Living before leaving
An end-of-life roadshow sheds light about palliative and hospice care in light of the lack of awareness.
Only about half of Singaporeans are aware of hospice and palliative care, and the awareness is particularly low for older Chinese, according to a Lien Foundation survey on death attitudes released in April this year. As such non-profit Nectar Care Service Singapore and the HCA Hospice Care launched its palliative care community outreach roadshow at SOTA (School of Arts). The roadshow, which had booths and talks on hospice and palliative care, will continue on to other parts of Singapore including Bedok, Hougang, Woodlands, Jurong and Central Singapore.
Palliative care encompasses care from the early stages of a disease while hospice care is care given towards the final stages of the disease. According to Dr R Akhileswaran, CEO and medical director of HCA Hospice Care, palliative care affirms life and regards dying as a normal process; it neither hastens nor postpones death. “It may be provided simultaneously with other medical interventions that treat the underlying disease process, but the intensity of palliative care services provided accelerates as the illness progresses.” He added that with hospice care, the patient has a limited life expectancy and “the goals for care are exclusively to achieve and maintain comfort, regardless of the symptom burden”.
Death a taboo subject
Shared Deputy Prime Minister (DPM) and Minister for Home Affairs Teo Chee Hean at the roadshow, “… death and dying are often considered taboo topics, which we prefer not to think or talk about. Many people never broach such topics with their loved ones, as they are afraid to talk about end-of-life issues. However, this means that important decisions about end-of-life are often made only after a medical crisis strikes, in an atmosphere fraught with stress and worry. This not only causes distress to patients, but also to their loved ones.”
He said that palliative care helps patients spend their last days in comfort and dignity by providing holistic care which includes pain control and symptom relief, psychosocial care, counselling and bereavement support for families. It also reduces fear and anxiety for both the patient and his family. DPM Teo said that every year, about 5,000 to 6,000 patients receive palliative care and with an ageing population, the number is expected to grow to about 10,000 by 2020. These patients could have the illnesses like cancer, renal disease, neurological disease, respiratory disease, heart disease, debility or dementia.
He said the Government is aware of this and the Ministry of Health announced its plans to strength palliative care for Singapore in June this year. MOH will make palliative care more accessible by increasing the capacity of both residential and home-based palliative care services. It will enhance the quality of palliative care through the newly-developed National Guidelines for Palliative Care. MOH is also improving the affordability of palliative care services by increasing the Medisave withdrawal limits for palliative care services from June 1, 2015. HCA Hospice Care has also opened its second day hospice centre at Blk 2 Marsiling Drive so more ambulatory patients can be cared for and given respite to their loved ones who might need to work during the day.
Added Venerable Seck Sian Siang, president of Nectar Care Service, “There is a time to be born, and a time to die. Thinking and talking about death need not be morbid; they may be quite the opposite. Ignorance and fear of death overshadow life, but knowing and accepting death erases this shadow. We can be more prepared if we accept this maxim and realise we can’t prevent death. What we can do for our loved ones is to ensure that their final days are lived with love, comfort and dignity.
Speaking openly to loved ones
In her speech, she shared that it is important to be aware of the emotional aspect of the dying process and for caregivers/family members to speak openly with their loved ones at this crucial state of life. She gave her recommendations:
• Thank the patient for being such a wonderful part of your life, and let him know how he has made you a better person. Tell him how much you have always appreciated him for being there for you.
• Tell the patient you love them, and always will. Tell him exactly what it is that you love about him, and how his love has positively affected your life.
• Ask him if there is anything that he would like for you to do for him – if he is able to communicate – whether before or after he has gone. Assure him that you will try your best to carry out his dying wish and follow though on that wish.
• Tell your loved one that it is okay for him to go and that you will be okay. Let him know you will keep living and will remember all the wonderful times that you had together.
Said Venerable Seck, “Once we are able to recognise and embrace this notion, the direction of care changes. The focus is on symptomatic care and the caregiver takes the cue from the patient and his desires. It is also about empowering the patient and the caregiver so both can walk the last journey of life in a memorable, meaningful way.”