Leaving Well
Games such as Jenga are some of the activities at HOPE and CARE that patients can take part in

At the end of life, illness and frailty can shift the focus of care to managing disease symptoms and attending to basic needs and bodily functions. While this brings comfort and dignity, it is also important to recognise personhood — a person’s perception of who they are and how they are seen by others.

At Yishun Health, palliative programmes such as HOPE and CARE strive to do just that: reinforce a dying person’s dignity and recognise them as someone with a history, memories, hopes and dreams.

These initiatives are just some of the many modes of palliative care, which comes under the Department of Geriatric Medicine. This type of care is not just for those at the end of life; it is an approach that provides patients and their families with a supportive environment focused on relieving physical, psychosocial and spiritual distress. This comprehensive, person-centered care may also be offered concurrently with curative care in both inpatient and outpatient settings. The goal is to offer patients and their families assistance, be it through medical support, home care, or access to funds or equipment. It is about moving beyond meeting medical needs to improving quality of life, such that a person’s preferences for care can be achieved.

Over the years, Yishun Health has stepped up its ongoing efforts to better cater to and proactively raise awareness of end-of-life issues.

HOPE AND CARE

The Holistic Patient Evaluation through Communal Activities and Rehabilitative Engagement (HOPE and CARE) programme brings patients and the palliative care team together in a novel way.

Eating, drinking and playing games are things that are mundane and simple to people, but for many patients, these are things that cannot be taken for granted. In YCH’s palliative ward, these activities have been incorporated into a hospital round that allows a multidisciplinary team to assess and manage patients in a group setting.

Under HOPE and CARE, patients gather for a group rehabilitation session followed by snacks and table games. Often, volunteers and family members participate in the fortnightly sessions. They are joined by a team comprising palliative care physicians, physiotherapists, occupational therapists, speech therapists, dietitians, social workers, pharmacists and nurses. During this joint multidisciplinary round, the team observes and assesses patients to obtain real-time information about their mood, pain, tiredness and function. Compared to bedside assessments done individually, this allows transdisciplinary care to occur with increased productivity.

Beyond saving time, increasing productivity, and enhancing communication, the most important aspect of HOPE and CARE is how it improves the quality of care through being patient-centred. Patients are able to receive medical and rehabilitation intervention despite the limitation of time and the patient’s flagging energy level. HOPE and CARE is really about breaking down the invisible wall between healthcare workers and patients, allowing patient-centric, transdisciplinary and multidisciplinary care to occur while everyone is having fun.

STAFFING HOPE AND CARE

Palliative Physicians observe and assess patients’ energy levels, alertness and how they interact with others to determine their overall physical and mental function.

Physiotherapists engage patients in activities to evaluate their mobility, range of motion, pain and other physical movements. This helps them to design appropriate levels of exercise for patients to maintain their well-being.

Speech Therapists assess patients’ swallowing function while the patients are enjoying the snacks and drinks. While observing the patients, they also assess for any communication deficits. Thereafter, they will prescribe suitable rehabilitation exercises where needed.

Occupational Therapists watch for small clues, such as how a patient holds a cup or a building block, to understand how well the patient is coping with activities of daily living. They assess cognitive function, executive function, dexterity, mobility and how a patient interacts with their environment.

Dietitians observe how well a patient is eating to determine appetite. This allows them to design nutrition plans based on patients’ needs.

Chan Sue Mei ensures that each patient eats adequately with enough nutrition

Medical Social Workers interact with patients and their families to assess how they respond to people in a social setting. By observing their mood and how engaged they are with the activities, they can evaluate the psychological and social health of patients.

Pharmacists observe whether patients are familiar with their medications as they are being served, and intervene with educational efforts on the medication indications and side effects.

Nurse Managers and Nurses engage with patients away from the bedside and in different ways. It builds rapport and gives them a chance to observe patients’ symptoms, ability for self-care, and the competence of their caregivers.

OTHER PROGRAMMES COVERED IN THIS CHAPTER:

Advance Care Planning (ACP) is one of the key ways Yishun Health is addressing end-of-life issues. First launched in 2013 as a pilot in various departments, ACP is now an integral part of many of our programmes and departments. As of FY2017, we completed 420 general ACPs and 1,591 Preferred Plans of Care (PPCs), and have documented more than 2,400 ACPs for individuals at every stage of health and at various locations — in our wards, outpatient clinics, patients’ homes, and even Wellness Kampungs. We have also reached out to over 9,000 people at ACP events held in the community. More specifically, we have rolled out more strategic initiatives related to ACP:

Mr K Shanmugam (fifth from left), Adviser to Chong Pang GROs and MP for Nee Soon GRC, paid a visit to the BSN exhibition

Disease-Specific ACP (DSACP) for Renal Patients

ACP 2.0: to drive ACP awareness in the community, promoting it as part of routine healthcare in primary care and outpatient settings

Collaborating with Drama Box and ArtsWok Collaborative on Both Sides, Now, a series of art workshops, talks and public performances held in Chong Pang district and themed around end-of-life isssues

Joined more than 20 institutions, led by the Singapore Hospice Council, to take part in Live Well, Leave Well, a campaign to raise public awareness on palliative care, advance care planning, and end-of-life matters