Dr James Luk Consultant (Geriatrics) FYKH - hkag.org ppt/S4-4_LUK.pdf · No person shall remove a...
Transcript of Dr James Luk Consultant (Geriatrics) FYKH - hkag.org ppt/S4-4_LUK.pdf · No person shall remove a...
Dr James Luk
Consultant (Geriatrics) FYKH
EOL care for older people
Good end-of-life (EOL) care is important in the management of patients with irreversible diseases besides cancer
Advanced dementia
Chronic lung disease
Chronic heart disease
End stage renal failure
Parkinsons disease etc
2
The dream for ldquogood deathrdquo Two important elements
To have choice and control over where death occurs (at home or elsewhere)
To have control over who is present and who shares the end
3
Reality - Patient Journey in HK
Elderly with irreversible chronic disease
(Living at home or RCHE)
AED
QMH General Medical Ward
Die in
acute
hospital
(often not
a ldquogood
deathrdquo)
Blood taking CT X ray IV
drip RT Foley pressure
sore unfamiliar
environment delirium
iatrogensis family difficult to
visit Med students Blood taking
unfamiliar crowded
environment IV drip
X ray strangers etc
Why 4
Obstacles for dying in place in HK
Social taboo
Depreciation of property price if die at home
RCHEs dislike people to die there
Lack of necessary medical support
Lack of systematical study of the preferences and attitudes of our elderly population
Lack of training and education to RCHE staff
Lack of government policy support
Lack of death education
Legal obstacles
5
Dying at home in HK Not a reportable death if die at home a registered
practitioner filled in Medical Certificate of the Cause of Death (Form 18) ndash available in offices of Registrar of Births and Deaths (RBampD) with serial numbers Every registered doctor can obtain one book (like cheque book)
There is a legal requirement to register a death within 24 hours
Doctor must have seen the patient within 14 days - (does not apply to cases with terminal conditions)
6
Death Registration Deaths can be registered on weekdays and Saturday mornings
at Hong Kong Island Deaths Registry or Kowloon Deaths Registry
On Sundays and General Holidays can approach the Births and Deaths General Register Office from 10 am to 1230 pm for service
After registration the Certificate of Death (Form 12) will be issued
Death registration also available in some designated police stations in the New Territories such as Cheung Chau and Mui Wo for deaths that occurred in the respective districts
7
Transporting a dead body Medical Certificate of the Cause of Death (Form 18) is not a
sufficient document for transporting a dead body
No person shall lsquoremoversquo a dead body unless you have obtained either
(1) the Certificate of Death (Form 12)
OR (2) in urgent cases a permit from the nearest police station
Any person who does not conform with this provision is liable on summary conviction to a fine level of 1 or to imprisonment for 6 months
8
RCHEs in HK 2 different types of registration
Nursing Home (NH) registered under the Hospitals Nursing
Homes and Maternity Homes Registration Ordinance (Cap 165)
Hostels Care and attention homes (CampA) and private RCHEs are registered under the Residential Care Homes Ordinance (Cap 459)
9
Section 4 Coroner Ordinance
According to the Section 4 Coroner Ordinance (CAP 504) ndashldquoit is a reportable death of a person where the death occurred in any premises in which the care of persons is carried on for reward or other financial consideration (other than in any premises which comprise a hospital nursing home or maternity home registered under the Hospitals Nursing Homes and Maternity Homes Registration Ordinance (Cap 165))rdquo
10
Hence it is a reportable death if it occurs in RCHEs where the residents need to pay a certain fee
Even in care and attention (CampA) homes run by non-government organization (NGO) the residents still need to pay a certain sum of money to the CampA homes
Reporting of Coroners cases are mandatory
Failure to report can be subject to a fine andor imprisonment (2 weeks)
11
Consequence of reportable deaths at home or RCHEs
Reporting to the Coroner will involve reporting to the police and a police report would have to be made
The body will then need to be certified dead before it is transported to the public mortuary
Police will then inform the next-of-kin the place and time for an interview with the forensic pathologist
