End of Life

From Social Collaborative Singapore
Jump to: navigation, search

This is the main page for End-of-Life.

For the White Paper, please click here.

For the Needs Assessment, please click here.


End of life care and palliative care is defined by the World Health Organisation as "an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual".[1] Even though it is an important part of healthcare, it is often overlooked and little awareness of it is raised given the taboo nature of talking about death. A survey has found out that most Singaporeans wish to die at home, however this is inconsistent with reality where most people die hospitals, nursing homes and charitable organisations [2].

Importance of Palliative Care

In Singapore, the life expectancy has increased through the years due to better medical care. As such, the lifetime spent with chronic illnesses has increased. Palliative care focuses on the quality of life of the patients nearing the end of their lives and seeks to allow them to live their final days in comfort and fulfil any goals or desire that they have in their final days. This allows for a more positive experience for the patient to make the most of their remaining days [3].

Stages of Palliative Care

Palliative care consists of the 3 stages, Symptom Management, Hospice/End-of-life care and bereavement [4]. It can be provided regardless of age and stage of illness.

Symptom Management

Various medication procedures such as intubation would severely decrease the quality of life that the patient experiences, studies have shown that 32% of patients would have elected to die rather then undergo invasive Home Mechanical Ventilation [5]. As such, palliative symptom management seeks to address the physical symptoms, psychological, social and spiritual dimensions of suffering holistically [6].

Hospice/End-of-Life Care

When the illness has reached a stage where recovery is unlikely, hospice care seeks to ensure that the quality of life of the individual remains high. The primary focus of care is not longer on the recovery of the individual, instead it is placed on supporting the individual and allowing them to live comfortably.


A common misconception is that palliative care focuses on the individual who is ill. However, palliative care extends further to include the families and love ones, ensuring that their emotional needs are met to help them cope with the grief of losing a loved one. This includes counselling and other forms of support that is provided.

Advance Care Planning

Resource Directory

Government Policy and Organisations

Government Organisations

Name Description
Agency for Care Effectiveness (ACE)[1]
  • National health technology assessment agency in Singapore, established by MOH in 2015
  • Publishes guides that outline recommendations on the appropriate use of health technologies
  • Publishes 'Appropriate Care Guides' that detail recommended care practices and pathways to improve selected areas of therapy
Agency for Integrated Care (AIC)[2]
  • Coordinates and facilitates effort among care providers for care integration
  • Developed Living Matters in 2011 - a national Advance Care Planning programme[3]
Ministry of Health (MOH)[4]
  • Statistics on Admissions and Outpatient Attendances, as well as home and in-hospice palliative care, is provided[5]

End-of-Life Planning

Name Description
Advanced Medical Directive (AMD)
  • Legal document
  • Oral and/or written instructions that convey treatment preferences in the event of a loss of decision-making capacity
  • Includes living wills, which are written, legal documents that spell out the preferred types of medical treatments and life-sustaining measures under specific circumstances
  • Allows patients to indicate their wish not to have any extraordinary life-sustaining treatment to be administered should they become unconscious or incapable of decision-making and are suffering from terminally illness
Lasting Power of Attorney (LPA)
  • Legal document
  • Legally designates a healthcare proxy who would make decisions on the healthcare of the individual in the event the individual is unable to do so
Advance Care Planning (ACP)
  • Not limited to end-of-life scenarios, but extends to long-term care situations as well
  • ACP is a process of assisting the individual to :
    • understand their medical condition and potential future complications;
    • understand the options for future medical care as it relates to their current health condition;
    • reflect upon their goals, values and personal beliefs;
    • consider the benefits and burdens of current and future treatments;
    • discuss choices with family/important others and health providers, and document these choices.
Syariah Court Singapore (for Muslims)
  • Facilitates the distribution of the deceased’s estate through the Inheritance Certificate according to Muslim law

