SINGAPORE: A three—year programme on palliative care piloted by the Tsao Foundation’s Hua Mei Mobile Clinic has shown that it is possible to manage the frail elderly at home, even at the advanced stage of their disease.
In the pilot programme, the typical patient was over 80 years old, was battling seven different illnesses and only had six months to live.
A survey showed more than half (52.7%) of the patients did not want to be tube—fed, and 8 in 10 (84%) wanted to die at home. For most patients, their primary caregivers were family members.
They also received support from medical professionals. This included medication, counselling and access to a 24—hour hotline.
According to the findings, most of the caregivers said their family member died a ’good death’ at home.
Minister of State for Health Amy Khor revealed the findings at a palliative care forum on Monday.
Besides nursing care for the patients, the pilot programme also provides support to the caregivers in the form of grief counselling and bereavement care.
The pilot served a total of about 53 patients over three years.
Dr Khor said patients have multiple needs at the end of life.
The pilot programme highlighted the importance of palliative care services collaborating with other agencies in the larger health and social care ecosystem to provide holistic care for patients, she said.
The issue of end—of—life care is one focus of the health ministry as Singapore’s population ages.
By 2030, about one in five Singaporeans or close to one million Singaporeans will be above the age of 65.
Dr Khor said coupled with a rise in chronic diseases, there will be strong demand for healthcare, including geriatric and palliative care services in the community.
"The Ministry of Health (MOH) will continue to invest in developing the needed services to improve access, affordability and quality of aged care. Besides infrastructural developments, we are also growing our pool of healthcare professionals to ensure the continued delivery of relevant and high—quality care," said Dr Khor.
The number of palliative care—trained nurses in Singapore has been rising steadily. It now stands at 337 across the public healthcare sector.
Dr Khor said: "MOH is committed to expanding the quantity and training of our nurses to support palliative care developments now and in the longer term.
"Courses and opportunities for upgrading are also available in our educational institutions such as at the Alice Lee Centre for Nursing Studies at the Yong Loo Lin School of Medicine, Nanyang and Ngee Ann polytechnics, as well as hospice providers such as Dover Park Hospice.
"With the increasing integration of end—of—life care within the ambit of mainstream care, we will support more nurses to be equipped with skills in palliative care and management."
Dr Ng Wai Chong, assistant director of Hua Wei Mobile Clinic, said: "I’m not surprised that many people want to die at home. But it’s about community resources to support that.
"For us, the way we manage our community’s long—term care, roughly, it takes us about S$6,000 to S$7,000 per patient per year to support running a team of doctors, social workers. Then of course a lot of these costs are not calculated. How much does it cost for a daughter to not work and support the mother? Actually it’s huge.
"The alternative is nursing home, hospitalisation, it’s also very costly, and the older person might not be able to die in a familiar environment."
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