Page 155 - Hospital Authority Convention 2017

Symposiums

S10.1 Palliative Care 10:45 Convention Hall C

End-of-life Care in Singapore
Goh-fung CR
Asia Pacific Hospice Palliative Care Network; Division of Palliative Medicine, National Cancer Centre, Singapore HOSPITAL AUTHORITY CONVENTION 2017
Palliative care in Singapore started from the hospice movement. In 1986, volunteers at St Joseph’s Home organised
themselves to provide care for patients dying in their own homes. They first joined the Singapore Cancer Society and
later formed their own organisation, now known as HCA Hospice Care. From the late 1980s to 1990s, various charitable
organisations provided both inpatient hospice care and hospice home care.

The Singapore Ministry of Health started giving support to these charities, known as Voluntary Welfare Organisations (VWOs)
from 1990 in the form of grants, and later subventions that fund partially the services being provided. The policy then, as now,
was that the government would fund acute care in hospitals, which were organised into business units wholly owned by a
government holding company, but intermediate and long-term care would be provided by VWOs, licensed by the Ministry of
Health. Development of these services would be guided by the various channels of funding provided by the government to
accredited units.

A majority of deaths (over 60%) occur in hospitals, so currently, all government acute care hospitals have palliative care
services, mostly consultative services. Step-down care in community hospitals is being ramped up, and all health clusters
(currently re-organised to three) have community hospitals which have palliative care beds. This is in anticipation of the lack
of caregivers to provide care at home now that families are smaller and two-income households are the norm. Hospice home
care services run by VWOs continue to serve the majority of patients at home, enabling over 50% of these patients to die at
home. A priority currently is the integration of palliative care into nursing homes to enable people to “age and die in place”.

S10.2 Palliative Care 10:45 Convention Hall C

“Keep Me Comfort at Home” – Palliative Care Nursing Support in the Community
Kwan C
Palliative Care, Bradbury Hospice, Hong Kong

Patients with chronic incurable diseases suffered from a number of physical and psychological distresses. When entering the
end stage of life, pain, symptoms, weaknesses, impaired mobility and self-care ability make staying at home difficult. This is
also a hard time for family caregivers. Even if they are capable enough to take up all the caring tasks, they would still find it
very stressful to look after a terminal patient at home. Caregiver anxiety is very common and real in the caring process. Home
care is an integral component of palliative service to support patients to stay at home as long as possible. Home care brings
the care to the patient and avoids the burden of transportation to clinics, particularly essential for patient at the terminal
stage. Palliative home care nurse plays the role of case manager, advocates for and coordinates the care of the patients. Wednesday, 17 May
Home care nurse pays regular visits to the patients’ homes or residential care units to provide holistic nursing care to the
patients including symptoms management, emotional support and facilitate coping at home. Home care nurse also provides
support to the family caregivers in educating caring skills, stress management and facilitate family communication. Home
care nurse maintains partnership with the patients and their families. Keeping a continuous and genuine communication
with them to adjust the care focus, meeting the changing needs of the patients along the disease and dying journey is vitally
important. Home care nurse walks with the patients and their families in this final and difficult part of the life journey. “Keep
me comfort. I want to stay at home” is very often a request of our terminal patient. This is always a challenge for palliative
home care nurse to support the patients at home as their needs and home situations are so varied and individual.

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