End of Life
From Social Collaborative Singapore
Action Plan 2016 (Institute of Policy Studies (IPS))
- Scenario-planning project involving about 100 experts from different domains
- One of key strategies developed was to initiate a National Conversation about end-of-life issues and develop an End-of-Life Toolkit to equip seniors with the necessary information in their decision-making process
- Factors like rising life expectancy, growing numbers of educated elders, technological advances in healthcare and increasing acceptance of the concept of patient autonomy suggest the time is ripe for a cross-sectoral, national initiative on end-of-life planning
Death Attitudes Survey (Lien Foundation, 2013)
- Increased desire for "die-loges" amongst Singaporeans - 71% of respondents saw a need for such conversations, with 91% of respondents aged 50-59 years old and 90% of respondents aged 60 and above wanting more public education on hospice palliative care
- 77% of Singaporeans wish to due at home, but government statistics show that only 27% of deaths in Singapore take place at home
- 64% of Singaporeans view hospice palliative care as expensive
- An earlier study conducted from 2008 to 2009 found that 50% of respondents had not spoken to terminally ill individuals whom they knew personally, with primary reasons given as discomfort and ignorance on the issue
Improvements in End-of-Life Care with a Protocol-based Pathway for Cancer Patients Dying in a Singapore Hospital (Academy Medicine of Singapore, 2012)
- This study investigated whether the adoption of a modified Liverpool Care Pathway (LCP) in Singapore hospitals would provide better quality end-of-life care for cancer patients
- After introducing and educating the medical oncology team and ward nurses on a modified LCP, the LCP was adopted and used on 30 patients.
- The study revealed promising results in terms of improved physical comfort and concluded by suggesting that this care pathway be extended to other settings in order to maximise benefits to patients dying from other causes.
Strengthening Safety Nets for the Elderly should be a Societal Concern (IPS Commons, 2016)
SUGGESTED ACTIONS[1]:
- Means-tested and limited unemployment benefits scheme to provide elderly workers with financial buffer as they seek/train for a job more suitable for their age and physical ability
- Raising the Silver Support Scheme (SSS) payout, which seems too low for our current cost of living
- Government to amend the Constitution and increase the percentage of returns that it can spend in order to finance 1 & 2
When Age Matters (IPS Commons, 2016)
SUGGESTED ACTIONS[2]:
- Open conversations, acknowledge existing problems, using specific terms such as “age-friendly”, “age-aware” to set a different, more friendly tone
- Workplaces to acknowledge needs and capabilities of workers of different age groups. Arrange for training, counselling and wellness programmes as a direct but encouraging acknowledgment of their needs
Healthcare Services and Accessibility for the Elderly
SUGGESTED ACTIONS[link here]:
- Expand MediShield to include all Singaporeans regardless of age or pre-existing illnesses
- Ensure all Singaporeans can pay the premium i.e. higher premiums for the extreme elderly or those with pre-existing illnesses
- Limit individual’s risk of medical bankruptcy by putting a cap on what they have to pay as their share
Appropriate Care Guide (ACG) (Ministry of Health) Under the Ministry of Health (MOH), ACG was created:
- Topics raised by relevant professional bodies/individuals
- Presence of an expert group (total of 12 health professionals) to ensure accuracy and relevance of recommendations for users
- Reviewed and endorsed by professional bodies like Academy of Medicine and College of Family Physicians
- Released to the public after 8-12 months from the start of creation
- Reviewed every three years for currency and new developments
The Policy Implications of Dying: End of Life Care (Civil Service College, 2007)
- To study to what extent governments should advocate and regulate end-of-life care and how
National Guidelines for Palliative Care and Interpretation Guide (Singapore Hospice Council, 2015)
- Help service providers better understand the requirements and desired outcomes of the National Guidelines for Palliative Care so they can put in place appropriate processes and practices to achieve these aims
- The document is divided into four domains - Patient Care, Family and Caregiver Support, Staff and Volunteer Management, and Safe Care[3]