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Hospice and Palliative Care
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Are hospices evaluated and regulated by the government?
Yes, all hospice services, including home care, day care and in-patient hospices, are licensed under the Private Hospitals and Medical Clinics Act 1980, Chapter 248. MOH also audits the services which are subsidized by it.
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Do hospices make death come sooner?
Hospice and palliative care, according to the World Health Organization definition of 1990, “neither hastens nor postpones death”. It focuses on maximizing quality of life in the time that remains and achieving the patient’s own goals.
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Is hospice care available 24 hours?
For in-patient hospices, there is medical and nursing staff available around the clock. Hospice home care services have staff covering calls at nights and weekends and public holidays. These staff will be able give advice over the telephone, and visit if necessary during an emergency. Hospice day care services operate only during normal working hours.
For more information, one can call the hospice toll free line at 1800 333 6666 during office hours or email help@lifebeforedeath.org.sg.
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How successful are the pain management techniques used in hospice and palliative care?
Cancer pain can be controlled using simple methods advocated by the World Health Organization in over 90% of the cases. Sometimes, some pains are complex and require the involvement of a multidisciplinary team, which hospice services have access to. Apart from oral medications, other techniques involving injections to block nerves or deliver pain medications by other routes, may be involved. A change in lifestyle, physiotherapy, massage and acupuncture may also have a place.
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What should we do if we are unhappy with the care provided by the hospice professionals?
You can speak to the person in charge of the professional team about what you find unsatisfactory, and explain your concerns and preferences. The hospice team will try their best to accommodate your requests within their resources.
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What can I do as a hospice volunteer and how do I become one?
Hospices rely on volunteers with different skills and contributions. Hospice volunteers may be required to deal with patients in advanced stages of disease and their families who may be in a lot of emotional distress. All the hospices are VWOs (Voluntary Welfare Organisations) which are run by management committees made up of volunteers. Hence volunteers with skills in management, finances, legal advice, human resource development and fund-raising are always welcome. If you want to volunteer, you can write to the Volunteer Coordinator of the particular hospice that you are interested in and you will be called contacted for a discussion.
For Patient
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If I seek the services of a hospice run by a religious organization, will I be subject to receiving religious counsel against his wishes?
All the hospice services, regardless of their religious affiliation, accept and care for patients of all races and religions. Staff is aware that spiritual and religious issues become important during this part of life, and are trained to recognize the sensitivities and practices of the common religions in our community.
All the hospices have policies which respect the patient’s own faith and prohibit religious counselling except on request of the patient in the religion of his choice.
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If I am staying in a long-term facility instead of my own home, can I still receive hospice care?
The Singapore Hospice Council hopes to work with its members and the Ministry of Health to resolve the issue of hospice care for residents of long-term facilities. Some hospice home care services will continue to see patients who transfer to nursing homes, even though there will be no government subvention given to the hospices.
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Can I be cared for only under one hospice service?
Yes, if you require hospice home care, only one of the hospice home care organizations can provide the service. But, should you need in-patient hospice admission, this can be done under another hospice organization.
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Are the fees charged by your hospice members subsidized by the government? How much do I have to pay per month to stay in a hospice? How do I know whether I am eligible to receive subsidies for hospice and palliative care?
Patients may qualify for subsidy according to the The Ministry of Health’s “means test” which is a tool to evaluate the patient’s financial status. For more information, please go to: http://www.moh.gov.sg/corp/elderlycare/subsidies/intro.do.
In-patient hospice care charges vary according to how much government subsidy the patient is eligible for. But if your family is unable to make up for the difference not covered by government subsidy, all the hospices are willing to provide extra subsidies from their own charitable collection. Fees are deductible from Medisave.
Medisave may be used for in-patient hospice care at Assisi Hospice, Dover Park Hospice and Bright Vision Hospital.
Hospice home care services are provided free of charge, whether you are eligible for government subsidies or not. Many receivers of hospice home care make donations to the charities if they wish to contribute.
A nominal fee is charged for hospice day care services.
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Can I pay for the unsubsidized portion of hospice care fees with my insurance policy?
Some insurance schemes cover terminal care, but this practice varies from policy to policy. It would be wise to check with your insurance provider in advance.
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If I am staying in a hospice, can family members still play a part in caregiving?
