Tan Tock Seng Hospital and Dover Park Hospice increase access to rehabilitation and palliative care

​​The TTSH Integrated Care Hub officially opens to better support patients and families towards independence at home and provide seamless access to palliative care

19 March 2024 – Bridging patients from the hospital and reintegrating them back into the community is the focus of the new Integrated Care Hub (ICH) by Tan Tock Seng Hospital (TTSH). The 17-storey, 608-bed ICH completes the first phase of the HealthCity Novena masterplan, which aims to better address the population’s healthcare needs in the region.

Anchored by the TTSH Rehabilitation Centre and Dover Park Hospice, the ICH was officially opened today by Mr Ong Ye Kung, Minister for Health.

Rehabilitating more patients to lead meaningful lives at home

The highest level of rehabilitation provided by the TTSH Rehabilitation Centre sees patients with traumatic brain or spinal cord injuries, complex stroke, or catastrophic limb loss. Here, patients have rehabilitation care and therapy safely intensified with new care models, technologies including robotics and virtual reality, and translational research with local and international partners.

Ventilatory Rehabilitation Unit

One new tertiary rehabilitation care model that has enhanced outcomes for patients is the new Ventilatory Rehabilitation Unit, the first of its kind in Singapore. This five-bed unit was specifically set up with specialist equipment and a dedicated team for Ventilator Assisted Individuals to undergo early, intensive, tertiary rehabilitation and management of their ventilator dependence prior to discharge.

Prior to the VRU setup, many of these patients had prolonged stays in the Intensive Care Unit or acute hospital wards due to the reliance on specialised equipment and care. While they are well cared for, these settings are more catered to managing their acute medical and surgical issues rather than providing specialised rehabilitation. Often, patients may not be able to work towards improvement in aspects such as speech, mobility, and swallowing, and caregivers are only able to begin learning relevant skills after discharge.

The VRU has reduced the total length of hospital stay by an average of 81 days, with patients achieving better mobility and speech outcomes. Caregivers are also engaged and begin training earlier in the patient's care journey, where they are empowered to perform tasks under supervision within the unit. This enables them to gain knowledge prior to discharge and allows them to care for their loved ones with confidence at home.

Mr Lau San Heng (71 years old) was involved in a road traffic accident and sustained injuries including to the brain and lungs. While recovering from his surgeries, he required a tracheostomy and was dependent on the ventilator. After a month of intensive rehabilitation in the VRU including mobilisation, swallowing, and speech therapy, he was able to reduce the ventilation support needed and no longer required the tracheostomy. Upon discharge, he could carry out daily activities and move around his home on his own.

His daughter Ms Vivian Lau recalls: "Initially we were prepared for my father to require extensive life support, but he began to recover. With the dedicated care of the rehabilitation team and the assistance of technology, he eventually managed to breathe on his own. We are relieved and grateful to bring him home without the need for ventilator support."

Delivering earlier, seamless palliative care to more patients

The relocation of Dover Park Hospice from its old premises (10 Jalan Tan Tock Seng) to the ICH in October 2023 marked a significant milestone for Singapore’s first purpose-built hospice. Occupying three storeys, the new home has increased its inpatient capacity from 50 to 70 beds with new and improved clinical infrastructures such as tele-monitoring that enables collection of vital signs data and monitoring of patient’s symptoms remotely. There is more space than before, allowing more patients and their families to access tailored palliative rehabilitation programmes such as R.I.S.E. (Restitutive. Integrative. Supportive. Empowering) and volunteer activities such as pet-assisted activities.

Integrated Palliative Care Programme

In October 2023, TTSH and Dover Park Hospice piloted the Integrated Palliative Care Programme, creating earlier, more seamless access to end-of-life care for patients. More patients with life-limiting conditions receive earlier referrals from TTSH to Dover Park Hospice’s inpatient, day care or home care services, or through an integrated team that co-manages their care, allowing patients to spend more quality time with their loved ones.

The numbers are encouraging: about 17% more patients with non-cancer conditions are seen by palliative care specialists within the hospital, and 70% of patients under Dover Park Hospice Home Care service passed away in their own homes, as compared to a national average of 39%. There are also twice as many patients admitted into the TTSH specialist palliative care ward, ensuring that they receive the holistic, patient-centred care that is a cornerstone of palliative care.

The pilot programme not only optimises patient care but facilitates the sharing and transferring of skills and knowledge between the specialist and palliative care teams. The hospice team is better able to manage patients’ complex medical or nursing needs without having to re-admit them to hospital. The partnership also helps build capability and capacity with the secondment of nurses from TTSH to Dover Park Hospice’s inpatient and home care services, which are expanding to serve more patients.

Dr Liew Li Lian, Chief Executive Officer, Dover Park Hospice said: "When a medical condition begins to limit life, this is where hospice care makes the biggest difference. Being in the ICH means Dover Park Hospice can step in earlier, working together with our TTSH colleagues, as palliative issues begin to arise. Our inpatient wards can look after patients who continue palliative radiotherapy to control cancers while beginning to address the patient’s wishes. Our day care can rehabilitate patients with very advanced chronic diseases to live their lives fully with their families, as normally and as long as possible. Our home care team addresses pain, discomfort and other issues in patients’ own homes. The physical proximity and setup of the ICH has changed the game for this care."

Extending palliative care to more homes and non-cancer patients

To help more Singaporeans fulfil their wishes to pass on in the comfort of their own homes, Dover Park Hospice is expanding its home care service to serve more patients island-wide in April 2024.

With increased life expectancy and higher incidence of chronic illnesses amongst Singaporeans, Dover Park Hospice has broadened its care beyond cancer patients to serve the non-cancer group: Programme Dignity in 2014, the first home care programme for people with advanced dementia, Programme IMPACT (Integrated Management and Palliative Care for Terminally-ill Non-Cancer) for people with end-stage organ failure (heart and kidney) in 2020 and the R.I.S.E (Restitutive. Integrative. Supportive. Empowering) programme in 2021 for people with advanced lung diseases. These programmes provide support and care for patients to be cared for at home, enhancing their quality of life and optimising their ability to lead a meaningful and dignified life till the end.

Caregivers a key focus at ICH

Most of the patients going home from ICH will require some form of care at home, and the TTSH team is enabling caregivers to learn skills and approaches to better care for their loved ones, and ensure a more comfortable and meaningful life for patients at home after discharge.

Care at the ICH steps up a patient’s recovery phase from an acute illness. Patients are empowered to take advantage of the purpose-built facilities and care protocols to keep active safely throughout their stay and start getting ready to go home.

The aim of helping all patients go home better is exemplified by dementia care excellence in ICH’s dementia ward, where the care team has implemented a multi-sensory intervention programme called Namaste Care. Approaches include creating a calm environment by incorporating familiar scents and home-like elements, and providing interactions such as hand massage, hair combing, and going through photos of places and items from the past.

The programme has shown to increase responsiveness by up to 50%¹, reduce rejection of care, and increase quality of life amongst patients by about 17%². Family caregivers have expressed closer relationships with their loved ones after participating in the therapy, and looked forward to emulating the sensory-based care at home. Staff in the ward have likewise found that the programme has enabled them to connect better with their patients.

Achieving another milestone in building better health for generations

"ICH creates the best enabling environment and protocols to step up what is traditionally considered step-down care," says Dr Lee Liang Tee​, Clinical Director for the ICH. "We leverage purpose-built rehabilitation facilities, personalised treatment plans, and innovative technology to help patients recover faster, regain their mobility and independence, and return to their lives at home and in the community with renewed meaning, purpose and confidence."