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This is a really touching story. Hope he can depart surrounded by his loved ones. 一路好走。。。 Kudos to all those who contributed and the efforts of Dr goh. https://www.channelnewsasia.com/news/singapore/bangladeshi-migrant-worker-dying-cancer-last-wish-go-home-12793700

For the benefit of forumers without a Business Times subscription. This article will be useful in understand palliative care in Singapore and in the debate over euthanasia. The dollars and cents of caring Hospices in Singapore, all of which run on public donations, are facing a strain on resources, reports MICHELLE QUAH Email this article Print article Feedback Bookmark and Share SPEAKING recently with a volunteer at a local hospice, I was brought to tears by his tale of how an old man was brought in for treatment by his son. The son was later found to have left a fake contact number and address, which essentially meant that he had abandoned his aged and ailing father at the hospice. Caring and sharing: The struggles faced by hospices are increasing every day as the need for end-of-life care grows with our fast-ageing population Shaken by the man's callousness, I was also acutely aware that the hospice, which runs only on public donations, now had to care for this man and others like him, out of its own pocket. These are just some of the struggles which hospices in Singapore - all of which run on public donations - face. And these are struggles and challenges which are increasing every day, as the need for end-of-life care grows with our fast-ageing population. Prime Minister Lee Hsien Loong noted just this month, at Assisi Hospice's 40th anniversary charity dinner, that the need has grown considerably in the last decade or so, with seven hospice and home palliative-care providers now serving 5,000 patients a year. 'The actual need is probably higher,' Mr Lee had said, as there are more who could benefit from such care but are not aware of it or find the subject taboo. Patients are seldom, if ever, turned away because they cannot afford it. All home hospice care provided by the VWOs are also free, borne by the VWOs and covered in part or in full by subsidies. A Today newspaper report last October said that of the 17,000 deaths in Singapore in 2007, only 26 per cent received some form of subsidised hospice or home hospice care - indicating a sizeable unmet need. Extending palliative care Mr Lee also said that palliative care - which includes any form of medical care that concentrates on reducing the severity of symptoms and on improving the quality of life for those with serious and complex illnesses - should be extended beyond cancer to include diseases such as end-stage organ failure and advanced dementia. The importance of palliative care cannot be understated. It is not just about pain management; it's about improving a patient's quality of life, while providing pain relief and the treatment of symptoms, along with emotional and spiritual support. It's also about providing counsel, support and relief to family members. Whether at home or in the hospice, such care allows patients to live out their final days 'surrounded by love and not full of tubes, masks and drugs', Mr Lee had said at the Assisi Hospice dinner. Need is growing While there's no doubt the need is growing, the current strain on hospices - most of which run on full capacity - is also great. At present, Dover Park Hospice (DPH), Assisi Hospice (AH), Bright Vision Hospital (BVH) and St Joseph's Home and Hospice (SJH) are the only full-time, in-patient hospices in Singapore. All four are voluntary welfare organisations (VWOs), depending on public donations - with subsidies from the government - as their primary source of funding. DPH, which has 40 beds, has a waiting list of anything from two to 10 patients. AH, with 35 beds, says that it has a waiting list for its in-patient service almost all the time. BVH's 32 hospice beds are usually fully occupied at any time. Over at SJH, half of its 22 beds are for hospice patients - and these are also fully taken up, most of the time. Palliative day care is also provided by HCA Hospice Care, AH and BVH. Home care - where trained professionals provide palliative care to patients in their home - is provided by HCA, AH, BVH, Metta Hospice Care, Agape Methodist Hospital and the Singapore Cancer Society. Data provided by these hospice-care providers as to their annual running costs illustrate just how much it takes to keep a hospice going: DPH says that its operating cost averages $4 million per annum; AH chalked up a running cost of $4.9 million in 2008; SJH's running cost is $2.7 million a year; HCA's running cost is about $4.2 million a year; Metta's running cost is $500,000 a year. Part of the cost of providing hospice care is funded by the government, through subsidies extended to patients. Patients pay what is not covered by the subsidy. But, for those who cannot pay - for example, the old man who was abandoned by his son - the cost is borne by the hospice, along with all other operating and administrative costs. Patients are seldom, if ever, turned away because they cannot afford it. All home hospice care provided by the VWOs are also free, borne by the VWOs and covered in part or in full - depending on the sum - by government subsidies. For most of the hospices, especially the larger ones, this means that the bulk of their operating costs are funded by public donations - which makes fund-raising such