Most hospices encourage the family to take part in the care of the patient. The process of dying is a complex one, and while the hospice team can help eradicate most of the physical pains and some of the emotional pain, family members and friends play a big part in helping the patient move towards a peaceful death. Family members are important because the best care can be given by the people who care for you most, and it is in the provision of care that many family members show their love. The hospices’ role is to empower the family to do this.
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What does in-patient hospice admission process involve?
First, the doctor in charge of the patient has to decide that hospice and palliative care is appropriate for the patient, and that the patient does not wish to be at home, or there are not enough caregivers at home to make home care feasible. The doctor then has to make a referral to the in-patient hospice of choice for the patient.
Family members will be consulted and information is given to them about the various hospices available. Considerations are usually given to the patient’s religion and preference, and how easy it is for families to travel to the hospice. Sometimes, family members may wish to visit the hospice to see the environment.
After receipt of the hospice referral form from the patient’s doctor, and admission to the hospice is deemed appropriate, hospice staff will usually contact the family to provide more information and make arrangements for means testing and agreement on the charges. The hospital will liaise with the hospice with regard to when a bed is available and when the patient is fit for transfer. A family member will be notified to accompany the patient during the transfer in order to help with the registration. Ambulance transfer is usually arranged by nursing staff at the hospital ward and paid for by the family.
On arrival at the hospice, the patient will be settled in his bed and he will be assessed by the nurses on the ward and by the admitting doctor. The family will also be interviewed so that a full picture of the medical and social conditions is obtained. A similar procedure will be followed for patients admitted from their homes.
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Is there a minimum age limit to seek for hospice and palliative care?
No, there are no age limitations for anyone requiring hospice and palliative care. The hospice services have accepted patients from birth to extreme old age.
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If I have a life limiting/degenerative illness and would like to seek hospice and palliative care. How can I do it?
You can contact any of the 8 Singapore Hospice Council members for advice. They can advise you on the care most suited for you and also advise you on the costs of receiving hospice and palliative care. There is a toll free hospice helpline 1800 333 6666 available during office hours or email help@lifebeforedeath.org.sg.
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Do I have to stay in a hospice to receive hospice and palliative care?
Most people in Singapore receive hospice and palliative care at home. This is in line with the wishes of most patients. It is only when the patient is unable to be cared for at home that in-patient hospice care becomes necessary. In 2005, the number of new patients receiving hospice home care was 2,909, while new patients at in-patient hospices were 984.
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Do I get the same level and quality of medical care in a hospice as compared to a hospital?
Hospice services are good at doing different things from hospitals. When the patient needs complicated investigations and treatment for acute problems, the hospital is the right place. After these problems are sorted out and the patient needs continued nursing care, medical supervision and adjustment of medications for pain and other symptoms, the hospice services are better at doing these. Nursing care in the in-patient hospices is usually better than at hospitals because their focus is different. Staffing ratios are similar to hospitals, but the nurses are more focused on the patient’s comfort and support of the family, and they are used to nursing very sick patients with complex nursing needs. The hospice services also provide counselling and pastoral care support.
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Would I be able to receive anti-cancer treatment, or treatment that controls the disease and enables me to live longer when I am under hospice and palliative care?
Many chronic diseases are not curable, but there may be treatments that affect the course of the disease and enable you to live longer with better quality of life. Patients under hospice and palliative care are often still on palliative chemotherapy, and radiotherapy may be used to control bone pain and other symptoms. Patients do not have to forgo disease-modifying treatments when they are under hospice and palliative care.
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What is the difference between an old folks home and a hospice? Which is better for me?
An old folks’ or nursing home is more suitable for people with more stable, but chronic illnesses who need mainly nursing care. Hospices cater for people whose illnesses are very advanced and who require more intensive nursing and medical input. As their conditions may be complex and change rapidly from day to day, the healthcare teams have to be able to respond to their needs.
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Is it important for me to select a hospice of my religion?
The hospice will not attempt to influence patients or convert patients if the patient does not wish to. The choice is left to you
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If I do not have any religion, can I opt to stay with a Christian- or Buddhist-run hospice?
Yes, you can do so. Our hospices aim to provide hospice and palliative care to all their patients. Your religion does not affect your chances of receiving hospice and palliative care. You should choose one that you are comfortable with.
- If I am single and do not have any relatives in Singapore, and have been diagnosed with terminal illness, what help can I seek?
