National home hospitalisation programme set to include palliative care

SINGAPORE: End-of-life care is set to be included in Singapore’s national home hospitalisation programme, with at least one hospital spearheading the move.
This is in line with the Ministry of Health’s (MOH) move to raise capacity in home palliative care, and make it more accessible for patients who wish to pass on at home.
It will also help address the resource crunch in hospitals and hospices across Singapore.
The Mobile Inpatient Care-at-Home (MIC@Home) programme offers alternative inpatient care to clinically suitable patients, who can choose to be cared for in their own homes instead of being warded. 
CNA has asked MOH about the possible timeline for the move.
At Alexandra Hospital, its transitional compassionate discharge programme aims to bring terminally ill patients back to their homes and fulfill their end-of-life wishes.
Since it was fully operational two years ago, the hospital has seen savings in both inpatient bills and up to eight days of hospital stays. It is now working to include this as part of MIC@Home. 
“We are hoping to work with home hospices to expand the programme and we are also in the process of working with (the) MIC@Home programme, to be able to roll out to some of the other sicker patients,” said Dr Yong Woon Chai, the hospital’s senior consultant and head of the palliative and supportive care programme.
“This would mean that it is an easier transition from hospital to home.”
For Ms Sum Chew Lai, this was an option that her family took for her late father. 
In April last year, the 88-year-old had suffered a stroke and was bleeding in his brain. Doctors told the family that his chances of recovery were very slim.
With the clock ticking, a tough decision had to be made. 
“Dad mentioned (previously) that if it came to a stage where he cannot respond, cannot make a decision, (what he wanted is for) no tubes (to be) in his mouth, nose to support him and to let him pass on peacefully,” said Ms Sum.
“So we respected his wishes. We told the doctors we wanted to bring him home,” she added.
“We also understand that this team of palliative doctors and nurses would provide some kind of support at home to let us take care of our dad during his last journey.”
A team from Alexandra Hospital then moved quickly to prepare Mr Sum’s home. They also provided medication and taught his family members how to administer them if required. 
For Ms Sum, being able to fulfill her father’s wishes to spend his final hours at home gave her family strength in a difficult time. 
“I was also very worried at times, whether he could make it home,” she said.  
“So we are so glad that the two hours he spent with us, even the last two hours – it’s so precious to our family and will always be in our memory.”
Currently, MIC@Home provides acute hospital care at a subsidised rate in a patient’s home.
MOH said in parliament last year that it is exploring the possibility of scaling up the programme, to include more patient types like those on palliative care.
St Luke’s Hospital told CNA that the move could address challenges in the end-of-life care sector.
Earlier this year, it launched a home care programme for terminally ill patients, and has seen more patients opting for such care.
However, scaling up requires a boost from the government. 
Dr Chia Tee Hien, medical director at St Luke’s Hospital, said more funding and resources will be needed to help more patients. 
Training healthcare professionals to support these patients will be important, he added. 
To that end, Dr Chia said opportunities for continuous professional development should be given to clinical teams so they know the latest evidence-based care practices.
There is also a need to increase community awareness of healthcare services, and encourage collaboration with various healthcare providers to provide “a seamless ecosystem of care for these patients”, he said. 
Dr Chia stressed that the challenges of providing home-based palliative care include the need to manage a patient’s various symptoms, which “can be very complex” and “require a multidisciplinary team to come on board”. 
“Basically, this is very resource-intensive and requires time, effort, and manpower expertise from different care team members,” he said.
Noting that it can be emotionally draining for family members to care for their terminally ill loved ones, Dr Chia added: “We need to put in place various resources and support to help them to cope with all these additional emotional demands.”