Palliative care and hospice care are interchangeable. In the early days, it was often called ‘hospice care’. It is a holistic approach encompassing medical and nursing care services for patients with critical or serious illnesses. The aim is to address the physical, psychological, social and spiritual needs of patients, and improve the quality of life of patients and their families.
Only for terminally-ill patients?
In the past, many people thought that only terminally-ill patients would be referred to palliative care services. In fact, palliative care has developed and gone beyond caring for critically-ill patients. As long as patients need it, early intervention can be arranged together with other treatments. At present, palliative care is mainly targeted for cancer patients, but it has also gradually grown to cover other diseases such as renal failure, chronic obstructive pulmonary diseases, and neurological diseases.
Public or private?
The 7 hospital clusters under the Hospital Authority (HA) all provide palliative care services, including in-patient service, outpatient service, palliative day care service, home care service and bereavement counselling, which are mainly based on the needs of terminally-ill patients and criteria set by the HA.
Some non-government organisations (NGOs), including nursing homes and social welfare organisations, also provide hospice accommodation and / or palliative home care services, giving patients and their families an additional option to receive end-of-life care at home or in a familiar environment.
Let’s compare the differences between hospice accommodation and palliative home care with the participation of caregivers.
Note: The information contained in the table was as of end of November 2020; for more updated information, please refer to recent updates released by the relevant institutions
3 self-financing nursing homes, including ‘Haven of Hope Sister Annie Skau Holistic Care Centre’, ‘The Jockey Club Home for Hospice’ and ‘The Hong Kong Anti-Cancer Society Jockey Club Cancer Rehabilitation Centre’, have doctors and nurses to provide medical and nursing care services, e.g., wound care. They also have social workers or chaplains to provide counseling and spiritual support.
Since these institutions operate on a self-financing basis, many services are charged separately.
Fees and charges
(Depending on the institution)
Daily rate: $420 - $2,300 per room
Monthly rate: $25,000 – above $81,000 per room; rates for short-term stays start from $9,600 per 5-day stay
Rates start from $100 - $200 per lodger per night, or $3,200 per lodger per month
Care items charges
The average length of stay for past cases has ranged from 12 to 90 days. Consumers who want to choose hospice accommodation should estimate the duration of stay and check with the institution about the costs of nursing items, medical examinations and medical supplies that may be used to calculate the approximate costs, and assess whether such services are within their household affordability.
All institutions provide subsidised services for people with financial difficulties to apply for. After approval, eligible persons can receive partial subsidies or use the services at a discounted price.
Hospice home care services
Scope of services
Case managers, nurses or medical social workers provide regular home visits, teach nursing care techniques, address the psychological and spiritual needs of patients and their families, and assist in advance care planning, so that patients can receive appropriate care at home, thus reducing unnecessary or repeated hospital admissions.
Limitations on application
The services provided by some institutions may require the referral by designated public hospitals or have quotas on applications.
5 institutions that provide these services include:
Summary of service items
Support of social workers
Fees and charges
Home visits by nurses or care workers are charged by session or visit. Depending on the institution, charges for subsidised services start from $30 per 45-minute session (additional sessions or special care items will be charged separately) or $240 per visit; charges for non-subsidised services start from $1,200 per visit plus doctor’s home visit fees (if any); home hospice package costs $8,000 per 4-week period
Some institutions are subsidised by funds and provide services free of charge.
i.) Psychological preparation and support for caregivers
Caregivers at home (such as relatives or foreign domestic helpers) need to provide personal care for long hours and cannot leave the patients at home alone, and therefore need sufficient support. Caregivers need to possess some basic knowledge about the patient's illness, and simple skills to handle practical tasks, such as administering medication, feeding, turning patient in bed, cleaning up human wastes, helping to bath / shower, etc.
ii.) Receive support from and maintain close contacts with qualified medical personnel
Palliative care nurses who make regular home visits often play the role of case managers. They are familiar with patients’ situation and can answer family members' questions. When unable to distinguish patients’ symptoms or conditions, caregivers can seek help from case nurses. At present, the number of doctors who can make home visits in Hong Kong is relatively small. In addition, doctors who provide such services need to have the relevant knowledge, such as knowing the drugs that patients are taking and the symptoms that may appear before death, and may need additional support from specialists or relevant medical teams. Patients and their families should consider whether such support is available from relevant medical personnel.
iii.) Not every patient is suitable to have home care
Patients who have symptoms that are recurring or complex, or if the disease develops rapidly, e.g., having sudden shortness of breath or severe pain; or requiring frequent dispensing of medication and close monitoring; or suffering from sudden severe bleeding, etc., are not suitable to receive home care. Only patients who are in stable conditions, and experiencing a slow and less painful deterioration of body functions, stand a better chance of being allowed to pass away at home.
iv.) Considerations of dying at home
Patients choosing to die at home will need the consensus and support of their caregivers and other family members.
Regardless of whether a patient chooses to die in a hospital, institution or at home, family members should discuss the plan as early as possible when the terminally-ill patient still possesses the mental and judgmental capabilities, and try to understand and take into account the patient's wishes, values, expectations, etc. Since the plan may change over time or as medical conditions change, flexibility and time should be allowed to review and adjust the plan regularly.
Furthermore, if the end-of-life care plan involves certain technicalities, such as whether or not to refuse certain medical treatments, etc., it may require the participation of a doctor or nurse.
The Consumer Council has compared the services scope and charges of various institutions late last year; for further details, please refer to the article ‘Select Hospice Care Carefully Let Patients Go Through Their Last Chapter in Peace’ (Chinese version only) in Issue #530 of CHOICE Magazine.
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