Singapore’s population is aging at an alarming rate, which means in time to come the number of elderly people in need of care will surge dramatically ahead of the number of young people available to care for them. What is more, as households shrink and young people become more and more internationally mobile, having kids is no guarantee that you’ll be looked after in old age (and frankly if that’s your main reason for having kids, good luck brainwashing yours).
At some point in your life (well, towards the end of it), you may reach the stage where you’re ill and about to die, but you don’t want to die surrounded by the four walls of a hospital ward. Home hospice care offers those with terminal illnesses the chance to die at home.
As morbid as this sounds, at some point this is an option you may have to pick for yourself or a loved one. So stop being squeamish and read on.
What is home hospice care?
Don’t confuse hospice care with general eldercare. A person only needs hospice care when they’re terminally ill and have been told that the end is near (usually 12 months or closer). (That being said, a significant minority of hospice patients do end up miraculously getting well and end up getting discharged.)
Unlike standard care (e.g. remaining in the hospital), hospice care concentrates on relieving the symptoms suffered by the patients, rather than attempting to cure them. Given the fact that procedures such as chemotherapy can be very painful, being transferred to hospice care can raise the quality of the remainder of the patient’s life.
Home hospice care enables the patient to be cared for at home by professionals who know how to alleviate their symptoms and help them move around. Instead of staying in a hospice ward or being placed in hospice day care, they get to live at home for the remainder of their lives. Most of the time, this involves a team of caregivers and medical professionals making housecalls and remaining contactable 24/7. The frequency of visits is variable, and usually increases as the patient’s condition worsens. Equipment such as hospital beds might be provided as well.
It should be noted that not all patients are eligible for home hospice care. That will depend on the patient’s medical needs. Patients who need frequent urgent care may have to be warded.
How much does it cost?
This is obviously the question on everyone’s lips. The cost of eldercare in Singapore is so high that many Singaporeans are forced to check into nursing homes in Johor Bahru, be cared for by untrained maids or check into facilities that are more like prisons than nursing homes.
Well, the good news is that home hospice care in Singapore is (surprise surprise) free and usually provided by voluntary welfare organisations. The trouble is that this means availability can be limited.
There are various organisations such as HCA Hospice Care, Assisi Hospice and Metta Welfare Association which provide free home hospice care. The catch is that patients must go through means testing, and must usually be referred by their doctors to the organisation. It is also usually a requirement that the patient have a caregiver at home, as the medical team does not stay at the patient’s home.
It should be noted that medications and other equipment or consumables are generally not free, although organisations will sometimes loan items such as hospital beds.
What are the alternatives?
An alternative to home hospice care is to pay a foreign nurse to act as a live-in caregiver. Such caregivers typically cost about $600 to $1,000 a month. These foreign nurses usually come from Indonesia, the Philippines, India, Sri Lanka and Myanmar and can be essential for elderly folk with mobility issues or who need constant monitoring. They differ from maids in that they have medical training and are usually experienced at working in hospitals. And no, you cannot get them to do your groceries or look after the kids as well. These are medical professionals and should be treated as such.
Local nurses are also available for the provision of home care, but cost a much higher fee of about $6,000 a month for working 12-hour shifts a day.
Do note that the cost of hiring a nurse does not include that of consulting a doctor or purchasing equipment or pain management medication.
While basic medical insurance plans do not cover the cost of palliative care, some insurance companies now offer riders covering hospice care or post-hospitalisation home nursing.
The truth is, home hospice care is still quite rare in Singapore. Those who cease treatment and cannot afford to check into a hospice ward are usually left to rely on family members or maids for the remainder of their lives. Hopefully, that is something that will change in time to come.
Would you consider home hospice care for a terminally ill family member? Share your concerns in the comments.