03 Oct 2011
By: MELISSA PANG
LUNG disease patient Lincoln Wong rarely receives regular guests at home – except for two visitors who drop by every month.
Like old friends, they ask the 65-year-old questions about his health – whether he is sleeping well, and if he is in pain. His blood pressure is taken and a set of forms is updated.
Once in a while, he would call them during emergencies and they would advise him on what to do.
Terminally ill patients like him normally spend their final days in a hospital or hospice.
But as a patient on the Holistic Care for Medically Advanced Patients (Home) programme, he receives end-of-life medical and nursing care as well as psycho-social support at home, free of charge.
The objective of this programme run by the Agency for Integrated Care (AIC) is to “improve the quality of life for end-of-life patients”, said AIC’s chief care integration officer, Dr Wong Loong Mun. The AIC was set up by the Ministry of Health to look into the enhancement and integration of the long-term care sector.
The need for such a home-care programme came about because palliative home care catered primarily to cancer patients, he said. “With the rising number of patients with chronic diseases and with many progressing to the advanced stage and experiencing similar distress as those with cancer, there was a need to... care for this group.”
Home is available only to patients suffering from advanced chronic obstructive pulmonary disease (COPD) and end-stage heart failure, with a prognosis of six to 12 months. COPD is a group of lung diseases that make breathing increasingly difficult.
But there are plans to include other non-cancer conditions such as liver failure.
Patients are referred to Home by their primary physician at a restructured hospital and a clinical test is done to assess suitability. The programme is provided free of charge, regardless of the patient’s financial status. This excludes the cost of medication and consumables such as feeding tubes.
Since its pilot phase in 2008, about 550 patients from National University Hospital and Tan Tock Seng Hospital have benefited from the programme.
AIC hopes it can benefit up to 3,000 patients between this year and 2016, by making it available at Singapore General Hospital, Khoo Teck Puat Hospital and Changi General Hospital next year.
Patients follow a structured and customised palliative home-care plan. This usually involves regular visits by a nurse in charge of caring for the patient and providing updates to a doctor, and a counsellor who facilitates discussions on advance care planning and provides caregiver support.
Advance care planning is the process in which patients discuss and state their wishes on medical care for when they are no longer physically or mentally able to make decisions. “The programme enables patients to be cared for and to die in comfort and dignity in a setting of his choice,” said Dr Wong, adding that a 24-hour on-call officer also helps reduce the number of visits to the hospital.
Primary care nurse Kalaichelvi Athimoola, 47, explained that with the regular visits, symptoms are picked up faster.
Doctors can thus treat patients earlier and prevent re-admissions.
Indeed, Mr Wong now sees his doctor only about thrice a year, from once every one to two months.
Whenever he suffers an acute attack, he no longer heads straight to the hospital. Instead, he will first call his nurse, who will assess the severity of his condition and advise him if a doctor is needed.
Email: melpang@sph.com.sg
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