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Written by: Comment Editor
2019-12-16 18:10
Last updated: 2019-12-16 18:11Ke Wenzhe, Taiwan's first full-time emergency and intensive care doctor, and Taipei Mayor Ke Wenzhe had a silent life and death: "There are two kinds of endings in life, one with throat insertion, and one without." It's not so easy.
The public consultation on advance medical directives and the death of the dwelling, which started in September, ended on Monday (16th), including the legal effect and form of advance directives, and whether it is necessary to amend the law to facilitate the death of residents in the elderly home. The only survey found that more than half of the citizens were not sure that they would be able to "finally die", and about half were unclear about the late care.
At the end of life, "good end" requires not only drugs and coffins, but also spiritual comfort and support from relatives and friends in the face of pain and fear of death. A survey commissioned by the United Hong Kong Foundation and commissioned by the Hong Kong Institute of Asia-Pacific Studies of the Chinese University of Hong Kong found that 86% of the respondents expect to end up in the community rather than the hospital. More than half of them hope to receive support from relatives and friends outside the treatment, but as many as 55% of them "Slightly unconfident," "unconfident," "very unconfident," or "don't know."
More than 96% of patients aged 65 and over died at the hospital, and about 40% of patients who died in the hospital lived in nursing homes, residential care homes or nursing homes. (Profile picture)
Hospitals are not necessarily the "end point"
In addition, Hong Kong people's awareness of advanced care has also stayed in the hospital. 77% of the respondents did not know where to provide advanced care services, and only 58% and 44% of them understood that advanced care services were not only "puerperal assistance". Includes "counseling" and "social support".
To keep patients in the community is to let them go through the last part of their lives in the place of their choice, such as in a familiar place such as at home, an elderly home or a nursing home, rather than looking up at the white lantern in the hospital. Although more than 80% of the citizens have this wish, things go against their wishes, and 96% of the elderly in Hong Kong are unable to do so. According to a report from the Jockey Club School of Public Health and Primary Medical Care, it is quite common for elderly residents in elderly homes to die in hospitals. More than 96% of patients aged 65 and over died in the hospital, and among those who died in the hospital, About 40% live in nursing homes, homes for the elderly or nursing homes.
At present, due to the legal requirements, the procedures for handling the natural deaths of elderly people are more complicated. As a result, most of the elderly homes tend to send the elderly to the Accident and Emergency Department, making it difficult for the elderly in the elderly to die at their place of residence. According to the Coroners Ordinance, if a patient dies naturally in an elderly home, the case must be reported to the coroner by the police. The police and forensic doctors will even conduct investigations and autopsies when necessary. The government launched a public consultation in September and plans to streamline procedures to facilitate homes to handle natural deaths and give patients other hospice options besides hospitals.
Comprehensive hospice care should be supported by hospitals, residential care homes and the community. (Profile picture)
Indispensable for the elderly
However, the government has amended legislation to abolish the reporting requirements for natural deaths. At the same time, it must improve the supervision of homes for the elderly and protect the rights and interests of the elderly. In the past, the service quality of individual private homes was mixed. The small ones treated the elderly badly, while the large ones were disorderly. The industry repeatedly reported scandals. For example, the media reported earlier that the elderly were tied to the hands and feet. The Ombudsman's Office also criticized last year that the Elderly Homes Ordinance and the Elderly Homes Regulations are backward, and serious violations have not been covered. As of the past four years before 2019, the SWD ’s number of cards "Keep clean body". The role of elderly homes in hospice care for the elderly is crucial, but social supervision is limited. The elderly homes are not afraid to violate regulations, and the government must strengthen supervision.
Comprehensive hospice care should be supported by hospitals, residential care homes and the community. If the responsibilities of the advanced care services are entirely passed on to either party, the burden on the current medical and social welfare system will be exacerbated. However, Hong Kong is limited by the shortage of medical and social welfare staff, and the elderly's desire to die in the community cannot be realized immediately. Huang Yuanshan, the head of the United Hong Kong Fund Policy Research Institute, said bluntly that the public hospital system is overloaded and public health care is urgently needed to connect with community health care. However, the current community medical resources are insufficient and Hong Kong has to build a community health care system from almost nothing.
In the short term, the government can make preparations for the establishment of advanced care services, including the role of coordinating the integration of "medical-social cooperation" resources. At present, the authority and responsibility of the Hospital Authority and the Department of Health in hospice services are unclear, such as providing elderly health services and forensic services. However, the Hospital Authority is also responsible for managing public hospitals in Hong Kong and related medical services. Coordination at the end of the day, to avoid joint responsibility into mutual responsibility. In the long run, the government must support medical personnel training.
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