Interval between death and interview varies but may be as early as within 24 hrs to several days
12
The disadvantages of current practice of sending all advanced dementia patients to hospital for EOL care
Huge burden to hospital system
Inappropriate use of acute hospital services
Unnecessary transport of ill elderly to die in an unfamiliar environment
Difficulty of acute ward staff to handle family bereavement
Difficult in offering a ldquogood deathrdquo in the acute medical wards
Lack of choice for the elderly and his family
It is not in line with the concept of aging in place and continuity of care
13
Dying in hospital not the only choice
In Singapore performed a retrospective study
10399 decedents aged gt65 years in 2006 were examined
31 of elderly passed away at home
(Beng et al 2009) 14
JOINT PROTOCOL FOR EXPECTED PLANNED HOME DEATHS IN BRITISH COLUMBIA
A dream comes truehellip
December 2006
httpwwwhealthgovbccahccpdfexpected_home_deathpdf
15
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
EOL care for older people
Good end-of-life (EOL) care is important in the management of patients with irreversible diseases besides cancer
Advanced dementia
Chronic lung disease
Chronic heart disease
End stage renal failure
Parkinsons disease etc
2
The dream for ldquogood deathrdquo Two important elements
To have choice and control over where death occurs (at home or elsewhere)
To have control over who is present and who shares the end
3
Reality - Patient Journey in HK
Elderly with irreversible chronic disease
(Living at home or RCHE)
AED
QMH General Medical Ward
Die in
acute
hospital
(often not
a ldquogood
deathrdquo)
Blood taking CT X ray IV
drip RT Foley pressure
sore unfamiliar
environment delirium
iatrogensis family difficult to
visit Med students Blood taking
unfamiliar crowded
environment IV drip
X ray strangers etc
Why 4
Obstacles for dying in place in HK
Social taboo
Depreciation of property price if die at home
RCHEs dislike people to die there
Lack of necessary medical support
Lack of systematical study of the preferences and attitudes of our elderly population
Lack of training and education to RCHE staff
Lack of government policy support
Lack of death education
Legal obstacles
5
Dying at home in HK Not a reportable death if die at home a registered
practitioner filled in Medical Certificate of the Cause of Death (Form 18) ndash available in offices of Registrar of Births and Deaths (RBampD) with serial numbers Every registered doctor can obtain one book (like cheque book)
There is a legal requirement to register a death within 24 hours
Doctor must have seen the patient within 14 days - (does not apply to cases with terminal conditions)
6
Death Registration Deaths can be registered on weekdays and Saturday mornings
at Hong Kong Island Deaths Registry or Kowloon Deaths Registry
On Sundays and General Holidays can approach the Births and Deaths General Register Office from 10 am to 1230 pm for service
After registration the Certificate of Death (Form 12) will be issued
Death registration also available in some designated police stations in the New Territories such as Cheung Chau and Mui Wo for deaths that occurred in the respective districts
7
Transporting a dead body Medical Certificate of the Cause of Death (Form 18) is not a
sufficient document for transporting a dead body
No person shall lsquoremoversquo a dead body unless you have obtained either
(1) the Certificate of Death (Form 12)
OR (2) in urgent cases a permit from the nearest police station
Any person who does not conform with this provision is liable on summary conviction to a fine level of 1 or to imprisonment for 6 months
8
RCHEs in HK 2 different types of registration
Nursing Home (NH) registered under the Hospitals Nursing
Homes and Maternity Homes Registration Ordinance (Cap 165)
Hostels Care and attention homes (CampA) and private RCHEs are registered under the Residential Care Homes Ordinance (Cap 459)
9
Section 4 Coroner Ordinance
According to the Section 4 Coroner Ordinance (CAP 504) ndashldquoit is a reportable death of a person where the death occurred in any premises in which the care of persons is carried on for reward or other financial consideration (other than in any premises which comprise a hospital nursing home or maternity home registered under the Hospitals Nursing Homes and Maternity Homes Registration Ordinance (Cap 165))rdquo