an integral concern for them. For the four in-patient hospices, for example, the Ministry of Health (MOH) has estimated that their 1,600 patients received a total of $3 million in subsidies in 2008 - far short of the operating costs of these hospices. Recognising the growing demand for hospice care - and, perhaps, the current strain on hospices - the government recently announced the release of Medisave for the payment of home hospice services. When asked by BT for more details, MOH said that it was 'working with providers of palliative care on the implementation details and will share these at a later stage when ready'. R Akhileswaran, CEO and medical director of HCA - the largest hospice home care service in Singapore, and a hospice day-care centre - explained that 'as all the hospice home care services run by VWOs in Singapore is free of charge, the release of Medisave . . . might help only those patients under private hospice home care services who pay a fee for the service'. He went on to say that 'those patients under home care services funded by either MOH or NCSS (National Council of Social Services) or both will be means tested' to determine the level of subsidy that they will receive. In other words, they will not be fully subsidised and will receive less if they belong to a higher income bracket. Either the patients or the home-care providers will have to make up the shortfall. Dr Akhileswaran said that MOH funding for home hospice care has been raised recently to $153 per nurse visit and $207 per doctor visit - with the exact amount of funding depending on the patient's income level. He added that NCSS funds 25 per cent of the MOH funding per visit, ie $38.25 (25 per cent of $153) per nurse visit and $51.75 (25 per cent of $207) per doctor visit. MOH also recently raised the level of subsidies provided to patients at in-patient hospices. It increased its subsidy tiers from four to nine in September, estimating that half of the subsidised patients will get more subsidies as a result of the change. The level of subsidy will also depend on the patient's total family income. Those with a total family income of less than $1,440 will have 75 per cent of their in-patient bill subsidised, those with an income level of between $1,441 and $2,200 will get 70 per cent, and so on. The subsidies are based on an increased estimated norm cost of $259 a day for in-patient services, up from $242 a day previously. Patients can also withdraw up to $160 per day from their Medisave for hospice stays. Still, the bulk of the funding for hospices comes from public donations. For example, DPH has to raise the bulk of the $4 million that it needs each year to provide subsidised and often free care for its patients. In March 2009, before MOH increased the level of subsidies for hospice care, a DPH taskforce estimated that the MOH subsidy covered only 33.2 per cent of the hospice's running cost, with patients paying 11.8 per cent and donations accounting for the remaining. Over at AH, according to its annual report last year, its almost $5 million in operating costs was funded primarily by donations, with government subsidies amounting to $1.2 million and patient fees totalling some $816,000. HCA gets the bulk of its funding from subsidies. According to its latest annual report, its total expenditure amounted to $4.12 million, of which $3.81 million came from MOH and NCSS funding. But donations from the public fell, due to the economic downturn, to $930,000, from $1.21 million the year before. 'Nearly 85 per cent of the patients at our hospices are heavily subsidised,' said Tan Kee Wee, chairman of the Singapore Hospice Council, the umbrella body for all organisations actively providing hospice and palliative care. 'Although the government provides the subsidies, they are insufficient to meet the hospices' annual budgets. Any shortfall has to be raised through donations and fund-raising activities,' he said. 'I am extremely gratified that the hospices work very hard to raise funds on their own through activities like charity dinners, charity fun days, and walkathons. Just last month, the Voices for Hospices concert, organised by BVH, helped raise nearly $100,000. And this Sunday, we have a walk organised by Dover Park Hospice.' It's clear that the various hospice-care providers in Singapore could do with more support and financial help, especially with demand for such end-of-life care increasing with an ageing population. The need for alternative forms of palliative care, not currently provided here, will only add to the demand. 'The demand for palliative/ hospice care will continue as our population ages and live longer. It is through such generous donations from the public that our hospices are able to provide the excellent care and services to our patients,' Dr Tan said. For more information on hospice and palliative care, please visit the Singapore Hospice Council's website at www.singaporehospice.org.sg The Dover Park Hospice (DPH) is raising funds this weekend, through its inaugural SUNday Walk, which will kick off from Raffles Place Park and end at Clarke Quay. Funds raised through the walk and its joint activities will be channelled towards continuing and expanding DPH's service offering and capacity, and the provision of subsidised care for those terminally ill patients who are unable to pay for their stay. Please visit DPH's website (www.doverpark.org.sg) or its SUNday Walk page (doverpark.org.sg/sunday/) for more information