Palliative care offered in inpatient hospital care

Name Description
Changi General Hospital (CGH)
Khoo Teck Puat Hospital (KTPH)
KK Women's and Children's Hospital
  • Palliative Care for children with cancer
National Cancer Centre Singapore, Department of Palliative Medicine (NCCS)[6]
  • Specialist centre in Singapore addressing cancer
  • First institution to establish a stand-alone Division of Palliative Medicine in Southeast Asia
National University Hospital (NUH)
  • As more elderly have died in the Emergency Department (ED) in recent years, NUH started a dedicated palliative care service in its emergency department to relieve patients' suffering[7]
  • e.g. Quiet room where family members can spend their last moments with the patient
Ng Teng Fong General Hospital (NTFGH)
Palliative Care @ Tan Tock Seng Hospital (TTSH)[7]
  • Care Continuity - by collaborating with Hospice partners to ensure seamless care transition for patients who want to transit to home or to inpatient hospices to receive palliative care. Partner Hospices include Dover Park Hospice, Assisi Hospice and HCA Hospice Care.

Non-Governmental Organisations (NGOs)

Hospice Care

Name Description
Singapore Hospice Council[8]
  • Umbrella body representing all organisations actively providing hospice and palliative care in Singapore
Assisi Hospice[9]
  • Founded by the Franciscan Missionaries of the Divine Motherhood (FMDM) Sisters in 1969
  • Offers home care, day care, hospice care and equipment loan
Dover Park Hospice [10]
  • Founded in 1992, Dover Park Hospice has served as a tranquil sanctuary for over 10,000 patients and families over the years, meeting their unique physical, emotional, psycho-social and spiritual needs through holistic palliative care.
  • Offers home care, hospice care and equipment loan
HCA Hospice Care [11]
  • Singapore's largest home hospice care provider and is a registered charity since 1989
  • Conducts palliative care training for its patients' caregivers, as well as other services such as day hospice care, paediatric palliative care, bereavement support and outreach programmes
  • Offers home care, day care and equipment loan
Hua Mei Centre for Successful Ageing (HMCSA) [12]
  • Integrated collective of various community aged care service models that have been pioneered by the organisation since 1993. They offer services ranging from care management, to traditional chinese medicine and dementia care systems
Metta Hospice Care [13]
  • Offers home hospice care and equipment loan
MWS Home Hospice [14]
  • Started by the Methodist Welfare Services
  • Offers home hospice care and equipment loan
Singapore Cancer Society [15]
  • Community-based voluntary welfare organisation
  • Does research and advocacy, public education, screening, financial assistance, patient services and support, and rehabilitation
  • Offers home hospice care and equipment loan
St. Andrew's Community Hospital [16]
  • Offers inpatient and home hospice care
St. Joseph's Home [17]
  • Offers inpatient hospice care

