September 7, 2016

For Patients

Pain Management

1. Pain killers Medication
If the pain is disrupting your normal way of life, and interfering with your thinking and concentration, it is important to use pain killers medications to help control the pain. Using medications does not mean that you will become dependent on them. While you should not take medications at the slightest hint of pain, do not wait until the pain is completely disabling. Use your discretion and know when the pain is getting too much for you to handle on your own.
If the medication prescribed by your doctor is not effective or has too many side effects, do not hesitate to ask your doctor to prescribe a different medication. It is your right to receive medication that is appropriate for you.

2. Relaxation Techniques
Constant pain can stress your body even if you are taking medication to control the pain. Using other pain-relieving methods such as massages, aromatherapy and warm baths can help you feel better physically and mentally. These methods will also give you greater control over managing your pain without complete dependency on medications alone.
Simple breathing exercises can also help give your body more energy to handle the pain. Normal breathing is shallow and does not clear your lungs fully. Take breaths slowly and deeply, and release breaths slowly. This will clear your lungs of “used air” and fill them with fresh air, giving your body the maximum amount of oxygen.

3. Engage the Mind
Distracting yourself from the pain can also help you manage it. Non-strenuous activities like reading books, listening to soothing music or taking a stroll in the park will engage your senses in something else and draw your attention away from the pain.

Speak to your family and friends about positive things, and strengthen your bond with them while relieving yourself of some pain. Cheerful thoughts and laughter may release endorphins in your body which may act as a natural buffer for pain.

4. Avoid Stress
Just as happiness can reduce pain, stress and anger can amplify pain. So, try to avoid situations where you might have to argue with someone or listen to someone talking about stress-inducing topics.

It is also vital to your mental health to minimize self-pity. The pain and symptoms in your body may constantly remind you of your situation and prompt you to fall into bouts of sadness, but you need to bring yourself to accept the situation. While constant moping will only worsen your condition and create a destructive cycle, acceptance can lead to better quality of life.

If I am single, with no relatives in Singapore, and diagnosed with terminal illness, what help can I seek?

You can talk to your doctor, nurse or medical social worker about hospice and palliative care. The hospice home care service can help you plan your care. You can stay at home for as long as you can manage. Your hospice home care may be supplemented with social support (eg. meals-on-wheels). However, in the later stages of your illness, you may then need in-patient hospice care.

What is the difference between an old folks’ home, a nursing home and a hospice? Which is better for me?

Hospices cater to people whose illnesses are very advanced and who required intensive nursing and medical inputs. As their conditions may be complex and change rapidly from day to day, hospice healthcare teams must be able to respond to their needs quickly and round the clock. A nursing home is more suitable for people with more stable, but chronic illnesses (eg. patients who are bed-bound, paralysed or require spoon-/tube-feeding, etc) who need extensive routine nursing care. An old folks’ home, on the other hand, are for healthy aged who may be mobile and independent, needing little nursing care.

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 in-patient hospices is usually better than that in hospitals because of their different focuses. While staffing ratios in hospices and in hospitals are similar, hospice nurses are more focused on the patient’s comfort and on supporting the family. They are also used to nursing very sick patients with complex nursing needs. The hospice services also provide counselling and pastoral care support.

Can I receive anti-cancer treatment, or treatment that controls the disease and enables me to live longer while I am under hospice and palliative care?

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.

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 Singapore Hospice Council members for advice on the hospice and palliative care most suitable for you, and on the costs of receiving it.

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, according to patients’ wishes. In-patient hospice care becomes necessary only when the patient cannot be cared for at home.

Is there a minimum age limit before one can seek hospice and palliative care?

No, there is no age limitation for anyone requiring hospice and palliative care. The hospice services have accepted patients from birth to extreme old age.

If I am staying in a long-term facility instead of my own home, can I still receive hospice and palliative care?

The Singapore Hospice Council hopes to work with its members and the Ministry of Health to resolve the issue of hospice and palliative care for residents of long-term facilities. Meanwhile, some hospice home care services are already continuing to see patients who transfer to nursing homes, even though there is no government financial support to these hospices for providing this service.

Can I be cared for by more than one type of hospice service?

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. At any one time, it is best that you receive the type of hospice service that is most suitable for your condition and family situation.

Is it important for me to select a hospice of my religion?

The hospice will not attempt to influence or convert patients if the patient does not wish to. The choice is left to you.

If I do not have any religion, can I opt to stay with a Christian- or Buddhist-run hospice?

Yes, you can. 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 seek the services of a hospice run by a religious organization, will I be subject to receiving religious counsel against my 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 the request of the patient, in the religion of his choice.

What does in-patient hospice admission process involve?

The following process is for patients admitting from hospitals. For patients admitting from their homes, a similar procedure will be followed.

Referral:
First, the patient’s doctor 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 that there are not enough caregivers at home to make home care feasible. The doctor then has to make a referral to the patient’s chosen in-patient hospice.

Family members will be consulted and given information about the various hospices available. Considerations are usually given to the patient’s religion and preferences, and how easy it is for the family to travel to and from the hospice. Some families prefer to visit the hospice to see the environment before they make any decision.

Preparations:
After receiving the hospice referral form from the patient’s doctor, and deeming the admission to the hospice appropriate, hospice staff will usually contact the family to provide more information, arrange for means testing and agree on the charges. The hospital will liaise with the hospice regarding 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 to help with the registration. Ambulance transfer is usually arranged by the hospital ward nursing staff and paid for by the family.

Admission:
On arrival at the hospice, the patient will be settled into his bed and assessed by the hospice ward nurses and admitting doctor. The family will also be interviewed so that a full picture of the medical and social conditions is obtained.

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 caring for the patient. The process of dying is a complex one, and while the hospice and palliative caregiving 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 will always be given by the people who care for you most, and it is through caring that many family members show their love. The hospices’ role is to empower the family to do this.

How much do I have to pay each month to stay in a hospice? Are the fees charged by your hospice members subsidized by the government? How do I know whether I am eligible to receive subsidies for hospice and palliative care?

In-patient hospice care charges vary according to how much government subsidy the patient is eligible for. The unsubsidized portion of your bills (at Assisi Hospice, Dover Park Hospice and Bright Vision Hospital) can be paid with Medisave. But if you or your family is unable to pay the unsubsidized portion of your bills, all our hospices are willing to provide extra subsidies from their own charitable collections.

For hospice day care services, a nominal fee is charged.

Hospice home care services are provided free of charge, whether you are eligible for government subsidies or not. Many receivers of hospice home care services make donations to the charities if they wish to contribute.

Patients may qualify for subsidy according to the Ministry of Health’s Means Test, a tool which evaluates the patient’s financial status. For more information, visit http://www.moh.gov.sg.

Can the unsubsidized portion of my hospice and palliative care fees be paid 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.

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, most definitely. In fact, as hospices’ main objective is to improve function for all their patients, many patients improve in their care and are able to do more for days, weeks, months or even years. The hospice is not a death house. The hospice and palliative caregiving team simply aims to provide holistic treatment that eases pains caused by the patient’s condition.