Understanding Hospice Care
Hospice care is far more specific and complex than general eldercare. While general eldercare focuses on providing various care services for seniors at any stage in their life, hospice care focuses on caring for people who are in the final stages of an incurable illness. Since this disease has become untreatable, it is important to note that hospice care focuses on improving an individual’s quality of life rather than treating their illness.
However, hospice care is not only for people with incurable cancers, but can also help those with advanced neurological conditions like Alzheimer’s disease, or late-stage heart, lung, and kidney disease. While the majority of people in hospice care is made up of elderly persons, children and young adults are also eligible.
When does hospice care begin?
Hospice care starts when disease in a person worsens to the point where any form of treatment can no longer cure or control it. Once a certified physician has determined that an individual’s life expectancy may be six months or less if the illness runs its usual course, they are immediately eligible for hospice care.
Additionally, this process can only begin if the individual has consented to forgo their existing treatments as it is no longer effective for them.
Other signs indicating that it may be time for hospice care include:
- Recurring or frequent infections
- Frequent hospitalisations or trips to the emergency room (ER)
- Inability to perform activities of daily living (ADLs) such as dressing, toileting, eating, walking, and personal cleaning
- Uncontrolled and frequent pain, nausea, vomiting, or shortness of breath
- Loss of appetite and significant bodily changes like weight loss
- Increased sleep or confusion
- Wanting to focus on quality of life, instead of curative treatment
What services does hospice care provide?
While the services offered at a hospice care centre may vary depending on the establishment, these are some of the common services provided.
One of the most common services provided is nursing care. Typically, individuals under hospice care are assigned to a case manager nurse, who are trained to attend to them by providing treatment and relief from symptoms of their disease or illness. Apart from the nurses, hospice nursing care usually takes an entire village to run due to its multidisciplinary nature. Doctors, nurses, health and social workers, and other medical professionals work together to fulfill all their medical responsibilities as a team. In some cases, complex nursing procedures may also be performed ranging from injections to wound care.
In contrast to nursing care, personal care is centred around basic activities of daily living such as eating, bathing, getting dressed, transferring, toileting, and continence. As their illness or disease progresses, individuals may lose the ability to perform basic self-care activities. This is where caregivers will step in to help those who need additional assistance.
It is essential to ensure that caregivers also get enough rest from their responsibilities as the failure to do so may result in stress or burnout. Through respite care, hospice staff will temporarily take over the responsibilities, giving family caregivers the time to mentally and physically recharge from their duties and take care of other aspects of their lives. At the end of the day, caregivers are still people and deserve rest and time for themselves as well.
Supportive rehabilitation in hospice care such as occupational therapy and physiotherapy does not necessarily focus on curing any injuries or disabilities. Instead, it helps people remain independent and improve their quality of life. This gives them the opportunity to stay as active as possible with minimum dependency on others, despite their life expectancy.
Through counselling, individuals who are at the final stages of their life can still continue to nurture their emotional and mental well-being as they navigate through this challenging time. Beyond supporting the patients themselves, these psychological services also help the immediate families as they journey through their adjustments and losses. Certain centres also provide spiritual care upon request to complement the counselling sessions.
Palliative Care vs. Hospice Care
Many have heard and used the terms palliative and hospice care interchangeably due to their various similarities. However, the two terms are actually rather different in nature. The key difference between palliative care and hospice care is when they are available. When someone is diagnosed with a life-threatening or chronic illness, hospice care isn’t typically the first choice.
Palliative care encompasses symptom management, hospice care and bereavement, and is an available option as soon as the individual is diagnosed. Meanwhile, hospice care is only advised when the individual is no longer seeing improvements even after treatment and has fewer than six months to live, as evaluated by a medical professional.
Another key difference between the two are their treatment options as well. Individuals under palliative care can still continue their curative or life-prolonging treatments, but those under hospice care need to put a stop to all forms of treatment aimed at recovery in order to qualify. Medical care doesn’t stop for those under hospice care, but the focus is directed towards treating the symptoms (as opposed to the illness) and improving one’s quality of life in the time that they have left.
Applying for Hospice Care in Singapore
There are a few steps you need to go through when applying for hospice care in Singapore:
Step 1: Get a Referral
All candidates who wish to apply are required to get a referral from your hospital, local polyclinic or General Practitioner (GP). The doctor will then provide you with the referral form and medical report, which you will need when submitting your application to the hospice care facility.
To be eligible, your medical report needs to state that you have an advanced and progressive disease. Do note that not all applicants are eligible and applications will still be subject to approval by the hospice care provider.
Step 2: Decide on the Hospice Care Facility of Your Choice
Choosing your hospice care facility would be the next step in the application process. While most centres in Singapore provide similar services, one of the main factors to consider is the location of the centre. If you are looking into inpatient hospice care for your elderly loved one, it is important to consider the proximity of the centre from your home to minimise travelling time and any other inconveniences. Likewise, for those who prefer home hospice care, choose a facility that can provide that particular option.