Nursing Homes

Name Description
Allium Healthcare
  • New private nursing home along Venus Drive
  • Proposed 4-storey, 129-bed facility
  • Designed to be a premium product, to meet the demand from the middle- to upper-income group
  • Of the 129 beds, 51 are single-occupancy care suits of 225 sq ft each, while 16 are companion suites of 327 sq ft each with en-suite bathroom, and executive suites start from 409 sq ft.
  • 6 care suits and 2 companion suites will be set aside for residents with dementia, and 15 companion suites for subsidised residents
  • 10 to 12 residents will share a living and dining area and a kitchen, as well as an area for rehabilitation and exercise facilities, in a "household"[8]
Jade Circle Nursing Home
  • Co-funded by Lien Foundation and Khoo Chwee Neo Foundation, in partnership with Peacehaven nursing home
  • Following the "Silver Hope" Model [9]
  • In 2015, Jade Circle was proposed as a 60-bed nursing home with single and twin-bedded rooms for subsidised patients, not just private patients
  • However, this was aborted because MOH considered that the conversion of all nursing homes to single and double-bedded rooms would hurt the affordability of care, if this model were to be scaled up
  • Lien Foundation commissioned 3 studies[10]:
    • "The Economics of Singapore Nursing Home Care" by consulting firm Oliver Wyman concluded that if the next 5000 nursing home beds (MOH to increase number of nursing home beds from 12000 to 17000 in 2020) follow the Silver hope model it would cost an additional $19 million annually – or an additional $8 to 13 per resident per day. However, cost savings would be generated through lower hospitalisation rates as these proposed living arrangements would ensure that elderly have the opportunities to be more mobile[11]
    • "Safe but Soulless" by Radha Basu provided an overview of nursing homes today and suggested possible ways to overcome challenges.
    • "Supporting Singaporeans’ Aspirations for Aged Care" by The Nielsen Company showed that Singaporeans are most concerned about being able to care for oneself and ageing in place, 60% of respondents thought that residents in nursing homes should stay in single or twin-bedded rooms
  • 90% of current nursing home beds are in 6- or 8-bedder dorms. The other 5% to 10% are single or twins, but more for infection control purposes. Japan had already phased out 6-bedder wards 40 years ago, and single beds has been the norm for almost a decade.
  • Revived in 2017 after the revision of plans, and to be completed in 2019[12][13]:
    • Extension to the north of the current Peacehaven Nursing Home in Changi
    • First in Singapore to adopt an ‘anti-diaper, restraint-free’ policy, made possible with specially imported beds that can be lowered to prevent falls, and which have sensors that can detect movement.
    • Reduction from original 60 beds to 22 beds (8 single rooms and 7 twin-sharing rooms)
    • Non-nurses to be trained as senior care associates, to give the caregiving manpower at the nursing home a boost. 22 residents in Jade Circle will be divided into two “households”, each cared for by a senior care associate, who will be assisted by a nursing aide.
    • Expanded scope to include bigger day activity centre so that elderly can age in community. Two-storey activity centre to include hydrotherapy pool, cafe, hair salon and gym
    • Unlike original concept, includes "full spectrum" of senior services from active ageing and preventive care to rehabilitation and residential care
    • Depending on the level of care needed, the estimated fees range between 1500 and 2500 for day centre care, and 2000 to 3500 for residential care before means testing
    • Overall development cost of Jade Circle has been reduced from the original $15 million to $14 million
  • Jade Circle as important pilot to set people thinking about long term care and the philosophy of dignity and humanity – providing a de-medicalised and more home-like model of care that prioritises resident autonomy beyond safety and risk management
Kampung Admiralty
  • An 11-storey Housing Board complex as Singapore's first 'retirement kampung'
  • 100 studio flats for the elderly
  • Includes medical and senior-care centres, a food court, shops and community gardens
  • Hopes to empower seniors to function independently in the community for as long as they can [14]
  • Similar to Assisted Living Options, but with no caregiver on standby for residents with dementia[15]
Lions Home
  • Runs two facilities in Bishan and Bedok
  • Initiative to let residents wear their own clothes since 2001 so as to make care "less institutional" [16]
  • Rehabilitation programmes include a motion sensing video game system for residents to exercise their range of movement, coordination and other physical functions [17]
NTUC Health [18]
  • Has three nursing home in Geylang East, Chai Chee and Jurong West
  • Focus on getting seniors back home as early as possible, so that they can continue their rehabilitation in the community
Orange Valley Nursing Home
  • Largest operator of nursing home facilities in Singapore with more than 1000 beds
  • First privately owned nursing home to provide outpatient rehabilitation services
  • Cost of staying at the home ranges from $3500 for private patients who opt for the open ward to $9000 for a private one-bedded room a month. Open wards are also available for subsidized patients.[18]
Peacehaven Nursing Home
  • Introduced incentivising model of care: Residents have to “earn” money through exercise sessions and daily chores before they can “spend” it activities they enjoy e.g. massage, instant noodles, biscuits, sweets
  • Giving residents their autonomy and keep their way of life, replicated from outside
  • Giving them choices and a sense of control in how much they exercise and spend their money empowers them with a sense of purpose[19]
Ren Ci Nursing Home in Ang Mo Kio
  • Dementia-friendly 'cluster-living' options for nursing home residents
  • 470-bed nursing home is the "biggest departure yet from the medicalised dormitory-style accommodation"
  • 16 residents in each four-bedded rooms 'household'[20]
St. Andrew Nursing Home (SANH)
  • Jurong home: Inter-generation playground and childcare within its premises for inter-generational bonding
  • Henderson home: "open concept" to encourage,and allow residents to interact with the community, especially those living in Henderson, Telok Blangah and Bukit Merah)[21]
St Bernadette Lifestyle Village
  • Private facility in Bukit Timah that provides 24-hour medical concierge and meals
  • 8 residents get help to live independently, including going on shopping trips to shopping malls
  • Fees are at $3650 per month[22]

