centric healthcare to care in the community," Dr Khor said.

"The elderly are more likely to face complex health issues and are at risk of being readmitted into hospitals if they do not receive proper care within the community and at home."

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.

Yishun Community Hospital gives glimpse of future care

Such facilities are cheaper to run and build and can ease the crunch at acute hospitals
By Salma Khalik, Senior Health Correspondent, The Straits Times, 29 Nov 2016

The template for the future of Singapore's healthcare system was on display yesterday as the Yishun Community Hospital was officially opened to take the load off the neighbouring Khoo Teck Puat Hospital (KTPH).

Community hospitals will play a bigger role in caring for patients in the future and are part of the transformation under the Healthcare 2020 Masterplan to "shift the centre of gravity from acute hospitals to the community", said Health Minister Gan Kim Yong.

As he officially opened YCH, Mr Gan said: "Over time, we see community hospitals expanding their roles to provide more short-term inpatient care for geriatric, dementia and palliative patients."

YCH, which is linked to KTPH, has cared for more than 1,400 patients since it became operational in December last year.

YCH, which has opened 238 of its 428 beds so far, is currently 60 per cent full, while the adjacent KTPH faces a bed crunch, with occupancy hovering at around 90 per cent.

It is much cheaper to run a community hospital, where the nurse-to-patient ratio is one to 16, which means one nurse can look after four times the number of patients compared with a general hospital. This is largely because, while its patients still need care, their conditions are stable.

Community hospitals are also cheaper to build, at roughly half the cost of an acute hospital.

That is why all future acute hospitals in the public sector will have a community hospital next door to allow patients to "transit smoothly from the acute hospital to the community hospital and eventually back home".

Aside from KTPH, Tan Tock Seng Hospital, Changi General Hospital, and Ng Teng Fong General Hospital all have community hospitals next door. Outram Community Hospital, expected to open in 2020, is being built on the Singapore General Hospital campus.

30,000 more healthcare workers needed by 2020 as population ages: MOH 2020 Healthcare Manpower Plan

By Sara Grosse, Channel NewsAsia, 20 Oct 2016

The Ministry of Health (MOH) launched a manpower plan on Thursday (Oct 20) in the hopes of attracting more Singaporeans to take up careers in the healthcare industry and ensure they are well-equipped.

The Health Ministry estimated that an estimated 30,000 more healthcare workers would be needed by 2020 to meet the demands of an ageing population.

Health Minister Gan Kim Yong, launching the 2020 Healthcare Manpower Plan on Thursday, said the plan aimed to meet the growth in demand for healthcare and sustain good salaries for workers.

The plan consists of three strategies: Equipping the healthcare workforce with relevant skillsets to prepare for the evolving healthcare needs of an ageing population, growing a strong local core by investing in fresh school leavers as well as mid-career entrants and improving the work environment and patient experience with technology.

The initiatives to equip healthcare workers with better skills include a new SkillsFuture Earn and Learn programme in gerontology nursing, which will be introduced by Nanyang Polytechnic from December 2016 to give new nursing graduates the opportunity to undergo on-the-job training.



More doctors are also being trained in the community, with a 30 per cent increase in family medicine trainees expected by 2019, the Health Ministry said.

To build a strong Singaporean core in the healthcare industry, MOH said scholarships and sponsorships would be available for young Singaporeans to pursue healthcare training programmes at both local and overseas institutions.

Mid-career professionals will be supported through several initiatives, including an enhanced healthcare professional conversion programme which will provide participants with a training allowance during their courses of study.

Another initiative is the Return to Nursing programme, which will see former nurses undergo a refresher course before starting work.

Their final days: More dying people sharing thoughts about life and death

More dying people are recording and sharing their thoughts about life and death with others
By Janice Tai, The Straits Times, 17 Oct 2016

What can the dying teach the living? Quite a bit, it seems.

A small but growing number of people spend their last days recording their thoughts on life and how they cope with impending death in order to share them with others.

They hope to get people thinking and talking about death early enough to re-examine their priorities in life, and take action on matters such as making wills or signing advance medical directives.

Mr Stephen Giam, 51, for instance, had advanced bile duct cancer. He died three weeks ago.

But before his death on Sept 26, he spent five of his last 20 days filming short videos of himself tackling various topics from his hospital bed. Titled "Stephen Says", the series of 19 YouTube videos covers issues such as: What's it like to have cancer? How do you make death your "slave"? How do you leave a legacy?

During his life, Mr Giam was a motivational coach. He told his doctors that perhaps being a "death coach" would be useful for others.

Sharing their personal journeys

"People are afraid, but they also want to learn from you. They are curious: what is it like to be dying?" he said in one of his videos.

The videos have since garnered about 70,000 views.

Mr Giam is not alone in his quest to use his dying moments to reduce the stigma associated with death. Industry observers say they see more of such projects nowadays because of a maturing consciousness among people who want to explore what it means to die well, and the availability of online platforms to get the discussion going.

Companionship provided so no one dies alone

More hospice volunteers, hospitals and individuals are providing end-of-life support
By Gurveen Kaur, The Sunday Times, 28 Aug 2016

The ultimate present you could give a dying person may well be your presence.

