Speech by Minister-of-State for Health Dr Amy Khor at the Tsao Foundation Experts Series 2012, “Palliative care in the community: Nurses leading the way”

Dr Mary Ann Tsao, President, Tsao Foundation
Dr Carol Long, Principal of Capstone Healthcare Group, USA
Distinguished Guests
Ladies and Gentlemen

Good afternoon. I am happy to join you today at Tsao Foundation’s expert series lecture 2012. I am glad that such a platform has been organized to address the important issue of end-of-life care in the community, and especially the critical role that nurses play in the provision of care.

Introduction

2. Singapore is ageing rapidly. By 2030, about one in five Singaporeans or close to one million Singaporeans will be above the age of 65 years old. The ageing population, coupled with a rise in chronic diseases, will be a strong driver for healthcare demand, including that for geriatric and palliative care services in the community. The Ministry of Health will continue to invest in developing the needed services to improve access, affordability and quality of aged care. Besides infrastructural developments, we are also growing our pool of healthcare professionals to ensure the continued delivery of relevant and high-quality care.

Ageing in Place

3. One of our key objectives is to help our elderly live long and live well. For those who need care, we want to ensure that community-based services are readily available so that our elderly can continue to receive care and support in a safe environment in their own homes, and be accorded as much independence as possible.

4. Indeed, “ageing-in-place” is the cornerstone of our healthcare policies for our seniors. We want to foster an inclusive and caring community where our elders can age with grace and dignity, and live in a familiar environment that incorporates elder-friendly infrastructures and community-based eldercare services. Ultimately, when the time comes, many of our older people would also wish to die peacefully in their own home, free from pain and surrounded by their families and loved ones. I am glad that our vision of home-centric care is also shared by Tsao Foundation, who has, for the past twenty years, dedicated itself in providing community-based care services in Singapore.

Hua Mei End-of-Life Programme

5. To enable ageing in place and a good death for our elders, we need to build capacity and continue to strengthen community-based care.

6. I understand that Tsao Foundation’s Hua Mei Mobile Clinic recently concluded a pilot on end-of-life care for frail elders in the community. The 3-year pilot is partly funded by the Tote Board Community Healthcare Fund. By incorporating elements of good end-of-life care into their home-based care model, Hua Mei’s pilot programme aims to make the patient’s final journey as meaningful and comfortable as possible, and avoid unnecessary pain and suffering.

7. Under this program, elderly patients and their families engage in Advance Care Planning to work out an appropriate care plan that would allow the patient to be cared for at home and in accordance with his or her other care preferences at the final stage of their lives. Care is provided by a multidisciplinary team of doctors, nurses and social workers from the Hua Mei Mobile Clinic, with the support of 24 hour care consultations. Besides nursing care for the patients, the pilot programme also provides support to the caregivers in the form of grief counselling and bereavement care. The pilot served a total of about 55 patients over two years.

8. I understand from the Hua Mei Mobile Clinic that the pilot had provided some useful insights into the optimal framework for end-of-life care. For example, the pilot found that with adequate support, it was possible to manage the frail elderly at home even when the disease was advanced. In fact, many patients wanted to be at home and the families reported a positive experience and satisfaction in being able to support their older relative in avoiding hospital admission and in achieving a good death. As patients have multiple needs at the end of life, the pilot also highlighted the importance of palliative care services collaborating with other providers and disciplines in the larger health and social care ecosystem to provide holistic care for the patients.

9. Overall, the project was a commendable one. I look forward to hearing more about its end-of-life program for frail older people by its Hua Mei Mobile Clinic later in the forum.

Nurses as Enabler of Care

10. Many palliative care services and projects like Hua Mei’s pilot would not have been possible without the dedication of our healthcare workers. The palliative nurse in particular, plays a critical role in supporting the patient and the family through life’s final journey.

11. In many ways, the role of a nurse today extends beyond just the provision of nursing care. The palliative care nurse counsels, offers emotional support and provides valuable care advice to the patient and his or her family through times of need. Equipped with good communication skills and deep empathy, the nurse is able to cultivate trust to discuss profound issues of death with the patient and family. It is through affirmation, empathy and compassion, that the nurse brings hope and comfort to the patient, and helps to relieve the mental anguish and fears brought about by an uncertain future.

12. The nurse is also a coordinator of care. She recognises the multiple complex needs of the patient and family as they cope with end of life issues, and facilitates access to other supporting services or expertise where required. Good care coordination improves patients’ comfort and maximizes their quality of life. The nurse also is an educator to the patient and family by empowering them with information on the disease as well as its symptoms management. This enhances their sense of control and reduces uncertainty and helplessness. The nurse also teaches basic care-giving skills to the patient’s caregiver(s) so that the terminally-ill patient can be cared for at home for as long as possible.

13. MOH is committed to expanding the quantity and training of our nurses to support palliative care developments now and in the longer term. The number of Palliative Care trained nurses has been rising steadily. We now have 337 Palliative-trained nurses across the public healthcare sector. Courses and opportunities for upgrading are also available in our educational institutions such as at the Alice Lee Centre for Nursing Studies at the Yong Loo Lin School of Medicine, Nanyang and Ngee Ann Polytechnics, as well as hospice providers such as Dover Park Hospice. With the increasing integration of end of life care within the ambit of mainstream care, we will support more nurses to be equipped with skills in palliative care and management.

Closing

14. The road in taking care of a dying patient is never smooth or easy. It requires the collaboration of care partners from different settings to holistically and effectively manage the needs of a frail dying elder. To do this, we need to develop a care support network to allow more elders to live meaningfully for as long as they can in the community, and finally die peacefully at home in the company of their families and loved ones.

15. As we up-scale our community aged care and palliative care services, we will correspondingly expand our healthcare workforce, especially nurses, to meet the wide range of needs of our elders.

16. I commend the Tsao Foundation for organizing this forum to address not just the issues of palliative care, but also to celebrate the meaningful and noble spirit of our nurses present at this forum today.

I wish you all an enriching time. Thank you.