10
Hence it is a reportable death if it occurs in RCHEs where the residents need to pay a certain fee
Even in care and attention (CampA) homes run by non-government organization (NGO) the residents still need to pay a certain sum of money to the CampA homes
Reporting of Coroners cases are mandatory
Failure to report can be subject to a fine andor imprisonment (2 weeks)
11
Consequence of reportable deaths at home or RCHEs
Reporting to the Coroner will involve reporting to the police and a police report would have to be made
The body will then need to be certified dead before it is transported to the public mortuary
Police will then inform the next-of-kin the place and time for an interview with the forensic pathologist
Interval between death and interview varies but may be as early as within 24 hrs to several days
12
The disadvantages of current practice of sending all advanced dementia patients to hospital for EOL care
Huge burden to hospital system
Inappropriate use of acute hospital services
Unnecessary transport of ill elderly to die in an unfamiliar environment
Difficulty of acute ward staff to handle family bereavement
Difficult in offering a ldquogood deathrdquo in the acute medical wards
Lack of choice for the elderly and his family
It is not in line with the concept of aging in place and continuity of care
13
Dying in hospital not the only choice
In Singapore performed a retrospective study
10399 decedents aged gt65 years in 2006 were examined
31 of elderly passed away at home
(Beng et al 2009) 14
JOINT PROTOCOL FOR EXPECTED PLANNED HOME DEATHS IN BRITISH COLUMBIA
A dream comes truehellip
December 2006
httpwwwhealthgovbccahccpdfexpected_home_deathpdf
15
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
The dream for ldquogood deathrdquo Two important elements
To have choice and control over where death occurs (at home or elsewhere)
To have control over who is present and who shares the end
3
Reality - Patient Journey in HK
Elderly with irreversible chronic disease
(Living at home or RCHE)
AED
QMH General Medical Ward
Die in
acute
hospital
(often not
a ldquogood
deathrdquo)
Blood taking CT X ray IV
drip RT Foley pressure
sore unfamiliar
environment delirium
iatrogensis family difficult to
visit Med students Blood taking
unfamiliar crowded
environment IV drip
X ray strangers etc
Why 4
Obstacles for dying in place in HK
Social taboo
Depreciation of property price if die at home
RCHEs dislike people to die there
Lack of necessary medical support
Lack of systematical study of the preferences and attitudes of our elderly population
Lack of training and education to RCHE staff
Lack of government policy support
Lack of death education
Legal obstacles
5
Dying at home in HK Not a reportable death if die at home a registered
practitioner filled in Medical Certificate of the Cause of Death (Form 18) ndash available in offices of Registrar of Births and Deaths (RBampD) with serial numbers Every registered doctor can obtain one book (like cheque book)
There is a legal requirement to register a death within 24 hours
Doctor must have seen the patient within 14 days - (does not apply to cases with terminal conditions)
6
Death Registration Deaths can be registered on weekdays and Saturday mornings
at Hong Kong Island Deaths Registry or Kowloon Deaths Registry
On Sundays and General Holidays can approach the Births and Deaths General Register Office from 10 am to 1230 pm for service
After registration the Certificate of Death (Form 12) will be issued
Death registration also available in some designated police stations in the New Territories such as Cheung Chau and Mui Wo for deaths that occurred in the respective districts
7
Transporting a dead body Medical Certificate of the Cause of Death (Form 18) is not a
sufficient document for transporting a dead body
No person shall lsquoremoversquo a dead body unless you have obtained either
(1) the Certificate of Death (Form 12)
OR (2) in urgent cases a permit from the nearest police station
Any person who does not conform with this provision is liable on summary conviction to a fine level of 1 or to imprisonment for 6 months
8
RCHEs in HK 2 different types of registration
Nursing Home (NH) registered under the Hospitals Nursing
