As the Republic of China celebrates Double Ten National Day today, elsewhere around the globe World Hospice and Palliative Care Day is being marked — at least by those involved in one of the most important, yet undervalued, components of medical care.
Few among the general public probably know about it. That could be because World Hospice and Palliative Care Day, which takes place on the second Saturday of October every year and is organized by the Worldwide Palliative Care Alliance committee, is less than a decade old.
It is billed as a day to celebrate and support hospice and palliative care. It is a day worth noting in Taiwan, as earlier this week the Economist Intelligence Unit (EIU) announced that its “2015 Quality of Death Index” ranked the nation the sixth-best place in the world to die, but the best place in Asia.
The ranking of 90 nations was based on hospital/hospice environments, staff numbers and training, affordability of care, and public involvement in palliative care. The EIU said that Taiwan is one of the few nations to have a hospice palliative care system.
However, given the warnings by the Taiwan Healthcare Reform Foundation and others about a shortage of hospice services in hospitals and health centers, and the usual massive urban/rural, city/county gaps that impact so many social issues in Taiwan, it appears that the EIU’s ranking must be treated with some skepticism.
While the National Health Insurance (NHI) program does promote palliative care and the Ministry of Health and Welfare has done a lot to promote hospice care, efforts to create a nationwide palliative care and hospice network are not moving as fast as necessary.
According to foundation officials, of the nation’s 27 ministry-affiliated hospitals, only three have palliative care beds, while nine of the nation’s 50 “sub-medical regions” lack palliative care, hospice beds and home care options.
Yet the demand for such care has skyrocketed in the past 15 years, especially among cancer patients. A senior Health Promotion Administration official recently said that 50 percent of terminally ill cancer patients received palliative care services as of 2012, compared with just 7 percent in 2000.
A survey conducted by the foundation in December last year found that almost 86 percent of respondents said that if terminally ill, they would prefer hospice care rather than being kept alive in pain in a hospital for a prolonged period of time, while the Taiwan Hospice Organization said about 300,000 people have registered with the NHI to have their preference for hospice palliative care instead of efforts to keep them alive noted on their NHI cards.
Right now, whether people actually end up having that choice depends on where they live. That is wrong.
While the ministry and other organizations are encouraging people to be more proactive by discussing Advance Care Planning directives with their doctors and family members, and having palliative care preferences noted on their NHI cards, the government and society must do more to ensure there are enough facilities and trained staff to meet current demand and projected future needs.
The public must also recognize that hospice and palliative care is not just about dying. It is about living with improved quality of life and reduced suffering, whether one is terminally ill or suffering from a life-limiting condition. It requires addressing not just the patient’s physical and medical requirements, but their psychological needs, as well as providing support for the patient’s family members and caregivers.
Given the rate at which the nation is becoming a super-aged society, these are issues that need to be addressed as comprehensively and as speedily as possible, from the top down and the bottom up.
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