Title: Home Hospice Services during COVID-19: Ensuring Comfort in Unsettling Times in Singapore
Abstract: Journal of Palliative MedicineVol. 23, No. 5 Letters to the EditorFree AccessHome Hospice Services during COVID-19: Ensuring Comfort in Unsettling Times in SingaporePriyanka Khatri, Santhosh Seetharaman, Chia May Jamie Phang, and Bin Xuan Andy LeePriyanka KhatriAddress correspondence to: Priyanka Khatri, MBBS, FAST and Chronic Programmes, Alexandra Hospital, 378 Alexandra Road, Block 20A, Singapore 159964, Singapore E-mail Address: [email protected]FAST and Chronic Programmes, Alexandra Hospital, Singapore.Division of Nephrology, National University Hospital, Singapore.Search for more papers by this author, Santhosh SeetharamanHealthy Ageing Programme, Alexandra Hospital, Singapore.Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Search for more papers by this author, Chia May Jamie PhangCommunity Eldercare Services, Methodist Welfare Services, Singapore.Search for more papers by this author, and Bin Xuan Andy LeeHome Care and Home Hospice, Methodist Welfare Services, Singapore.Singapore Hospice Council, Singapore.Search for more papers by this authorPublished Online:4 May 2020https://doi.org/10.1089/jpm.2020.0186AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail Dear Editor:Home hospice services are an integral part of palliative care. Providing quality home hospice services amid the global pandemic of COVID-19 poses its unique challenges.1 We describe the measures implemented by one of the home hospice organizations in Singapore that allowed continued patient care without jeopardizing the health of staff.Previsit Triage to Assess the Need for a Home Visit1.Home visits are restricted to patients with significant symptom burden. All visits are triaged by senior doctors/nurse managers to explore alternative management options like video consults.2.Mandatory previsit screening is performed for patients and their family members on the day of the home visit. The screening questions are regularly updated as per guidance by the Ministry of Health (Fig. 1).3.A senior physician, per a predefined nationwide management algorithm, handles any positive responses.FIG. 1. MWS home care and home hospice 2019 novel coronavirus outbreak response plan. MWS, Methodist Welfare Services.Ensuring Staff Safety1.Work from home policy is implemented for all home hospice staff. Institutional devices enabled with remote access are provided to them for continued patient care.2.Adequate personal protective equipment (PPE) supplies have been obtained.3.Only one caregiver is allowed with the patient during the home consultation.4.Protocols for proper disinfection of equipment used for home visits have been implemented.5.Our staff has been advised to minimize the use of public transport. Taxi fares are provided to them. Some hospice services in Singapore use dedicated vehicles for home visit purposes.Manpower Management1.Segregation to four smaller teams is implemented.2.We have involved part-time physicians in our team. These physicians have prior experience in palliative care.Staff Training and Communication1.Administrative staff members have been trained to conduct the previsit screening. They are advised to contact the clinical staff if any issues arise during the screening process. Protocols for escalation have been established for them as sometimes the family members may not be very receptive to the questions.2.Training of all clinical staff has been done on the proper use of PPE.3.Regular updates to staff are provided in weekly clinical meetings. Additional communication platforms include videoconferencing, secure messaging, and institutional e-mails.Special Scenarios Requiring Guidance from Regulatory Authorities1.As per current practice in Singapore, all patients with pneumonia are isolated and tested for COVID-19. Consensus guidelines on home-based testing have been developed upon discussion among the stakeholders (i.e., Singapore Hospice Council, Agency for Integrated Care, and Ministry of Health). These guidelines allow us to defer testing as long as the patients express elicit preference for home-based care and are at low risk of acquiring COVID-19 infection. Home hospice team then visits the patient's home in full PPE.2.We are working on guidelines to allow special privileges for home hospice team to visit long-term facilities in nursing homes even in a state of lockdown.With the mentioned measures, there have been no infections in our team. Home-based palliative care during COVID-19 is feasible with rigorous planning and workflows in place to protect patients, caregivers, and the health care workers.Reference1. Hospice NAFHCA: Mobilize home care and hospice to fight COVID-19. www.nahc.org/wpcontent/uploads/2020/03/FactSheet_COVID19v2.pdf (Last accessed April 2, 2020). Google ScholarFiguresReferencesRelatedDetailsCited byExploring the Measurement of Hospice Resilience14 March 2023 | Illness, Crisis & Loss, Vol. 31, No. 4Hospices and Emergency Preparedness Planning: A Scoping Review of the Literature17 May 2023 | Journal of Palliative Care, Vol. 13Difficulties and Needs of Adolescent Young Caregivers of Grandparents in Italy and Slovenia: A Concurrent Mixed-Methods Study28 February 2022 | International Journal of Environmental Research and Public Health, Vol. 19, No. 5One Year on: An Overview of Singapore’s Response to COVID-19—What We Did, How We Fared, How We Can Move Forward30 August 2021 | International Journal of Environmental Research and Public Health, Vol. 18, No. 17COVID-19 GİBİ SALGINLARDA EVDE BAKIM HİZMETLERİNİN ÖNEMİ: KISA BİR BAKIŞ9 March 2021 | Turkish Journal of Family Medicine and Primary Care, Vol. 15, No. 1 Volume 23Issue 5May 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Priyanka Khatri, Santhosh Seetharaman, Chia May Jamie Phang, and Bin Xuan Andy Lee.Home Hospice Services during COVID-19: Ensuring Comfort in Unsettling Times in Singapore.Journal of Palliative Medicine.May 2020.605-606.http://doi.org/10.1089/jpm.2020.0186Published in Volume: 23 Issue 5: May 4, 2020Online Ahead of Print:April 15, 2020PDF download
Publication Year: 2020
Publication Date: 2020-04-16
Language: en
Type: article
Indexed In: ['crossref']
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Cited By Count: 5
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