Homes and Maternity Homes Registration Ordinance (Cap 165)
Hostels Care and attention homes (CampA) and private RCHEs are registered under the Residential Care Homes Ordinance (Cap 459)
9
Section 4 Coroner Ordinance
According to the Section 4 Coroner Ordinance (CAP 504) ndashldquoit is a reportable death of a person where the death occurred in any premises in which the care of persons is carried on for reward or other financial consideration (other than in any premises which comprise a hospital nursing home or maternity home registered under the Hospitals Nursing Homes and Maternity Homes Registration Ordinance (Cap 165))rdquo
10
Hence it is a reportable death if it occurs in RCHEs where the residents need to pay a certain fee
Even in care and attention (CampA) homes run by non-government organization (NGO) the residents still need to pay a certain sum of money to the CampA homes
Reporting of Coroners cases are mandatory
Failure to report can be subject to a fine andor imprisonment (2 weeks)
11
Consequence of reportable deaths at home or RCHEs
Reporting to the Coroner will involve reporting to the police and a police report would have to be made
The body will then need to be certified dead before it is transported to the public mortuary
Police will then inform the next-of-kin the place and time for an interview with the forensic pathologist
Interval between death and interview varies but may be as early as within 24 hrs to several days
12
The disadvantages of current practice of sending all advanced dementia patients to hospital for EOL care
Huge burden to hospital system
Inappropriate use of acute hospital services
Unnecessary transport of ill elderly to die in an unfamiliar environment
Difficulty of acute ward staff to handle family bereavement
Difficult in offering a ldquogood deathrdquo in the acute medical wards
Lack of choice for the elderly and his family
It is not in line with the concept of aging in place and continuity of care
13
Dying in hospital not the only choice
In Singapore performed a retrospective study
10399 decedents aged gt65 years in 2006 were examined
31 of elderly passed away at home
(Beng et al 2009) 14
JOINT PROTOCOL FOR EXPECTED PLANNED HOME DEATHS IN BRITISH COLUMBIA
A dream comes truehellip
December 2006
httpwwwhealthgovbccahccpdfexpected_home_deathpdf
15
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Reality - Patient Journey in HK
Elderly with irreversible chronic disease
(Living at home or RCHE)
AED
QMH General Medical Ward
Die in
acute
hospital
(often not
a ldquogood
deathrdquo)
Blood taking CT X ray IV
drip RT Foley pressure
sore unfamiliar
environment delirium
iatrogensis family difficult to
visit Med students Blood taking
unfamiliar crowded
environment IV drip
X ray strangers etc
Why 4
Obstacles for dying in place in HK
Social taboo
Depreciation of property price if die at home
RCHEs dislike people to die there
Lack of necessary medical support
Lack of systematical study of the preferences and attitudes of our elderly population
Lack of training and education to RCHE staff
Lack of government policy support
Lack of death education
Legal obstacles
5
Dying at home in HK Not a reportable death if die at home a registered
practitioner filled in Medical Certificate of the Cause of Death (Form 18) ndash available in offices of Registrar of Births and Deaths (RBampD) with serial numbers Every registered doctor can obtain one book (like cheque book)
There is a legal requirement to register a death within 24 hours
Doctor must have seen the patient within 14 days - (does not apply to cases with terminal conditions)
6
Death Registration Deaths can be registered on weekdays and Saturday mornings
at Hong Kong Island Deaths Registry or Kowloon Deaths Registry
On Sundays and General Holidays can approach the Births and Deaths General Register Office from 10 am to 1230 pm for service
After registration the Certificate of Death (Form 12) will be issued
Death registration also available in some designated police stations in the New Territories such as Cheung Chau and Mui Wo for deaths that occurred in the respective districts
7
Transporting a dead body Medical Certificate of the Cause of Death (Form 18) is not a
sufficient document for transporting a dead body
No person shall lsquoremoversquo a dead body unless you have obtained either
