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SINGAPORE: Singapore health authorities want to expand the home-nursing sector but healthcare professionals said it will take time.
Among their concerns are recruiting the right people and managing costs so that home nursing is more affordable than checking into a hospital.
Once every two weeks, nurse Boon Lee Chin comes to visit Yue Ah Leng, who suffers from an enlarged prostate. She changes his urinary catheter, checks on his health and for the hour or so she's there also as a friend.
Boon Lee Chin said: "We act as a companion, as a friend to them, especially those who are lonely. We have to help them, for example, to read their letters, or make phonecalls to the hospital to make appointments."
The rest of the time, Mr Yue is looked after by his children.
Yue Poh Yoke, his daughter, said: "Sometimes my dad's catheter tube may lead to an infection after it's been changed. Then I have to call the nurse for help."
One of the main challenges to expanding home-based nursing care is to raise public awareness and acceptance of such services.
For instance, in the past, nurses and doctors may be asked by some family members not to make home visits in their uniforms, for fear of neighbours finding out about the patient. However, there is less stigma nowadays. In fact, the Yues rely on neighbours to help out once in a while.
Each visit by the nurse from the Home Nursing Foundation costs S$50, but those with subsidies, like the Yues, pay a lot less. Still, it is seen as expensive, especially when some patients pay nothing upfront to stay in hospital.
Loh Shu Ching, general manager, Home Nursing Foundation, said: "So if I was really sick, I didn't really need to take anything out of my pocket to pay for my care. But now, I'm more stable, I come home and yet I have to come up with some money."
That's why the Ministry of Health wants to make home nursing more affordable, by extending the 3M framework - Medisave, Medishield and Medifund - to cover long-term and home care.
As a first step, patients can now use their Medisave, the national medical savings scheme, to pay for palliative care.
Another challenge is getting the right people for the job. Community-based care is mostly run by volunteer welfare organisations, which cannot match the salaries or career opportunities in hospitals.
The Health Ministry is training more nurses and doctors and will look overseas to make up the shortfall. But those in hospice care said there is a limit to that.
Dr R Akhileswaran, CEO & medical director, HCA Hospice Care, said: "Knowing the culture, palliative care involves a lot of communication. And so if we have a lot of foreign doctors or foreign nurses, sometimes communication is an issue. And if the communication is not as it's supposed to be, the care may not be adequate."
Healthcare workers added there must be better coordination between home-care providers, and hospitals and clinics to ensure better patient care. - CNA/vm
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