How to help dying patients go home

SYDNEY - A third of palliative-care patients at Greenwich Hospital in Sydney are able to go home, said Dr Andrew Broadbent, director of palliative care there and a lecturer at the University of Sydney.

This is good as most people want to die at home rather than in hospital. These patients would have had their medical problem, like pain or nausea, controlled.

He said many patients come to the hospital taking 15-20 types of medicines a day. The palliative-care doctors and pharmacists reassess their medical conditions and cut the number of drugs to about seven, which makes them feel better, he added.

Before they go home, the palliative team sits down with family members to teach them what to do in emergencies, such as the patient getting a heart attack.

A week or two prior to discharge, the patients are given a "gate pass" that lets them go home for the day, to get them feeling comfortable away from the hospital.

About 10 per cent of patients do not want to leave because they are scared. Hence, the hospital offers a "trial discharge" where it will keep the hospital bed for them for three days.

The hospital also gets in touch with the patient's family doctor. These general practitioners need to agree to do home visits if necessary, and to sign the death certificate when the time comes.

Financially, house visits are not attractive since the fee of about A$55 (S$70) is generally double what the doctor would charge a patient in his clinic.

But Dr Broadbent said many GPs agree to take over the care of palliative patients, especially if they had been looking after the person before.

HammondCare, a Christian charity organisation which runs 10 levels of eldercare services, including Greenwich Hospital, also follows up, if necessary, with visits by its specialists, nurses, therapists or social workers.

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