Other NGOs

Name Description
Active Ageing Hub
  • MOH plans to build 10 Active Ageing Hubs in new public housing estates
  • Part of a $3 billion plan, first announced by MOH to help Singaporeans lead active lives as they age
  • Rehabilitative care and social programmes for the residents in the area, complementing services offered by the hospital in Serangoon Road
  • First completed Hub located in McNair Road, meeting the needs of elderly residents in Kallang and Whampoa
  • For a nominal annual fee of $5, residents have access to gym and activities like line-dancing and IT classes
  • 40 daycare places for elderly residents, and provides medical care at home for 100 house-bound residents in the area
  • Another centre to be opened in St George's Lane in 2019, just five minute from the centre in McNair Road. Together, they will serve 1500 elderly residents [23]
Lien Centre for Palliative Care[19]
  • Collaboration between Lien Foundation and Duke-NUS Medical School
  • Research programmes looking into clinical, social and cultural aspects of palliative care in Singapore and Asia
  • Focuses on palliative care education and development of healthcare professionals.
Project: One More Thing[20]
  • Youth movement started by non-profit group Youth Without Borders
  • Aims to fulfill the wishes of the elderly folk from hospices, day care centres and poorer neighbourhoods
  • Using social media, the group posts these wishes online in order to connect the youth and elderly in the community
Project We Forgot[21]
  • A community for caregivers to persons with dementia (PWDs) that provides locally-relevant support, knowledge, and access to services.
  • Through online and offline channels – online via our website and content, social media, and a dedicated social network (launching 2018); offline via local events.
Senior Activity Centres[22]
  • Located in the void decks of HDB rental blocks
  • Elderly living nearby are encouraged to spend time at these centres, where they can meet their neighbours to chat, do some exercises and activities
  • A set of services that assist with late life, emergency matters, and legacy preparation.
  • These services include:
    • An online knowledge base to easily get information on late-life matters, including end-of-life preparations.
    • A life planning account to store important documents, plan for instructions to be carried out, and obtain important end-of-life services.
    • Stories magazine to open viewers to the topic of life, legacies and heritage.
    • A online platform for tributes to loved ones, personalized to individuals and communities, with functions and services important at later life and beyond.


