Living out their remaining days in the comfort and familiarity of their own home is something many elderly people would like.

While Asian values dictate that children take care of their elderly parents and make a place for them in their homes, social conditions are changing and this might not always be so.

Many ageing singles in Singapore will find themselves living alone and having to fend for themselves. They will need some help.

According to the Ministry of Health, there are about 600 patients over 65 here who receive home medical care and another 2,500 receiving home nursing care.

In home medical care, doctors visit chronically ill patients and review their medical conditions, while home nursing care is for patients who need simple procedures like getting their blood pressure checked or having wounds dressed.
According to Dr Noreen Chan, chairman of the medical sub-committee at the Singapore Hospice Council which represents eight organisations that actively provide hospice and palliative care, patients should have a life-limiting illness with a prognosis of about a year to qualify for hospice home care.

In addition, they need to have a caregiver. Dr Chan, who is also the medical director of Dover Park Hospice, explained that as doctors and nurses are unable to provide constant care, having a caregiver is a prerequisite for home care. The caregiver can either be a family member or a foreign domestic worker.

Hospice home care is provided free of charge regardless of the patient's financial situation and there is no age restriction, but patients will need a referral from a doctor. This is to ensure that hospice home care staff are aware of the patient's medical condition, so that they can help manage the symptoms.

Dr Chan said that hospice home care allows patients to spend quality time at home.

She added that it is extremely important if the patient wishes to die at home.

'Hospice home care becomes more important as patients become more home-bound and it is more difficult for them to travel to see their doctors in hospitals.'

HCA Hospice Home Care, which has over 800 patients, has a team of six doctors and 20 nurses attending to them.

As the service is provided free, the organisation gets funds from the Ministry of Health as well as donations from corporate sponsors and the public.

A doctor or nurse assesses a patient's medical condition and provides medical advice during each home visit.
Visits vary from a daily one to a monthly visit, depending on the patient's condition.

During the visit, family members are trained to look after the patient.

By 2030, 18.7 per cent of the population - or about 873,500 people - will be aged 65 and above. This compares to 8.4 per cent of the population in 2005.

More home care and hospice care services will be needed.

In the light of the increasing number of frail elderly, MrKavin Seow, senior manager of Touch Home Care, believes that home care services will be in greater demand.

A spokesman for Bright Vision Hospital, which provides hospice home care, said that more hospice home care services may allow more people to care for and be with their loved ones at their point of death.

At present, there are about 10 home medical and 13 home nursing service providers.

However, while hospice home care may allow family members to spend more time with the elderly, the Bright Vision Hospital spokesman also said that sometimes the service may not be able to provide sufficient care at home.

'Being filial means providing the best health care available for the terminally ill and, sometimes, that may be best available at an inpatient hospice,' said the spokesman.

staceyc@sph.com.sg

'My nurse, my friend'

Since November last year, Madam Lucy Koh, 70 (top pic, left), and Ms Teh Chin Eng, 45 (top pic), have been meeting once a week at Madam Koh's flat.

Ms Teh is Madam Koh's nurse, but the two women feel more like friends.

However ill she may be feeling when MsTeh visits, Madam Koh never fails to greet her friend with a hug.

Madam Koh was diagnosed with colon cancer in 2006. With the help of her maid and Ms Teh, she manages to enjoy the comforts of her own home with her daughter and her two grandsons, aged 14 and 18.

Each time Ms Teh visits Madam Koh, she assesses her condition. This includes monitoring her blood pressure, skin and her bowel movements.

Through these visits, Ms Teh has managed to learn a lot about Madam Koh.

'When I visit her, she will tell me without any sadness that she thinks the tumour is bigger and that she knows it is getting worse. Not many patients can face their illness like she does,' said Ms Teh.

In a story that she wrote with the help of her daughter for Hospice Link, the Singapore Hospice Council newsletter, she described how Ms Teh went beyond the call of duty.

'On encountering new challenges like swollen feet, for example, Chin Eng drops by for an unscheduled visit and hands over prescriptions for medicine or painkillers from the doctor, which my daughter gets from the hospital pharmacy,' she wrote.

In addition, Madam Koh also wrote how, at one point, Ms Teh visited her every day when she was feeling unwell.

According to Ms Teh, her job as a hospice home care nurse comes with its challenges but because of the interaction and her growing friendship with Madam Koh, they have established a close rapport, which helps make it easier to care for her.

'Once I bought chwee kueh as she only has an appetite for soft food. I didn't know she was yearning for it, and that really livened her spirits. She felt I was able to sense her needs,' said Ms Teh.

Madam Koh didn't speak much because of her condition, but her delight in her new-found friend was evident when her eyes lit up as she said: 'She is a very good nurse.'

There are about 2,500 patients over 65 here receiving home nursing care.

This story was first published in Mind Your Body, The Straits Times, on July 2, 2008.