Spending one’s final moments at home is a simple wish, but the coordination required is complex, and existing processes often fall short. To fulfil patients’ wishes of dying at home, HCA Hospice developed a national compassionate discharge framework and is the only organisation that offers round-the-clock facilitation.
Not long ago, the way end-of-life care was handled often meant spending one’s final days in a hospital, often without choice. Many families were unaware of compassionate discharge, a process that allows terminally ill patients to return home for their final journey. Dying at home surrounded by loved ones in a familiar space was often out of reach.
Since its founding, HCA Hospice has been an advocate for home hospice care, supporting patients’ requests to spend final moments on their terms and in their own space. By facilitating compassionate discharges with hospital colleagues for suitable patients with a prognosis of less than a week, HCA ensures they can pass on in comfort and dignity, where they feel most at peace.
A CHALLENGING HISTORY
Not without its challenges, the compassionate discharge journey is a delicate, time-sensitive process requiring meticulous coordination. It demands a collective effort from hospital care teams, HCA staff and families. Some patients have only hours to live, making swift implementation critical. Yet, without standardised procedures across institutions, inconsistencies and gaps in care were common.
“The lack of a structured process puts immense strain on the team and diverts time from ongoing patient care,” said HCA Head of Data, Innovation and Research Yeo Zhi Zheng, who oversaw the development of the compassionate discharge protocol. HCA staff, already stretched with daily home visits, often had to drop everything when any of these calls came in, especially urgent requests requiring immediate admissions and home visits.
Many hospital doctors were also unfamiliar with the process. “Each institution had their policies and procedures for medication procurement, discharge protocols, and caregiver training, leading to inconsistent care transitions,” Zhi Zheng added. As a result, families, emotionally and logistically unprepared, found themselves overwhelmed, sometimes readmitting loved ones into hospital.
Recognising these challenges, Zhi Zheng and his team made a bold move in 2019 to reform HCA’s compassionate discharge process. A doctor was assigned to liaise with hospitals via a dedicated telephone line, reducing the strain for individual nurses. However, limited resources meant the service was only available on weekdays. Patients who wished to return home on weekends or public holidays had to wait till the next workday, a distressing delay for those with limited time left.
A NEW HOPE
HCA believes that dying at home should be an option available to anybody at any moment. After extensive pilots and studies, HCA scaled up its compassionate discharge service in mid-2024 to operate seven days a week, including public holidays. Today, HCA is the only institution in Singapore that provides this level of support across the country.
To resolve inconsistencies among institutions, HCA collaborated with the Singapore Hospice Council and was approved by the Ministry of Health (MOH) to create a national compassionate discharge framework, which is now being applied in various healthcare settings. HCA Senior Resident Physician Dr Lyu Xiao Juan, who is overseeing compassionate discharge requests, recalls a case where an elderly patient’s discharge had to be delayed to a weekend due to complex care needs. “Our round-the-clock service ensured a smooth transition home even at weekends,” she shared. “It greatly reduces unnecessary waiting time for patients, especially when every hour counts.”
Now, HCA’s journey with patients begins even before they leave the hospital. A phone or video call with the hospital team and family bridges communication gaps and provides reassurance. Once the patients are home, HCA’s doctors, nurses, and medical social workers provide medical and psychosocial support, helping them ease concerns and find meaning in their last moments.
Each day, HCA facilitates an average of two compassionate discharge cases in Singapore, for a total of nearly 400 instances per year — more than half of the country’s burden. Within seven days of discharge, about 80 per cent of patients pass away, with HCA visiting them as much as two times during this critical period. Many take their last breath within hours of arriving home. To ensure that no family faces this moment alone, HCA prioritises same-day in-person visits. When immediate visits are not possible, video calls provide support, followed by a home visit the next morning. No matter the hour, help is just a call away through HCA’s 24-hour helpline.
THE JOURNEY AHEAD
MOH aims to reduce hospital deaths among those with life-limiting illnesses from 61 per cent to 51 per cent by 2026, with smoother compassionate discharges identified as a key priority in the refreshed National Strategy for Palliative Care. As demand grows, HCA remains committed to expanding its reach.
“HCA is at the forefront of this effort, working closely with different hospitals to optimise the process even more in terms of safety and consistency,” Zhi Zheng shared. “We are also exploring strengthening collaborations with emergency departments to support patients assessed to be terminal after having presented there, post work-up and stabilisation, and who have expressed wishes to die at home.”
As medicine advances and end-of-life needs evolve, home remains a sanctuary filled love and memories and the comfort of familiarity. HCA will continue striving to journey alongside families throughout, ensuring any final wish to return home is always duly fulfilled.