Step 3: Wait for the Initial Assessment of Your Evaluation
Once you have gotten your referral and chosen your preferred centre, it is time to wait for the results. During this process, the centre’s medical staff will evaluate the individual’s suitability for hospice care based on the information on the referral form and medical report.
If your loved one is successfully accepted, a primary nurse will be assigned to manage and plan their treatment and get in contact with you and your family to arrange for an initial clinical assessment. Depending on the admission plans, an ambulance transfer may be arranged if the individual is fit for transfer.
List of Hospices in Singapore
Assisi Hospice is the only hospice in the country providing all three forms of care services, which includes inpatient, day care, and home care aid. Established in 1969, they are also one of the oldest hospices in the country. With 85 inpatient beds and a doubled capacity for Home Care and Day Care, they are able to serve more than 2,000 individuals each year. One of the key features of their establishment is that their facilities are designed to encapsulate a homely ambience away from home by providing lots of natural light and nature-centred spaces.
- Website: https://www.assisihospice.org.sg/
- Location: 832 Thomson Road
- Telephone: 6832 2650
- Operating Hours: Open 24 hours daily
Dover Park Hospice
Founded in 1992, Dover Park Hospice is a secular, non-profit organisation created to meet the growing demand for hospice care in Singapore. They are also the country’s first purpose-built hospice, designed to provide a tranquil and serene environment to bring their residents closer to nature. Through all their facets of hospice work from patient care and social activities, to administrative support, the team at Dover Park Hospice is dedicated to maintaining the quality of service that they have been putting forth in the past 25 years.
- Website: https://www.doverpark.org.sg/
- Location: 10 Jalan Tan Tock Seng
- Telephone: 6500 7272
- Operating Hours: Open 24 hours daily
HCA Hospice Care
As Singapore’s largest hospice care provider, HCA Hospice Care serves more than 3,500 individuals annually and makes about 37,000 home visits. One of the biggest benefits at HCA is how their core service, home hospice care, is provided at absolutely no charge. This allows individuals from lower income families to receive the necessary care without the need to go above and beyond their financial needs. Besides hospice care, HCA is an NCSS Centre of Specialization for palliative care and conducts palliative care training regularly for family caregivers.
- Website: https://www.hca.org.sg/
- Location: 705 Serangoon Road, Block A #03-01 @Kwong Wai Shiu Hospital (Headquarters)
- Telephone: 6251 2561
- Operating Hours: Monday to Friday from 8:30am to 5:30pm
Metta Hospice Care
As a member of the Singapore Hospice Council and Asia Pacific Hospice Network, Metta Hospice Care provides free home hospice care to those who are terminally ill, and has helped more than 5,000 individuals live with dignity throughout the last phase of their lives since June 2000. Their primary focus is on individuals with life-limiting illnesses including cancer and end-stage renal failure, that usually have a prognosis of less than a year. Through their organisation’s holistic approach to hospice care, their care recipients are committed to supporting their emotional and social welfare as much as their physical well-being.
- Website: http://www.metta.org.sg/hq/
- Location: 32 Simei Street 1
- Telephone: 6580 4688
- Operating Hours: Monday to Friday from 8:30am to 5:30pm
Methodist Welfare Services (MWS) Home Care & Hospice
Methodist Welfare Services (MWS) have come a long way since their humble beginning in 1976. Today, their spectrum of care meets the specific needs of 8,400 disadvantaged seniors, youth, children and families. Their comprehensive hospice care team provides round-the-clock support and is dedicated to helping individuals with advanced diseases who wish to spend their final days at home with their families. Aside from providing home-based hospice care for frail residents, the MWS Home Care team also supports elderly persons from MWS Senior Activity Centres who have the means to age in place within their community.
- Website: https://mws.sg/product/mws-home-care-and-home-hospice/
- Location: 2 Kallang Ave, #08-14 CT Hub
- Telephone: 6435 0270
Singapore Cancer Society (SCS) Hospice Care
Established in 1987, Singapore Cancer Society (SCS) Hospice Care was the first ever hospice home care service in Singapore. Since then, they have been continuously providing hospice care to various communities in the country and is now one of the founding members of the Singapore Hospice Council. Their programme provides a full suite of care services including clinical assessment and treatment, psychosocial services, home rehabilitation, and loan of equipment, ensuring that individuals under their care are supported in all aspects of their journey.
- Website: https://www.singaporecancersociety.org.sg/
- Location: 15 Enggor St, #04-01 Realty Centre (Main Office)
- Telephone: 6221 9578
- Operating Hours: Monday to Friday from 8:30am to 6:00pm
Home Hospice Care with Homage
Seniors who wish to age in place often struggle to find a suitable hospice home care service provider which allows them to receive the care they need and age with dignity alongside their families.
With our Home Palliative and Hospice Care services, Homage goes beyond end-of-life care and focuses on improving one’s overall quality of life in their last moments. While taking care of one’s physical welfare is an essential aspect of hospice care, holistic healthcare and looking after your mind and spirit is just as important.
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