  1. World Health Organization. (n.d.). Palliative care. World Health Organization. Retrieved October 28, 2021, from https://www.who.int/news-room/fact-sheets/detail/palliative-care.
  2. LEAVING WELL: END-OF-LIFE POLICIES IN SINGAPORE. Lkyspp.nus.edu.sg. (n.d.). Retrieved October 28, 2021, from https://lkyspp.nus.edu.sg/ips/research/managing-the-challenges-of-an-ageing-society/leaving-well-end-of-life-policies-in-singapore.
  3. Why is palliative care important? Crossroads Hospice . (n.d.). Retrieved October 28, 2021, from https://www.crossroadshospice.com/hospice-palliative-care-blog/2019/march/14/why-is-palliative-care-important/.
  4. Tan, J. H. (2021, July 13). Palliative care 101: All you need to know about end-of-life care. Homage. Retrieved October 28, 2021, from https://www.homage.sg/health/palliative-care/.
  5. Huttmann, S. E., Magnet, F. S., Karagiannidis, C., Storre, J. H., & Windisch, W. (2018). Quality of life and life satisfaction are severely impaired in patients with long-term invasive ventilation following ICU treatment and unsuccessful weaning. Annals of Intensive Care, 8(1). https://doi.org/10.1186/s13613-018-0384-8
  6. Kittelson, S. M., Elie, M. C., & Pennypacker, L. (2015). Palliative Care Symptom Management. Critical care nursing clinics of North America, 27(3), 315–339. https://doi.org/10.1016/j.cnc.2015.05.010
  7. Cheong, 2014. National University Hospital starts palliative care service in emergency department. Retrieved from http://www.straitstimes.com/singapore/health/national-university-hospital-starts-palliative-care-service-in-emergency-department
  8. GK Goh to launch purpose-built nursing home. Retrieved from https://sg.finance.yahoo.com/news/gk-goh-launch-purpose-built-003000526.html
  9. Yong, 2016. Singapore nursing homes need new model of care: Lien Foundation CEO. Retrieved from https://sg.news.yahoo.com/depersonalised-and-dehumanising-singapore-113454493.html
  10. Nursing Homes Singapore. Retrieved from http://nursinghomes.sg/
  11. Chan, 2016. Nursing home patients could benefit from fewer beds in wards: Study. Retrieved from https://www.channelnewsasia.com/news/singapore/nursing-home-patients-could-benefit-from-fewer-beds-in-wards-stu-7919038
  12. Phua, 2017. Jade Circle nursing home project revived, to be ready end-2019. Retrieved from https://www.channelnewsasia.com/news/singapore/jade-circle-nursing-home-project-revived-to-be-ready-end-2019-9008096
  13. Boh, 2017. Plans revived for nursing home with single, twin rooms. Retrieved from http://www.straitstimes.com/singapore/plans-revived-for-nursing-home-with-single-twin-rooms
  14. Basu, 2017. Long-term eldercare: More options now, but more data also needed. Retrieved from http://www.straitstimes.com/opinion/long-term-eldercare-more-options-now-but-more-data-also-needed
  15. Yuen, 2018. More home-based care options likely for seniors. Retrieved from http://www.straitstimes.com/singapore/housing/more-home-based-care-options-likely-for-seniors
  16. Poon, 2017. Lions Home residents get to wear their own clothes. Retrieved from http://www.straitstimes.com/singapore/lions-home-residents-get-to-wear-their-own-clothes
  17. Poon, 2017. Bringing quality care up a notch at nursing homes. Retrieved from http://www.straitstimes.com/singapore/health/bringing-quality-care-up-a-notch-at-nursing-homes
  18. Choo, 2018. Orange Valley opens sixth nursing home. Retrieved from http://www.straitstimes.com/singapore/health/orange-valley-opens-sixth-nursing-home
  19. Tai, 2017. 20 cents for a massage, 60 cents for instant noodles: Peacehaven nursing home residents 'earn' and 'spend' on activities. Retrieved from http://www.straitstimes.com/singapore/20-cents-for-a-massage-60-cents-for-instant-noodles
  20. Tai, 2016. Singapore nursing home models ‘need to balance benefits, cost’. Retrieved from http://www.straitstimes.com/singapore/health/spore-nursing-home-models-need-to-balance-benefits-cost
  21. Chua, 2018. Integrated nursing home and senior care centre opens in Henderson. Retrieved from http://www.straitstimes.com/singapore/health/integrated-nursing-home-and-senior-care-centre-opens-at-henderson
  22. Yuen, 2018. More home-based care options likely for seniors. Retrieved from http://www.straitstimes.com/singapore/housing/more-home-based-care-options-likely-for-seniors
  23. Abdullah, 2017. Active ageing hub opens in McNair Road. Retrieved from http://www.straitstimes.com/singapore/active-ageing-hub-opens-in-mcnair-road