Almost 8 in 10 Singaporeans wish to die at home: Survey

SINGAPORE - When death comes knocking, what do Singaporeans wish for?

A new study, commissioned by Lien Foundation, found that 77 per cent of Singaporeans wish to die at home, but only 27 per cent of Singaporeans do so.

Of those who want to die at home, most said they would still choose to do so even if there was insufficient support from family, friends or medical professionals.

The study, which polled more than 1,000 people here for their views towards death and dying, also found that they wish to die affordably and not leave financial burdens behind. And it would help to have well-trained doctors and nurses guide them about hospice palliative care.

They also want a platform to talk about death in the community, such as national conversations and public education on hospice palliative care to discuss issues on death and dying.

Noting the gap between expectations and reality, Lien Foundation's CEO Mr Lee Poh Wah said: "We will have a greater chance of being able to die at home - if our healthcare system is strongly geared towards hospice palliative care and it provides more professional and social support to meet patients' preferences.

"A core proposition of hospice palliative care is to empower the dying with suitable care to let them spend their last days where they wish to be. Our health policy needs to contain the institutionalisation of death, and increase the proportion of home deaths."

The Singapore Hospice Council reported 4,203 new home hospice care patients from April 2012 to March 2013, and the hunger for such care is projected to grow, said the foundation.

The survey also showed that three quarters of Singaporeans are open to receiving hospice palliative care for themselves and 80 per cent are open to getting hospice palliative care for their loved ones. 71 per cent agreed it is important that hospice palliative care services be made readily available.

Eight in 10 placed having control over pain relief and other symptom control as one their top priorities at the end of life.

View of hospice palliative care as costly

Feedback on hospice palliative care services was also positive. About six in 10 who knew someone with hospice palliative care experience rated the services to be good or very good. Ratings were highest for home hospice palliative care services.

While these findings indicate positive receptivity and a latent demand for such care, the foundation notes that there are significant barriers to receiving hospice palliative care.

More than two in five respondents of those who would not consider hospice palliative care cited high costs as the reason.  More than half of all surveyed said they think hospice palliative care is expensive.

Eight in 10 of all respondents said that hospice palliative care should be covered by medical insurance.

Top death fear - medical costs

The study found that medical costs are what Singaporeans fear most, followed by being a burden to family and friends.

When asked what are the priorities at the end of life, 87 per cent of Singaporeans wanted to ensure their death will not be a financial burden to family members.

These results are similar to the 2009 poll, where being a burden to the family emerged as the top fear, followed by medical costs.

This is the second death attitudes survey by the Lien Foundation, the first being a street poll in 2009.

Addressing the fear of costs, Dr Jeremy Lim, Partner and Head of Asia Pacific Life Sciences from Oliver Wyman suggested providing free palliative care for all in the community.

Dr Lim, who was involved in drafting the report on the national strategy for palliative care in 2011, opinioned that other than meeting the wishes of Singaporeans, providing free palliative care would minimise patients seeking help in acute hospitals where running costs are high and further adding to bed pressures.

"Enabling patients to be cared for at home and in the community - which is what they want - is less costly than hospitalisation," he said.

"Hospital beds not filled with palliative care patients can be used for other patients. Everyone can benefit from having community palliative care free."

yamadak@sph.com.sg