Singapore Medical Association 34th National Medical Convention Professional Symposium On Home Healthcare

02 Nov 2003

By Dr Balaji Sadasivan

Venue: Singapore International Convention and Exhibition Centre

HOME HEALTHCARE

It is my pleasure to be here with you at this SMA 34th National Medical Convention. The organisers have chosen the theme of Home Healthcare for this professional symposium.

Home healthcare is an integral component of our healthcare system. Internationally, there may be some differences in the definition or provision of home healthcare. Locally, home healthcare refers to the provision of healthcare services, to homebound patients, at their place of residence. The bulk of home healthcare services would be for continuing care of chronic conditions. Acute problems do arise in these patients, and if these conditions do not require hospital-based care, the home healthcare providers also attend to these acute episodes.

The home healthcare providers include the general practitioners, private specialists, home medical teams, home nursing teams and therapists. Most of you are familiar with general practitioners' and private specialists' services. Let me therefore speak about the home medical and home nursing services and the recent developments for these services.

HOME MEDICAL AND HOME NURSING SERVICES

The doctor in home medical service provides consultation to the homebound elderly at the elderly residence. The doctor is supported by his team which include the nurse, social worker and allied health staff. Our first home medical service, the Hua Mei Mobile Clinic, started operations in 1993. In 1996, there were 3 voluntary welfare organisations providing home medical services and today, the number of providers have increased to 11. The thrust to the increase in home medical service providers over the last 2 years was the provision of government funding for the service. In 2001, Ministry of Health provided funding to home medical and home nursing services through the approved providers under the Framework For Integrated Care for the Elderly. In October 2002, government funding was extended to other home medical providers. Providers have to apply to Ministry of Health for approval for funding. Home medical care is provided to homebound patients who have great difficulty in leaving the home. The care is usually for follow-up of chronic medical conditions, and occasionally for acute conditions. Home nursing is similarly provided to homebound patients, usually for surgical dressings, change of catheters, injections, blood sugar testing or blood pressure testing.

The development of home nursing services was closely linked to the development of home medical services. A number of the organisations providing home medical service also provide home nursing service. Going back in history, the first home nursing service began in 1976, under the Home Nursing Foundation. Over the years, the number of home nursing service providers have increased and we now have 13 home nursing providers.

In support of the provision of home medical and home nursing services, the Ministry of Health provided $3.46 million in 2002, for the subvention of home medical and home nursing services. My Ministry has also drawn up guidelines and standards of care to assist providers.

AGEING POPULATION

Our population is ageing. The proportion of elderly aged 65 years and older have increased from 4.9% in 1980 to 7.4% in 2001, and this proportion will increase to 13% in 2020. The proportion of elderly with reduced mobility increases with increasing age. Home medical and home nursing services play an important role in caring for the homebound elderly sick and enables the elderly to remain in the community. As the population ages, the need for the home healthcare services will increase.

In the hospital setting, healthcare workers have the support of their co-workers within the institution. The immediate support team of home medical and home nursing staff are smaller and these home care staff have to be able to work independently. As the elderly form the major bulk of patients of home care services, doctors and nurses of these services must be equipped with the skills to manage the elderly.

TRAINING FOR HOME HEALTHCARE

There are a number of courses available locally to train doctors and nurses in geriatric care.

(i) The Division of Graduate Medical Studies, Faculty of Medicine NUS, has a 1 year part time Graduate Diploma in Geriatric Medicine programme for primary care physicians. The first course was conducted in 1997/8 and a total of 45 doctors have successfully completed the examinations of this Diploma course.

(ii) In January 2003, the College of Family Physicians Singapore conducted a Basic Home Healthcare Course to introduce the concept of home health care to GPs and equip them with basic skills in managing health problems of home-bound elderly persons. I am told that this a one off course but I believe the College will be prepared to conduct additional courses, if there is adequate demand for it.

(iii) The College of Family Physicians also has a 2 year fellowship Programme in Aged Care for those who have completed the M Med Family Medicine.

(iv) For nurses, the Nanyang Polytechnic offers a full time 1 year Advanced Diploma Course in Gerontology Nursing, and it also offers part-time short modular courses on eldercare. Courses in gerontology counselling, nursing and home care are also provided by other organisations.

In addition to these training courses, hands on experience will be needed to consolidate the training and to build up the expertise of the doctors and nurses for home care.

PARTNERSHIPS AND SYNERGY IN HOME HEALTHCARE

We know that the needs of an elderly may change with time. We know that the elderly sick often have multiple problems that may require management by multiple disciplines. The elderly requires therefore a continuum of care that caters to their changing needs. For good continuity and seamlessness of care, Home Healthcare which forms one component of this continuum of care has to be well integrated with the other components of care. This will facilitate the movement of the elderly from one service or provider to another, based on the alderfly's care needs.

Among the home healthcare providers, there can also be synergy through partnership building. Let's take an example. The GPs are in a position where they will be called on to provide home care to their patients, but the GPs, particularly the solo GPs, lack the support of nurses and allied health professionals. They are also faced with having to take care of their patients in their clinics or they may be required to do a geriatric assessment for their patients who have become homebound. A possible option for GPs is to have partnership with the home medical and home nursing teams to provide care to their homebound patients. There are probably other options to be explored with other providers.

CONCLUSION

In conclusion therefore, Home Healthcare plays an important role in our healthcare system, and with our ageing population, its role is expected to increase. Although we have a number of home medical and home nursing providers, further development will be required for this sector to meet and respond to the evolving needs of our elderly. It is timely that SMA has chosen to address home healthcare in this Medical Convention and I would also like to wish all participants a fruitful and successful symposium.

Thank you.