You can talk to your doctor, nurse or medical social worker about hospice care. For single persons, the plan of care can be made by the hospice home care service. You can stay at home for as long as you can manage. You may be supplemented by social support such as meals-on-wheels, but in the later stages of your illness, you may need in-patient hospice care.
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If I recover during my stay with one of your hospices, would I be able to transfer to a hospital to continue further treatment?
Yes, we do have patients who manage to improve and leave the hospice in healthier condition than they have entered. The hospice is not a death house, and the hospice caregiving team aims to provide holistic treatment that eases pains caused by the patient’s condition.
For Caregivers
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Do all hospices provide the same type of palliative care?
Our 8 hospice members provide a range of services and facilities for patients. For example, some hospices provide day care, some home care and others in-patient care for patients.
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I am the primary caregiver of a patient and I am considering hospice care. What do I need to do to apply for admission to a hospice?
You should discuss this with the patient’s doctor who will advise you on the patient’s eligibility for hospice care. If appropriate, the doctor will then fill the Hospice Common Referral Form and fax or mail it to the relevant hospice service. The hospice service will then contact you.
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What do I need to do to prepare for my relative/parent/friend’s admission?
You need to keep the patient’s NRIC ready and also be prepared to give a detailed history to the hospice staff. You will be guided by the hospice staff on any documentary evidence that may be required to complete the patient’s admission process.
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How do I know when is the best time to send someone to a hospice for palliative care?
Hospice care is most commonly provided at home by a hospice home care service. Most patients die at home and never need to go to an in-patient hospice. The time to initiate an in-patient hospice referral is when the doctor tells you that the patient’s disease is not curable and the patient has symptoms that are not controlled or the family is unable to cope with the care of the patient at home. Hospice services are very experienced in dealing with these kinds of situations.
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Should one wait for the doctor to suggest hospice and palliative care first?
Most doctors know about hospice and palliative care, and some will recommend it without hesitation. However, certain doctors may hold back from suggesting it for various reasons. You can ask your doctor whether you or your family member can benefit from hospice and palliative care. Waiting for your doctor to bring up the topic may keep you from receiving the necessary care when you need it most.
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Is there any special equipment that needs to be installed at one's home before hospice care begins?
In general, the requirement for special equipment only extends to the physical and medical needs of the patient, and will be recommended by the patient’s healthcare team upon discharge from the hospital. Additional equipment may be required at later stages of the patient’s disease. Hospice staff will be able to advise on what is required and how to obtain such equipment.
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How difficult is it to care for a dying person at home?
It is not easy to care for a dying person, especially when the person is a loved one. You have to tend to the needs of the person while managing your own health and emotions. The demands of caring for a dying person grow over time, as the person gets closer to death. Long nights will become common, and can get lonely for a single caregiver. The home visits of hospice staff at regular intervals during such times will help you in managing the needs of the dying person while maintaining your own wellbeing at the same time. The hospice staff can be contacted easily during the working days if advice is needed. In addition, hospice home care services have a patient care helpline that relatives can call if they are worried, after office hours during the week and during weekends and public holidays.
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How can the hospice team help a patient and his family through home care?
Different members of the hospice team have different skills. There are doctors and nurses to help the patient with the advice on medications and maintenance of personal hygiene and comfort. Counsellors help the patient and his family in dealing with emotional turmoil, and trained volunteers serve as respite caregivers (temporary caregivers that allow the primary caregiver to get some rest or run errands).
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If one is admitted into a hospice, does it put him on a one-way road to death?
Although most hospice patients begin receiving hospice care knowing that they have only a few more months left, some patients manage to improve and leave the hospice in a healthier condition than they have entered. The hospice is not a death house, and one of the aims of hospice care is to keep the patient as well as possible for as long as possible.
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What type of support does the hospice provide for the family members of the patient?
Besides respite care and additional help (for home care), hospice volunteers and counsellors are able to help family members deal with their grief over the imminent death of the patient. Such support is also available after the death of the patient.
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If I have a dying friend, would it be rude of me to suggest hospice care as an option?
As a friend, you would want to look out for the best interests of your dying friend. Suggesting hospice care would not be considered as rude if done in a sensitive manner. Pick up some brochures at a hospice and talk to your friend about the importance of receiving the right type of care. You can also direct your friend to this website to explore the options and services available and to put any doubts and fears to rest.
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