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Hospice at Home Programme

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Who is Eligible

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Hospice Service

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Hospice at Home Programme

Nurses and doctors along with trained volunteer assisted with

Relief of Pain

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Nursing Care

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What is Hospice or Palliative Care?

“ Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. ”


 (World Health Organization 2002 / Appendix 1)

WHO Definition of Palliative Care for Children

Palliative care for children represents a special, albeit closely related field to adult palliative care. WHO’s definition of palliative care appropriate for children and their families is as follows; the principles apply to other paediatric chronic disorders (WHO; 1998a):

  • Palliative care for children is the active total care of the child’s body, mind and spirit, and also involves giving support to the family.
  • It begins when illness is diagnosed, and continues regardless of whether or not a child receives treatment directed at the disease.
  • Health providers must evaluate and alleviate a child’s physical, psychological, and social distress.
  • Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited.
  • It can be provided in tertiary care facilities, in community health centres and even in children’s homes.

In fact Hospice care or palliative care is just good medical care which can be offered early in the course of illness (cancer or non-cancer), in conjunction with other therapies where the aims are to cure or control the illness.

Level 1
Basic needs Hospice at Home / GP’s /Nursing homes

Level 2
Complex needs Inpatient hospice – when symptom control (e.g. peritoneal or abdominal tap, IV antibiotics/fluids) cannot be done at home.

Level 3
More complex needs Acute care hospitals eg palliative radio therapy or chemotherapy, neuro-surgical pain relief.

*Medical reasons for admission – symptoms difficult to control at home or require interventions such as peritoneal/abdominal tap, IV antibiotics, IV fluids OR allow for respite for family caregiver at home:-

  • requires more intensive emotional/spiritual support
  • complex wound management
  • may need multidisciplinary consults

Care delivery system requirements to be noted here are that care is seamless, site of care is based on need and can fluctuate and an important factor for quality care is co-ordinated care.

Will be based on disease trajectories, complexity of care needs and care deliverer:-

  • the public (NGO’s)
  • the Government
  • the private sector.

Arising from the pattern of disease in the community and their trajectories, three groups can be identified:

  1. Mostly cancers (who are not cured) characterized by short years of stability and then a rapid decline to end of life.
  2. Mostly non – communicable diseases such as heart and lung where the decline is over years with occasional exacerbation.
  3. Mostly the frail (usually with ageing) and dementia where the decline is gradual over years with progressive dependence.

Palliative Care for Whom?

The need for holistic or whole person medical care often arises in the course of many diseases, for instance cancer. Annually about 40,000 people in Malaysia are found to have cancer where up to 60% have advanced, often incurable cancer. Many others have chronic life limiting diseases of the heart, lung, kidney or nervous system. For children it can be congenital or chronic disorders.

Both group of patients will have similar problems – physical, psychological, social or spiritual – that are distressing and diminishes their quality of life. These problems can be addressed and reduced.

Some Thoughts on Delivery of Health Care in Malaysia

It may be ironic that along with the increasing life span of humans globally there is also a growing need for care, especially long term care. Current models of care delivery have to change to deal with this challenge.

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