(1) the Certificate of Death (Form 12)
OR (2) in urgent cases a permit from the nearest police station
Any person who does not conform with this provision is liable on summary conviction to a fine level of 1 or to imprisonment for 6 months
8
RCHEs in HK 2 different types of registration
Nursing Home (NH) registered under the Hospitals Nursing
Homes and Maternity Homes Registration Ordinance (Cap 165)
Hostels Care and attention homes (CampA) and private RCHEs are registered under the Residential Care Homes Ordinance (Cap 459)
9
Section 4 Coroner Ordinance
According to the Section 4 Coroner Ordinance (CAP 504) ndashldquoit is a reportable death of a person where the death occurred in any premises in which the care of persons is carried on for reward or other financial consideration (other than in any premises which comprise a hospital nursing home or maternity home registered under the Hospitals Nursing Homes and Maternity Homes Registration Ordinance (Cap 165))rdquo
10
Hence it is a reportable death if it occurs in RCHEs where the residents need to pay a certain fee
Even in care and attention (CampA) homes run by non-government organization (NGO) the residents still need to pay a certain sum of money to the CampA homes
Reporting of Coroners cases are mandatory
Failure to report can be subject to a fine andor imprisonment (2 weeks)
11
Consequence of reportable deaths at home or RCHEs
Reporting to the Coroner will involve reporting to the police and a police report would have to be made
The body will then need to be certified dead before it is transported to the public mortuary
Police will then inform the next-of-kin the place and time for an interview with the forensic pathologist
Interval between death and interview varies but may be as early as within 24 hrs to several days
12
The disadvantages of current practice of sending all advanced dementia patients to hospital for EOL care
Huge burden to hospital system
Inappropriate use of acute hospital services
Unnecessary transport of ill elderly to die in an unfamiliar environment
Difficulty of acute ward staff to handle family bereavement
Difficult in offering a ldquogood deathrdquo in the acute medical wards
Lack of choice for the elderly and his family
It is not in line with the concept of aging in place and continuity of care
13
Dying in hospital not the only choice
In Singapore performed a retrospective study
10399 decedents aged gt65 years in 2006 were examined
31 of elderly passed away at home
(Beng et al 2009) 14
JOINT PROTOCOL FOR EXPECTED PLANNED HOME DEATHS IN BRITISH COLUMBIA
A dream comes truehellip
December 2006
httpwwwhealthgovbccahccpdfexpected_home_deathpdf
15
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Obstacles for dying in place in HK
Social taboo
Depreciation of property price if die at home
RCHEs dislike people to die there
Lack of necessary medical support
Lack of systematical study of the preferences and attitudes of our elderly population
Lack of training and education to RCHE staff
Lack of government policy support
Lack of death education
Legal obstacles
5
Dying at home in HK Not a reportable death if die at home a registered
practitioner filled in Medical Certificate of the Cause of Death (Form 18) ndash available in offices of Registrar of Births and Deaths (RBampD) with serial numbers Every registered doctor can obtain one book (like cheque book)
There is a legal requirement to register a death within 24 hours
Doctor must have seen the patient within 14 days - (does not apply to cases with terminal conditions)
6
Death Registration Deaths can be registered on weekdays and Saturday mornings
at Hong Kong Island Deaths Registry or Kowloon Deaths Registry
On Sundays and General Holidays can approach the Births and Deaths General Register Office from 10 am to 1230 pm for service
After registration the Certificate of Death (Form 12) will be issued
Death registration also available in some designated police stations in the New Territories such as Cheung Chau and Mui Wo for deaths that occurred in the respective districts
7
Transporting a dead body Medical Certificate of the Cause of Death (Form 18) is not a
sufficient document for transporting a dead body
No person shall lsquoremoversquo a dead body unless you have obtained either
(1) the Certificate of Death (Form 12)
