Quicker referrals for home hospice care to make palliative care more accessible
Published on
03 Apr 2024
Published by
The Straits Times
SINGAPORE – A new portal that helps doctors expedite hospice care referrals could help to make palliative care more accessible to the community.
Developed by the Singapore Hospice Council (SHC), the SHC Home Hospice Capacity Dashboard hosted on its website provides real-time information on the home hospices’ capacity in the country, saving doctors time as they will not have to call the various providers to check on vacancies.
Patients will be more quickly assured of their end-of-life care.
“The process is smoother and when time is of the essence, a targeted accurate referral becomes important.
“The prognosis for palliative care is one year but some patients are on compassionate discharge and may have just hours or days to live,” said Ms Sim Bee Hia, SHC’s executive director.
The portal is part of SHC’s efforts to facilitate easier access to palliative care for the community in a rapidly ageing Singapore. It was launched in December 2023 and now has about 400 users.
The portal is not just for palliative care specialists but open to all doctors, including polyclinic doctors and private sector doctors like general practitioners (GPs) and specialists, said Ms Sim.
“One of the current challenges is lack of awareness. Many seniors who are frail are staying in the community. They see GPs and polyclinic doctors. Hence, there is a necessity to make the referral process as easy as possible.
“The focus is shifting to palliative care being everybody’s business, and to make it easy (for) non-palliative care healthcare professionals,” she added.
After doctors check vacancies on the portal, referrals are made with the current system administered by the Agency for Integrated Care or using the form on SHC’s website.
Due to the overwhelming demand for palliative care in a home setting, home hospice care providers here have had to refuse admission of new patients when they are full, said Dr Chong Poh Heng, vice-chairman of SHC and medical director of HCA Hospice.
“We are taking in patients with limited prognosis, but some of them are with us for a few months, and so some of those services which are very stretched will stop taking new cases.
“The only problem is that it is invisible to the people who are making referrals,” he said.
What happens is that they would be notified by the provider only after a referral was made, he added.
“In a crisis situation like a compassionate discharge, we are hoping that with this certainty of a match between a referral and a service prior to the patient coming out from the hospital, (it) will prevent patients from falling between the cracks.”
This can happen, even though the hospices will want to make sure that everyone who needs the care can get it.
The Ministry of Health launched the refreshed National Strategy for Palliative Care in July 2023 to expand and improve palliative care to enable more people to fulfil their wish to live their last days with dignity and in comfort.
On March 19, Health Minister Ong Ye Kung said that the home palliative care capacity in Singapore will be increased to 3,600 places by end-2025, up by 50 per cent from the current 2,400.
Building up capacity takes time because it typically takes up to a year or two to train a nurse in palliative care, said Dr Chong.
Dr Jennifer Guan, a consultant in Tan Tock Seng Hospital’s palliative medicine department, recalled a case that happened before December 2023 where she had a referral rejected for a patient with end-stage renal failure because of a lack of vacancies.
She made another referral, only to be notified of the rejection some two days later. A third referral succeeded, about a week after the first attempt.
“There’s a lot of calling around and asking around to see if they can take the patients,” she said of the pre-dashboard situation.
Another doctor who has used the dashboard, Dr Clare Tay, has also had multiple referrals rejected previously because the home hospices were at maximum capacity.
The Speedoc GP, whose work includes caring for patients as they transition to hospice care, said the dashboard comes in handy during home visits.
“When patients and families are agreeable, I access the hospice dashboard during the home visit and offer a suitable option based on availability of resources,” she said.
The nine home hospice providers here are Assisi Hospice, Buddhist Compassion Relief Tzu-Chi Foundation (Singapore), Dover Park Hospice, HCA Hospice, Metta Hospice Care, MWS Home Care & Home Hospice, Singapore Cancer Society, St Andrew’s Community Hospital, and Tsao Foundation (Hua Mei Mobile Clinic).
By July, SHC aims to provide real-time information on the capacity of inpatient palliative care providers as well.
Source: The Straits Times © SPH Media Limited. Reproduced with permission.
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