SPEECH BY PROFESSOR KENNETH MAK, DIRECTOR OF MEDICAL SERVICES, MINISTRY OF HEALTH, AT THE DOVER PARK HOSPICE SYMPOSIUM 2023, ON 6 APRIL 2023

Associate Professor Jeremy Lim, Chairman of Dover Park Hospice

Dr Liew Li Lian, CEO of Dover Park Hospice

Dr Seet Ai Mee, Co-founder of Dover Park Hospice

Ladies and Gentlemen

1.             Good morning. It is my pleasure to join you at Dover Park Hospice’s inaugural symposium entitled “Empowering Caregivers as Partners in the Caregiving Journey”.

2.             I have known many of you here in various settings, some of you when I was a doctor in the hospitals and some subsequently as the Chairman of Medical Board in Khoo Teck Puat Hospital. In each phase that I interacted with any of you, I have seen the passion, enthusiasm and motivation that many of you have towards your patients, their relatives, caregivers and family. I want to thank and acknowledge all of you for your service, your contributions, and your willingness to come together as a community to participate in this symposium.

Caregivers as Partners

3.         When designing care systems, the key stakeholders that most often come to mind are the healthcare institutions, community services, and healthcare professionals. Indeed, we deeply appreciate all these partners. Yet, we often need reminding that the entire care system focuses on addressing the needs of the patient or client and an often missed partner are the caregivers of our patients and clients. We should always remember that caregivers are those who play the most important role on a day-to-day basis, in supporting and meeting the needs of our patients and clients, in their homes and in the community.

4.        Caregivers care for their loved ones with great strength and resilience, often neglecting their own needs and when the patient passes on, they grapple with grief and bereavement. Their journey in supporting their loved ones is not an easy one. And many of us here either have gone through that journey or are going through that journey or have seen someone go through that journey. There is often much angst and frustration experienced. There will be moments of joy and happiness experienced for their loved ones. But there are often feelings of anger, depression and self-doubt. They often feel as if their care-giving journey is a lonely one and many feel a lack of affirmation that there is support at hand to empower them, support them in their own personal needs, and reinforce them in times of crises. When there is fatigue and exhaustion, they wish for an understanding ear, a sympathetic presence and an opportunity to experience a reprieve, to be allowed to rest and recover from their caregiving experiences.

5.        I am hopeful that with the diversity of practitioners, academics, policymakers and caregivers gathered today, we can share our rich experiences, and learn from each other. In so doing, I also hope that we may gain the insight that caregivers are not alone and that there are many in the community who are willing to support them. We hope to empower our caregivers to take charge of their caregiving journey, to learn how to take care of themselves as they strive to better care for their loved ones.

Focus Areas under Caregiver Support

6.        Supporting caregivers involves empowering them with skills and training, enabling them to balance their various roles, take breaks and care for themselves, and help them manage the costs of care. A good foundation to design our support framework, is the Caregiver Support Action Plan (CSAP) which was rolled out in 2019. This covers five broad themes: (i) Care navigation, (ii) Financial support, (iii) Workplace support, (iv) Caregiver respite services, and (v) Caregiver empowerment and training.

7.        Caregivers of palliative care patients face particular challenges, as they witness their loved ones deteriorate and cope with end-of-life symptoms. In order to better support these caregivers, we must involve not only hospice providers and the Ministry of Health (MOH), but also other community care providers, and the society at large. I will highlight four areas that we are collectively working on.

8.        Firstly, we want to equip caregivers with the skills and resources they need to better anticipate and support their loved ones, when they experience end-of-life symptoms. Today, hospitals and hospices provide some resources and training for caregivers when their loved ones are given a compassionate discharge, but the experience of caregivers remains uneven. MOH is working with the Singapore Hospice Council and providers to improve this situation. For instance, we are developing a suite of discharge resources for caregivers, including pre-packed medications in required doses and a guidance folder on death certification, including templates and instructions for the GP.

9.        Secondly, we want to make it easier for caregivers to arrange for respite care, so that they may rest and recharge. We have been piloting the subsidised Home-Based Respite Care service since 2019 and have recently expanded its scope to allow acute hospitals to make referrals on behalf of caregivers. With this improvement, we hope to see more caregivers supported from the time when their loved ones are discharged from hospital, which can be a very stressful period of transition.

10.    Thirdly, we want to defray the cost of community caregiving. We have recently rolled out the enhanced Home Caregiving Grant, which provides a monthly cash payout of up to $400 to those with a permanent disability that is at least moderately severe. This grant complements means-tested subsidies provided for palliative care services and other financial schemes such as MediSave, MediShield Life and CareShield Life. With all these measures in place, we hope to support more caregivers in their caregiving journey, thus facilitating our seniors to age and die in place.

11.    Finally, we want to support more to make end-of-life care plans, through Advance Care Planning (ACP), which empowers caregivers to know what their loved ones want and allows them to comply with the wishes of their loved ones with more certainty and peace of mind. We are working with public healthcare institutions, polyclinics, and community agencies to engage in this important conversation early. We will do more to raise awareness about the importance of pre-planning in the coming months.

Dover Park Hospice’s Efforts in Caregiver Support

12.    We are glad to have Dover Park Hospice (DPH) as one of our key partners in the palliative care sector. Since its establishment in 1992, Dover Park Hospice demonstrated its commitment to its mission of caring holistically for those in their end-of-life journey. This is written into their care philosophy.

13.    DPH’s medical social workers organize monthly Caregiver Support Group meetings which allow caregivers to connect with each other, share their experiences, and share tips on self-care. DPH’s Caregivers’ Respite Fund also helps to defray the cost of respite care for caregivers experiencing burnout and stress.

14.    DPH has also worked with the Palliative Care Centre for Excellence in Research and Education to conduct a Caregiver Survey to understand the challenges faced by caregivers amidst the COVID-19 Pandemic and inflationary pressures. The study found that over 40% of caregivers surveyed were at risk of depression during these challenging times. The survey highlighted issues that we should pay attention to, and scope for support to be made more easily accessible.

15.    In addition to these efforts, DPH is working with TTSH to pilot an integrated care model, where clients can access services seamlessly across Home, Day Care and Inpatient Hospice settings. If successful, this will better support the changing needs of patients, and make it easier for caregivers by reducing those painful transitions across the palliative care ecosystem.

Closing

16.    In closing, I would like to extend my warmest congratulations to DPH as it celebrates its 30^th anniversary and commend the efforts of its staff, both past and present, to better care for the patients that they have, their clients and their caregivers.

17.    We have an exciting conference programme today, which I am sure will inspire everyone present as we learn from one another. I wish all of you a fruitful day of learning and discussion. 

18.    Thank you.