OR (2) in urgent cases a permit from the nearest police station
Any person who does not conform with this provision is liable on summary conviction to a fine level of 1 or to imprisonment for 6 months
8
RCHEs in HK 2 different types of registration
Nursing Home (NH) registered under the Hospitals Nursing
Homes and Maternity Homes Registration Ordinance (Cap 165)
Hostels Care and attention homes (CampA) and private RCHEs are registered under the Residential Care Homes Ordinance (Cap 459)
9
Section 4 Coroner Ordinance
According to the Section 4 Coroner Ordinance (CAP 504) ndashldquoit is a reportable death of a person where the death occurred in any premises in which the care of persons is carried on for reward or other financial consideration (other than in any premises which comprise a hospital nursing home or maternity home registered under the Hospitals Nursing Homes and Maternity Homes Registration Ordinance (Cap 165))rdquo
10
Hence it is a reportable death if it occurs in RCHEs where the residents need to pay a certain fee
Even in care and attention (CampA) homes run by non-government organization (NGO) the residents still need to pay a certain sum of money to the CampA homes
Reporting of Coroners cases are mandatory
Failure to report can be subject to a fine andor imprisonment (2 weeks)
11
Consequence of reportable deaths at home or RCHEs
Reporting to the Coroner will involve reporting to the police and a police report would have to be made
The body will then need to be certified dead before it is transported to the public mortuary
Police will then inform the next-of-kin the place and time for an interview with the forensic pathologist
Interval between death and interview varies but may be as early as within 24 hrs to several days
12
The disadvantages of current practice of sending all advanced dementia patients to hospital for EOL care
Huge burden to hospital system
Inappropriate use of acute hospital services
Unnecessary transport of ill elderly to die in an unfamiliar environment
Difficulty of acute ward staff to handle family bereavement
Difficult in offering a ldquogood deathrdquo in the acute medical wards
Lack of choice for the elderly and his family
It is not in line with the concept of aging in place and continuity of care
13
Dying in hospital not the only choice
In Singapore performed a retrospective study
10399 decedents aged gt65 years in 2006 were examined
31 of elderly passed away at home
(Beng et al 2009) 14
JOINT PROTOCOL FOR EXPECTED PLANNED HOME DEATHS IN BRITISH COLUMBIA
A dream comes truehellip
December 2006
httpwwwhealthgovbccahccpdfexpected_home_deathpdf
15
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Dying at home in HK Not a reportable death if die at home a registered
practitioner filled in Medical Certificate of the Cause of Death (Form 18) ndash available in offices of Registrar of Births and Deaths (RBampD) with serial numbers Every registered doctor can obtain one book (like cheque book)
There is a legal requirement to register a death within 24 hours
Doctor must have seen the patient within 14 days - (does not apply to cases with terminal conditions)
6
Death Registration Deaths can be registered on weekdays and Saturday mornings
at Hong Kong Island Deaths Registry or Kowloon Deaths Registry
On Sundays and General Holidays can approach the Births and Deaths General Register Office from 10 am to 1230 pm for service
After registration the Certificate of Death (Form 12) will be issued
Death registration also available in some designated police stations in the New Territories such as Cheung Chau and Mui Wo for deaths that occurred in the respective districts
7
Transporting a dead body Medical Certificate of the Cause of Death (Form 18) is not a
sufficient document for transporting a dead body
No person shall lsquoremoversquo a dead body unless you have obtained either
(1) the Certificate of Death (Form 12)
OR (2) in urgent cases a permit from the nearest police station
Any person who does not conform with this provision is liable on summary conviction to a fine level of 1 or to imprisonment for 6 months
8
RCHEs in HK 2 different types of registration
Nursing Home (NH) registered under the Hospitals Nursing
Homes and Maternity Homes Registration Ordinance (Cap 165)
Hostels Care and attention homes (CampA) and private RCHEs are registered under the Residential Care Homes Ordinance (Cap 459)