At Assisi Hospice, 15 volunteers take turns to sit by the side of dying patients until their last breath.

They are part of No One Dies Alone, a volunteer-centred programme that provides companionship to dying patients who have neither family nor close friends to accompany them in their final hours.

The volunteers simply provide a comforting presence, lending emotional and psychological support without the help of medical equipment or medication.

At the hospice, it was a long-time volunteer, Ms Jaki Fisher, who suggested the programme in 2013 after hearing about it from a friend in the United States.

The English-language teacher, who is in her 30s, says: "It resonated as I have felt alone before and would not want these patients to feel this way before they die."

No One Dies Alone was started in 2001 by Ms Sandra Clarke, a nurse in the US, and has been implemented in several hospitals there.

Help dementia patients live - and die - with dignity

By 2030, 80,000 Singaporeans are expected to have the disease. Many suffer in silence amid poor quality of life. Palliative care in advanced dementia can help.
By Allyn Hum, Published The Straits Times, 5 Jul 2016

One of the difficulties I face as a geriatrician is the sense of helplessness in addressing the challenges experienced by my patients living with dementia.

Contrary to popular belief, dementia is not part of the normal ageing process. It is an incurable neurodegenerative disease which causes sufferers to lose their autonomy and identity.

Dementia, of which the commonest form is Alzheimer's, has no regard for social class, education or affluence, afflicting people from all walks of life. Memory and basic functional loss erode individual independence and dignity. In its advanced stages, patients eventually require care for basic needs and are often bedbound.

In 2012, about 28,000 people in Singapore aged 60 and older had dementia. The number is expected to soar to 80,000 by 2030. The number will increase with Singapore's ageing population, as the odds of developing dementia increase as one grows older. Singapore's economic, social and healthcare burden from dementia is estimated at $1.4 billion annually.

Patients with advanced dementia have poor life expectancy. In an effort to prolong life, many are tube-fed or placed on intravenous drips. Some are restrained to prevent self-harm. Unfortunately, these well-meaning treatments rarely improve survival, while severely impacting the quality of life.

It is therefore imperative that we put in place interventions which focus on helping patients live and die with dignity.

Fear of dying alone increases among elderly folk

'When I die, I want someone to know'
Cleaner's fear of dying alone is a fear shared by rising number of elderly folk living alone here
By Danson Cheong, The Sunday Times, 10 Apr 2016

Eighty-five-year-old Mr Wee Yok Tai has lived in the same one-room flat in King George's Avenue for 30 years and is terrified that he will die alone in it.

The retired cleaner has no family and lives by himself in the spartan rental unit. He counts among his possessions a worn mattress, an empty fridge and two CCTV cameras on the ceiling.

They were installed about a year ago by undertaker Roland Tay, who came up with the unusual idea when Mr Wee asked him for help.

Mr Tay paid $1,000 for the equipment and monitors live footage from it at least three times a day using his mobile phone to check that Mr Wee is all right. Should anything happen, he will head over to help.

"I am alone, and there is no one to take care of me," Mr Wee said in Hokkien. "Two of my neighbours died and people found out only because of the smell. I don't want the same thing to happen to me."

Mr Tay, known for arranging free funerals for murder victims and the needy, suggested setting up a CCTV network, with one camera monitoring the bed and the other the outside of the toilet. "I could visit him every two or three days instead, but if something happened, it would be too late already," said Mr Tay, who still makes it a point to visit Mr Wee every few weeks.

Privacy concerns are the least of the octogenarian's worries.

"I see (Mr Tay) as a friend. I'm in my old age already, and when I die, I want someone to know," said Mr Wee, who got to know Mr Tay through friends.

Mr Wee has severe arthritis and cannot walk without using a cane. The pain means he spends much of his day seated on a plastic stool in the middle of the room.

"Every day, I sit here and then I sleep, I just don't want to fall down," said Mr Wee, who fears that such an accident could kill him.

The bachelor's fear highlights a very real concern elderly residents living alone here face, a problem that social workers say will only get worse as society ages.

New law enables South Koreans to 'die well'

New law enables terminally ill patients to reject treatment and die with dignity
By Chang May Choon, South Korea Correspondent In Seoul, The Straits Times, 29 Jan 2016

As she ages, housewife Lee Hyeon Seon, 60, is becoming more afraid of contracting some form of cancer - the number one killer in South Korea. If that happens and she becomes seriously ill, she hopes that her children will respect her wish to reject artificial life-prolonging treatment in hospital and allow her to spend her final days at home.

This way of dying with dignity, also called "well-dying" in South Korea, has been the subject of a national debate for nearly two decades, since two doctors were convicted of assisted murder and given suspended prison terms in 1997 for pulling the plug on a brain-damaged patient at the request of his wife.



Come 2018, Ms Lee will be able to indicate how she wants her life to end, when a well-dying Bill comes into effect.

The law, which allows incurably ill patients to opt out of life-prolonging treatment, was passed by the National Assembly on Jan 8, paving the way for the development of palliative and hospice care services that are lacking in the country.

