September 2, 2016

Hospice & Palliative Care

Overview
Hospice and palliative care is a holistic approach to caring for patients going through serious illnesses. It aims to meet all needs (physical, emotional, psychosocial and spiritual) so as to alleviate suffering and maximise quality of life for patients and their loved ones. Staff and volunteers work in multi-professional teams to support these patients and their families, and enable patients to live their last days fully.

Definition
Hospices function on the belief that each individual should have a pain-free and dignified death, and that the family of the dying should have support during this difficult period. They provide hospice or palliative care which refers to the holistic care towards patients’ physical, emotional, mental and spiritual wellbeing. Services not only focus on the relief and management of patients’ pain caused by illnesses or treatments, but also facilitate bonding among patients, friends, family and volunteers. While palliative care refers more to hospital-based services, hospice care refers more to hospices’ community-based services.

Situations Covered
Hospice and palliative care is not restricted to any one type of life-limiting illness. Although cancer is the most common ailment of patients receiving hospice and palliative care, patients with any terminal and life-limiting condition can be properly cared for. Palliative care is generally provided for patients who have been diagnosed with just months to live (not years), but it can also be provided for patients in the early stages of their illnesses.

Common Misconceptions
Hospice and palliative care is commonly misunderstood as a service provided for patients staying at the hospice. In fact, most hospice and palliative care receivers are cared for in their own homes. In such cases, a family member is the primary caregiver while hospice staff provide support. Some patients choose to use day care services at the hospice. In such cases, patients are bussed to the hospice, spend the day there involved in various therapies and activities, and are sent home in the evening.

Hospice and palliative care is not as simple as a nurse or nurse aide providing patients with medical and physical care (eg. ensuring patients take their medications, bathing patients, etc). It provides both patients and their families with holistic care and support (eg. pain management, physiological and psychological therapies, coaching on basic caregiving for caregivers, and bereavement counselling). Because of the holistic nature, hospice and palliative care is provided by a team consisting of the patient’s doctor, nurses, nurse aides, social workers, counsellors and therapists. Each expertise is called upon as and when their services are needed.

One need not be financially well off to engage the services of a hospice and palliative care team. Hospice and palliative care services are provided at very low costs, and are often covered by government medical care programs in many countries.

Receiving hospice and palliative care does not mean that patients are moving towards death. There have been cases where these patients’ conditions stabilize under the care of hospice and palliative caregivers, and they go on to live normal lives for some years.

Is hospice and palliative care available 24 hours?

Different hospice services have different operational hours. In-patient hospices have medical and nursing staff available around the clock. Hospice day care services operate only during normal working hours. Hospice home care services have staff covering calls at nights and on weekends and public holidays. These staff can give advice over the telephone and visit, if necessary, during an emergency.

Do hospices make death come sooner?

Hospice and palliative care, according to the World Health Organization’s 1990 definition, “neither hastens nor postpones death”. It focuses on maximizing quality of life and achieving the patient’s own goals in the time that remains.

Are hospices evaluated and regulated by the government?

Yes, all hospice services (including home care, day care and in-patient care) are licensed under the Private Hospitals and Medical Clinics Act 1980, Chapter 248. The Ministry of Health also audits the services that it subsidizes.

What can I do as a hospice volunteer?

All the hospices are Voluntary Welfare Organisations (VWOs) which are run by management committees made up of volunteers. Hospices also rely on volunteers who may be required to deal with patients in advanced stages of diseases and their families, all of whom may be in a lot of emotional distress. Hence, volunteers with different skills and contributions (in management, finances, legal advice, human resource development and fund-raising) are always welcome.

How do I become a hospice volunteer?

If you wish to volunteer, please contact the Volunteer Coordinator of the respective hospice.

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.

How successful are the pain management techniques used in hospice and palliative care?

In over 90% of cases, cancer pain can be controlled using simple methods advocated by the World Health Organization. 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 delivery of pain medications by other routes may be involved. A change in lifestyle, physiotherapy, massage and acupuncture may also have a place.