All smiles at the National Medical Excellence Awards 2023. (From left) Clin Asst Prof Christopher Lien, Senior Consultant, Department of Geriatric Medicine, CGH; Ms Jesslyn Ang Lay Teng, Senior Staff Nurse, Community Nursing, CGH; Ms Yee Kai Ying, Executive, Intermediate and Long-Term Care Integration, SingHealth-CGH; Mr Ong Ye Kung, Minister for Health; Dr Shaun Gerald Nathan, Senior Resident Physician, Medical Services, SACH.
With Singapore’s rapidly ageing population, advance care planning and end-of-life care are integral to the delivery of care that matters most to residents in nursing homes and their families. Though such conversations can be difficult and emotional, they play an important part in explaining the underlying disease processes and clarifying the goals, priorities and preferences of patients and their loved ones. Nursing home care can also be complex, with residents becoming progressively frailer with multiple comorbidities and complex health needs.
Established by CGH in 2015, the EAGLEcare (Enhancing Advance Care Planning, Geriatric Care and End of Life Care in Nursing Homes in the East) programme has been providing coordinated health and social support for residents of nursing homes. Through a collaborative model of care delivery in partnership with St. Andrew’s Community Hospital (SACH), nursing home partners and general practitioners (GPs), EAGLEcare provides access to clinical care 24/7 and psychosocial support in identifying and managing symptoms for residents at their end-of-life.
Residents are systematically identified and screened according to specific indicators, and suitable residents are enrolled into the EAGLEcare programme. Enrolled residents are cared for by their regular nursing home staff and GPs, supported by the EAGLEcare team — comprising physicians and community nurses from CGH trained in geriatric and palliative care — and are complemented by SACH’s Violet Programme (ViP) after office hours. Treatment can also be facilitated remotely, enabled by telemedicine when required.
With the support of EAGLEcare, nursing home residents are encouraged to discuss legacy matters with their loved ones by engaging in Advance Care Planning (ACP) and establishing a Preferred Plan of Care, which encompasses instructions of their preferences and extent of treatment measures towards their end-of-life.
“As far as possible, care is delivered so that the wishes of residents and their loved ones can be respected and honoured in their final moments,” says Clinical Assistant Professor Christopher Lien Tsung Chien, Senior Consultant, Department of Geriatric Medicine, CGH, and Programme Director of EAGLEcare.
The EAGLEcare clinical team conducts hands-on training sessions for nursing home staff.
Another key outcome from EAGLEcare with enhanced end-of-life care is the reduction in hospital admissions for the residents. The decrease in avoidable hospital admissions improved residents’ quality of life at the end-of-life by allowing them to be comfortably cared for at the nursing homes instead of in hospital.
Spreading its Wings
To date, more than 460 nursing home staff have been equipped with ACP facilitation as well as geriatric and palliative care skills under the EAGLEcare programme. They are also guided by customised care paths to respond to common geriatric and end-of-life conditions.
“Capability-building for nursing home staff is an ongoing learning journey for the EAGLEcare team, as we work alongside our nursing home colleagues to understand the clinical complexities of each resident, in a way that can be best explained and embraced by the resident and their families,” adds Clin Asst Prof Lien. “For both the EAGLEcare team and the nursing home staff, this requires not just clinical knowledge and care skills, but also the ability to listen and accompany the residents and their families compassionately through their care journeys.”
At NTUC Health Nursing Home (Chai Chee) for instance, with strengthened knowledge and professional care capabilities, nurses have reported improvements in identifying symptoms and ways to alleviate conditions, and have developed more confidence when caring for residents.
“Our patients and their relatives have also taught us with their questions and their concerns,” says Ms Jesslyn Ang Lay Teng, Senior Staff Nurse, Community Nursing, CGH. “Through earning their trust to be able to care for their loved ones at this most critical juncture towards their end-of-life, it has given us the most important insights to continue to improve the care that we can deliver in a meaningful way.”
Two other nursing homes — the Lions Home for the Elders (Bedok) and Apex Harmony Lodge — have come on board the programme, and there are plans to reach out to more nursing homes in the East.
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