This is similar to the Advance Medical Directive Act passed in Singapore in 1996. Taiwan adopted similar legislation in 2000.

In South Korea, critics and religious groups have criticised the Bill, saying it can be deemed as disrespect for life and goes against Confucian values of filial piety.

There are also concerns over the potential for abuse if doctors allow patients and their family members to choose death over treatment.

But the law has drawn support from elderly folk. A survey last year showed that nine in 10 Koreans aged 65 and older did not want to receive treatment to extend their lives if they knew they were suffering from an incurable disease.

"I don't want to prolong the pain and suffering," said Ms Lee. "It's my own life. I want to make my own decision how it should end."

New Yishun Community Hospital takes in its first patients

Community hospital opens 2 wards; a dozen recovering patients move over from KTPH
By Salma Khalik, Senior Health Correspondent, The Straits Times, 29 Dec 2015

The 428-bed Yishun Community Hospital (YCH) opened its doors to patients yesterday, a move that should ease the bed crunch faced by the adjoining Khoo Teck Puat Hospital (KTPH).

Two wards, with 68 beds in total, are now open, said Ms Pauline Tan, Singapore's former chief nurse who now heads YCH. Five wards, with 170 beds in all, will be opened by next April, she added.

The hospital will gradually open its other wards, but is not expected to be fully open by next year.

Yesterday, the new hospital took in its first dozen patients, all recovering patients from the 590-bed KTPH, where space is tight as its occupancy rate averages more than 95 per cent - the highest of all public hospitals here.

About 200 of YCH's beds can be converted for use by KTPH should the need arise. Such "swing beds" are now the norm for community hospitals next to a general hospital.

The new hospital, which will also house the Geriatric Education and Research Institute, costs $320 million. A community hospital generally costs about half as much as a general hospital to build and operate, as its patients are not critically ill, but on the road to recovery.

Ms Tan said the hospital is opening "on time and on budget".

YCH mimics the home environment, she said. Patients who are able to, have to eat their meals in the dining area and not in bed. The idea is to get them well and home as soon as possible, she said.

Alexandra Health System (AHS), which runs KTPH and YCH, has a team of 30 people - nurses, therapists and a doctor - who visit patients at home to help them manage their transition back to their homes and any chronic ailment.

Dementia-friendly society 'crucial for ageing well'

Minister stresses need to raise awareness, build suitable infrastructure and focus on research
By Linette Lai, The Straits Times, 24 Oct 2015

Tackling dementia on "a few fronts" is the key to helping Singaporeans age well, Health Minister Gan Kim Yong said yesterday.

This includes raising awareness about the condition, building infrastructure suited to people who have it, and focusing research on how to delay its onset.

"While it is important for us to focus on the 'hardware', it is even more important for us to foster stronger community support and create dementia-friendly communities," Mr Gan said.

He was speaking at the Alzheimer's Disease Association's (ADA) 25th anniversary symposium held at the Concorde Hotel .

In Singapore, dementia affects an estimated one in 10 people aged over 60. Alzheimer's disease is the most common type of dementia, affecting over 70 per cent of patients.

Yesterday, Mr Gan highlighted the example of Chong Pang, where the Agency for Integrated Care and Alexandra Health System have been working to pilot such a community.

Their task was to make sure everyone in the area - from retailers to primary school pupils - had a basic understanding of the condition and how to help those with it cope.

Chong Pang has around 50,000 residents, 20 per cent of whom are aged above 65. An estimated 1,000 of these seniors have dementia, and may run into problems when going about their daily chores.

End-of-life care at A&E for the terminally ill

Hospitals implement procedures to ensure that needs and wishes of dying patients are quickly met
By Samantha Boh, The Sunday Times, 18 Oct 2015

Terminally ill patients are getting the care they need faster at several hospital emergency departments, thanks to new procedures there.

Doctors and nurses at the emergency departments are now trained in basic palliative care skills and a specialist team is activated once patients who need complex end-of- life care arrive there.

In the past, the directive was to go all-out to resuscitate a patient, regardless of his condition, causing some to die surrounded by machines instead of their families.

Now, the focus is to make the patient comfortable by, for instance, getting painkillers to him quickly.

A palliative care procedure - or protocol - was first introduced at the National University Hospital (NUH) in June last year and since then, four more hospitals have followed suit.

Tan Tock Seng Hospital (TTSH) started using such a protocol in January. A palliative care team is alerted when a patient with advanced stage cancer or organ failure arrives at the emergency department.

The team is also notified if a patient is suffering from extreme pain, breathlessness and other symptoms associated with dying.

The aim is to shorten the wait for medicine, such as morphine which, under previous rules, was given only after the patient was warded - which could take 12 hours.

"We want to bring palliative care to the fore so that patients who require such care get it on time," said Dr Mervyn Koh, head of the palliative medicine department at TTSH.

The new procedures also ensure that patients' end-of-life wishes are fulfilled. In some cases, this means taking the patients to an "end-of-life care room" to spend their last moments with their families. No attempts to resuscitate are made there.