Study suggests better ways to design hospices
SINGAPORE — Bodies of loved ones being wheeled out at the same exit as the trash, dying patients and their family lacking sufficient private space to spend time together and patients aimlessly passing their final days with little to occupy them.
SINGAPORE — Bodies of loved ones being wheeled out at the same exit as the trash, dying patients and their family lacking sufficient private space to spend time together and patients aimlessly passing their final days with little to occupy them.
These undignified circumstances were some of the issues identified in a nine-month design study of the hospice sector here, commissioned by the Lien Foundation and ACM Foundation.
The study, done in collaboration with Assisi Hospice, Dover Park Hospice and St Joseph’s Home and Hospice, also identified design principles for hospices in a guide called Hospitable Hospice.
For example, private or community areas such as cafes could be created for patients to spend time with their families, regular activities such as art classes can be organised and a weekly “kopitiam” service created to give them a greater choice of food.
Launching the guide yesterday, Lien Foundation Chief Executive Officer Lee Poh Wah said a copy of the study’s findings has been submitted to the Ministry of Health (MOH) for its consideration and to seek funding.
Today’s hospices, he said, were “built for yesterday” and are very much “misunderstood”. “In our frantic quest to add hospice capacity, it is very important for us to aspire to a level of care and services for our parents and for ourselves.”
These principles need not be limited to the hospice sector and can also be applied at nursing homes and acute hospitals, as most people die in hospitals, at home or nursing homes.
“I hope there will be an osmosis effect, where a lot of the hospices’ skills and values can be migrated to other organisations in the intermediate and long-term care sector,” said Mr Lee.
When contacted, the MOH said it has received the report and is “currently studying the suggestions that have been proposed”.
The study, carried out by healthcare design consultancy fuelfor over a period of nine months, found that hospices were often isolated from the community and were not designed to support good end-of-life care practices.
It also proposed a model for end-of-life care called Care Central, featuring a mix of public, private social and medical spaces throughout a hospice, aimed at serving the varied needs of patients and their families. For example, families could say their farewells to their loved ones in a “Goodbye Garden” instead of an impersonal room near the back exits of hospices.
Another suggestion was an “Open Hospice” that is integrated into communities.
But experts present yesterday said Singaporeans may not be ready to have death so close to their doorsteps.
Dr Wu Huei Yaw, Medical Director of Dover Park Hospice, said: “A lot of people still aren’t ready to talk about death. Even building day-care centres for the elderly (in the neighbourhood) has evoked so much emotion.”
The experts also echoed the challenge of cost highlighted in the report: Palliative care can be costly and many insurers do not cover it, although means-tested subsidies are available.
Infrastructural costs could also be considerable, although Mr Poh pointed out that some of the ideas “don’t cost a lot of money”.
The Lien Foundation and the hospices said they are in talks with the MOH over funding.
Assisi’s Palliative Care Physician Ong Yew Jin said: “It is about convincing people of the need for certain spaces. How do we get funding to have a room for people to pray? For dining rooms? All these need money, but (they) are not ‘norms’ that are funded.”
The study comes even as hospices are slated to expand their capacity. Assisi’s bed capacity will double when its new building is completed in 2016.