Dr Christina Tiong, CEO of Home Nursing Foundation
Ladies and gentlemen,
1. Good morning. I am delighted to see the good turnout today in support of end-of-life care for frail homebound seniors. I also thank Home Nursing Foundation (HNF) for their contributions to Singapore’s healthcare sector, especially with their plans to scale up and increase their capabilities within the community palliative care sphere.
Singapore’s Demographic Challenge: An Ageing Society
2. Singapore has a rapidly ageing population. By 2030, 1 in 4 Singaporeans will be aged 65 and above, an increase from 1 in 5 today. Against this backdrop, we expect the number of patients who need palliative care to rise. Our healthcare system and society will need to build capabilities quickly now, to be in time to meet these future palliative care needs.
Key Shifts Moving Forward
3. Surveys done by Lien Foundation in 2014 and Singapore Management University in 2019 showed that 3 in 4 Singaporeans prefer to pass on at home. In reality however, only 1 in 4 passed on at home. With this in mind, we need to work towards enabling more deaths at home, rather than in hospitals, to fulfil the wishes of our population. Our palliative care efforts will be anchored within the community, as a complement and continuation of our Healthier SG efforts. We will also continue to refine our care models and upskill our manpower to provide timely access to quality palliative care in the community.
4. There are three shifts we should make, and partners like HNF will play a critical role in the sector being able to make these shifts.
5. First, we will need to increase the palliative care capacity. Over the years, we have increased the places available for patients to be cared for in centres or at home. Our home palliative care providers together provide more than 3,100 places since 2020. The number of day hospice places has also increased since 2017 by over 60% to about 160 places today. This is in addition to about 250 Inpatient Hospice Palliative Care Service beds we have at present, within inpatient hospices, community hospitals and nursing homes for patients with more complex palliative needs.
6. We will also expand capacity within the home care sector, to ensure that those who wish to pass on at home can do so peacefully. Home palliative care providers will train and support caregivers to provide day-to-day care. In turn, caregivers will be supported through services like Home-Based Respite Care to help them cope with their loved ones’ care needs, and relieve their stress for an identified period of time. This can help to reduce the risk of caregiver burn-out. MOH is also working with our partners in the sector to address other barriers to continued care at home, such as equipment availability.
7. Second, we will need to raise palliative care capabilities across the wider healthcare sector, so that healthcare professionals in all settings can manage patients with palliative needs, with palliative care specialists focusing on the most complex cases. MOH has invested significantly in palliative care training for healthcare workers. For example, the Graduate Diploma in Palliative Medicine has trained more than 100 physicians. For nurses, there are training courses offered by our nursing schools. Most recently, we rolled out the Palliative Nursing Competency Framework. The framework highlights the job roles and skill competencies of nurses in caring for end-of-life patients. Social workers, therapists and other allied health professionals also play important roles in identifying and caring for the patient, and starting conversations about end-of-life care.
8. In particular, home care organisations, such as HNF, should be upskilled to continue providing support for their clients at their end-of-life stage, instead of handing such cases over to specialist palliative care providers. Similarly, Nursing Homes should also gradually be able to manage their end-of-life residents on-site, so that they too, can spend their last days in a familiar environment. Take for example, Madam C, a 91 year old resident of St. Andrew’s Nursing Home (Henderson). After numerous hospitalisation episodes, she articulated her wish to spend her final days in the nursing home, through her Advance Care Plan. For more than a year, the St Andrew’s Community Hospital palliative care team worked closely with the Nursing Home GP and nursing staff, and equipped them with the skillsets to manage her care. Eventually, the St. Andrew’s Nursing Home (Henderson) team was able to independently care for her through episodes of delirium, infections and progression of her kidney disease, and she passed on in peace in the nursing home. This case illustrates the potential and capacity that the community has to offer to care for these patients.
9. Third, we will need to raise palliative care awareness and change societal mindsets. The Singapore Hospice Council (SHC) and the Agency for Integrated Care have run media campaigns and community engagement programmes to raise public awareness and receptivity of end-of-life care and Advance Care Planning. In the next phase, we will work more closely with our health and community care partners like all of you to increase accessibility of Advance Care Planning, so that we can honour the care preferences of our population.
10. Through the collective efforts of numerous stakeholders like those of you seated here today, the palliative healthcare sector has made significant strides over the years. This gives me confidence that we will be able to meet the challenges that lie ahead, amid an evolving healthcare landscape.
11. We have an exciting conference line-up today, which I am sure will inspire everyone present as we learn from experts and from one another. I wish you all a fruitful day of learning and discussion.
12. Thank you.