9
Section 4 Coroner Ordinance
According to the Section 4 Coroner Ordinance (CAP 504) ndashldquoit is a reportable death of a person where the death occurred in any premises in which the care of persons is carried on for reward or other financial consideration (other than in any premises which comprise a hospital nursing home or maternity home registered under the Hospitals Nursing Homes and Maternity Homes Registration Ordinance (Cap 165))rdquo
10
Hence it is a reportable death if it occurs in RCHEs where the residents need to pay a certain fee
Even in care and attention (CampA) homes run by non-government organization (NGO) the residents still need to pay a certain sum of money to the CampA homes
Reporting of Coroners cases are mandatory
Failure to report can be subject to a fine andor imprisonment (2 weeks)
11
Consequence of reportable deaths at home or RCHEs
Reporting to the Coroner will involve reporting to the police and a police report would have to be made
The body will then need to be certified dead before it is transported to the public mortuary
Police will then inform the next-of-kin the place and time for an interview with the forensic pathologist
Interval between death and interview varies but may be as early as within 24 hrs to several days
12
The disadvantages of current practice of sending all advanced dementia patients to hospital for EOL care
Huge burden to hospital system
Inappropriate use of acute hospital services
Unnecessary transport of ill elderly to die in an unfamiliar environment
Difficulty of acute ward staff to handle family bereavement
Difficult in offering a ldquogood deathrdquo in the acute medical wards
Lack of choice for the elderly and his family
It is not in line with the concept of aging in place and continuity of care
13
Dying in hospital not the only choice
In Singapore performed a retrospective study
10399 decedents aged gt65 years in 2006 were examined
31 of elderly passed away at home
(Beng et al 2009) 14
JOINT PROTOCOL FOR EXPECTED PLANNED HOME DEATHS IN BRITISH COLUMBIA
A dream comes truehellip
December 2006
httpwwwhealthgovbccahccpdfexpected_home_deathpdf
15
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Death Registration Deaths can be registered on weekdays and Saturday mornings
at Hong Kong Island Deaths Registry or Kowloon Deaths Registry
On Sundays and General Holidays can approach the Births and Deaths General Register Office from 10 am to 1230 pm for service
After registration the Certificate of Death (Form 12) will be issued
Death registration also available in some designated police stations in the New Territories such as Cheung Chau and Mui Wo for deaths that occurred in the respective districts
7
Transporting a dead body Medical Certificate of the Cause of Death (Form 18) is not a
sufficient document for transporting a dead body
No person shall lsquoremoversquo a dead body unless you have obtained either
(1) the Certificate of Death (Form 12)
OR (2) in urgent cases a permit from the nearest police station
Any person who does not conform with this provision is liable on summary conviction to a fine level of 1 or to imprisonment for 6 months
8
RCHEs in HK 2 different types of registration
Nursing Home (NH) registered under the Hospitals Nursing
Homes and Maternity Homes Registration Ordinance (Cap 165)
Hostels Care and attention homes (CampA) and private RCHEs are registered under the Residential Care Homes Ordinance (Cap 459)
9
Section 4 Coroner Ordinance
According to the Section 4 Coroner Ordinance (CAP 504) ndashldquoit is a reportable death of a person where the death occurred in any premises in which the care of persons is carried on for reward or other financial consideration (other than in any premises which comprise a hospital nursing home or maternity home registered under the Hospitals Nursing Homes and Maternity Homes Registration Ordinance (Cap 165))rdquo
10
Hence it is a reportable death if it occurs in RCHEs where the residents need to pay a certain fee
Even in care and attention (CampA) homes run by non-government organization (NGO) the residents still need to pay a certain sum of money to the CampA homes
Reporting of Coroners cases are mandatory
Failure to report can be subject to a fine andor imprisonment (2 weeks)
11
