The Straits Times (2 January 2014) - Mr Tan (not
started him on oxygen.
Could the Project Care
team take a look at him?”
This is a typical call that Project Care would
receive from a nursing home.
Started in 2009, the project is an ongoing
collaboration between Tan Tock Seng Hospital
(TTSH) and six nursing homes in central
Singapore. Its aim is to coordinate medical
care for nursing home residents – including
those with advanced or terminal illnesses –
who may sometimes require care from
specialists in the hospital.
For instance, under the project, adjustments
of medication can be made for elderly
residents. Should residents need to undergo
investigations quickly at TTSH, this can
also be arranged.
Staff from the nursing homes are
taught how to take care of their
residents who have more
complex conditions or terminal
The project also assists
patients and their families
in planning for future
medical or palliative care
in the nursing homes.
A team from TTSH and
the nursing homes hold
advance care planning with
the patients and their family
Part of the conversation
would be devoted to explaining
the patient’s medical condition.
After receiving repeated
counselling and explanations
about the choices available, the
patient and his family would
eventually decide on their preferred
type and place of treatment.
Care is then delivered in collaboration
with the doctor at the nursing home. Nurses
there assess and monitor the patient’s condition.
Mr Tan, for instance, was admitted to the
nursing home after suffering a stroke
three years ago. He is able to speak
and eat normally, but requires a
wheelchair to move around.
He also suffers from chronic
obstructive lung disease, in
which the lungs and
progressively and irreversibly damaged, resulting
in worsening breathlessness.
When he made his advance care plan, he and
his son had asked for treatment of his illness in
the nursing home, where possible.
On one occasion, when our doctor and nurse
from TTSH assessed him, they found that he had
a chest infection, which worsened his chronic
obstructive lung disease. This resulted in a cough,
fever and breathlessness.
In addition, the chest infection affected his
ability to swallow, making him cough even more
when he ate solid food.
We started Mr Tan on intravenous antibiotics,
nebulisation, oxygen therapy and oral medication
at the nursing home, instead of hospitalising him.
At the nursing home, the physiotherapist
attended to him to encourage the clearing of
phlegm, while the nurses monitored his condition
closely. Also, his diet was changed to one with
meals of softer consistency.
After 10 days, he recovered. He was able to sit
up in the wheelchair, have meals in the common
dining hall and participate in his usual activities.
When a patient is terminally ill, it is often
difficult for his family members to
comprehend or accept his condition.
They would usually be told about the
patient’s deteriorating medical condition
each time he is admitted to a hospital or
place of care. But they seldom seem to
fully understand, or perhaps they may be
in denial, that the repeated admissions
are a sign of approaching death.
On numerous occasions, patients
would be sent back to the hospital during
their last hours when it was obvious that
further hospitalisation would not change
anything. Families, sometimes, make
inappropriate decisions because they are
unable to think straight during times of
stress. They may also not have been
counselled sufficiently well enough to
make informed and realistic decisions
during the last few precious hours of
their loved ones’ lives.
PATH OF THEIR CHOOSING
Some patients choose to
spend their last days in a
Take Mrs Lim, for
instance. A resident with
a brain tumour, she
was able to have her
managed through the
collaborative efforts of
both the TTSH and
nursing home teams.
She died in her
nursing home room,
with her husband beside
Her husband remarked
how much more peaceful
the nursing home was than
a busy hospital ward.
Currently, about 400 nursing
home residents have completed
advance care plan discussions.
Many of them have been treated in the
homes, instead of being sent back to the
This has helped them recover from their
illnesses in an environment they are familiar
with, while being cared for by nurses who
understand them well.
Many residents and their families
have expressed gratitude for the
The families also said
they gained a better
understanding of their
loved ones’ medical
were comforted that their
loved ones were receiving special care, especially
during the end-of-life stage.
Dr Sabrina Wong Kay Wye is a family physician
with special interest in geriatrics and end-of-life
care at the department of continuing and
community care at Tan Tock Seng Hospital. The
hospital has a 25-year history in geriatric medicine
and is part of the National Healthcare Group, the
regional health system for central Singapore.
Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.