Consequence of reportable deaths at home or RCHEs
Reporting to the Coroner will involve reporting to the police and a police report would have to be made
The body will then need to be certified dead before it is transported to the public mortuary
Police will then inform the next-of-kin the place and time for an interview with the forensic pathologist
Interval between death and interview varies but may be as early as within 24 hrs to several days
12
The disadvantages of current practice of sending all advanced dementia patients to hospital for EOL care
Huge burden to hospital system
Inappropriate use of acute hospital services
Unnecessary transport of ill elderly to die in an unfamiliar environment
Difficulty of acute ward staff to handle family bereavement
Difficult in offering a ldquogood deathrdquo in the acute medical wards
Lack of choice for the elderly and his family
It is not in line with the concept of aging in place and continuity of care
13
Dying in hospital not the only choice
In Singapore performed a retrospective study
10399 decedents aged gt65 years in 2006 were examined
31 of elderly passed away at home
(Beng et al 2009) 14
JOINT PROTOCOL FOR EXPECTED PLANNED HOME DEATHS IN BRITISH COLUMBIA
A dream comes truehellip
December 2006
httpwwwhealthgovbccahccpdfexpected_home_deathpdf
15
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Transporting a dead body Medical Certificate of the Cause of Death (Form 18) is not a
sufficient document for transporting a dead body
No person shall lsquoremoversquo a dead body unless you have obtained either
(1) the Certificate of Death (Form 12)
OR (2) in urgent cases a permit from the nearest police station
Any person who does not conform with this provision is liable on summary conviction to a fine level of 1 or to imprisonment for 6 months
8
RCHEs in HK 2 different types of registration
Nursing Home (NH) registered under the Hospitals Nursing
Homes and Maternity Homes Registration Ordinance (Cap 165)
Hostels Care and attention homes (CampA) and private RCHEs are registered under the Residential Care Homes Ordinance (Cap 459)
9
Section 4 Coroner Ordinance
According to the Section 4 Coroner Ordinance (CAP 504) ndashldquoit is a reportable death of a person where the death occurred in any premises in which the care of persons is carried on for reward or other financial consideration (other than in any premises which comprise a hospital nursing home or maternity home registered under the Hospitals Nursing Homes and Maternity Homes Registration Ordinance (Cap 165))rdquo
10
Hence it is a reportable death if it occurs in RCHEs where the residents need to pay a certain fee
Even in care and attention (CampA) homes run by non-government organization (NGO) the residents still need to pay a certain sum of money to the CampA homes
Reporting of Coroners cases are mandatory
Failure to report can be subject to a fine andor imprisonment (2 weeks)
11
Consequence of reportable deaths at home or RCHEs
Reporting to the Coroner will involve reporting to the police and a police report would have to be made
The body will then need to be certified dead before it is transported to the public mortuary
Police will then inform the next-of-kin the place and time for an interview with the forensic pathologist
Interval between death and interview varies but may be as early as within 24 hrs to several days
12
The disadvantages of current practice of sending all advanced dementia patients to hospital for EOL care
Huge burden to hospital system
Inappropriate use of acute hospital services
Unnecessary transport of ill elderly to die in an unfamiliar environment
Difficulty of acute ward staff to handle family bereavement
Difficult in offering a ldquogood deathrdquo in the acute medical wards
Lack of choice for the elderly and his family
It is not in line with the concept of aging in place and continuity of care
13
Dying in hospital not the only choice
In Singapore performed a retrospective study
10399 decedents aged gt65 years in 2006 were examined
31 of elderly passed away at home
(Beng et al 2009) 14
JOINT PROTOCOL FOR EXPECTED PLANNED HOME DEATHS IN BRITISH COLUMBIA
A dream comes truehellip
December 2006
httpwwwhealthgovbccahccpdfexpected_home_deathpdf
15
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
RCHEs in HK 2 different types of registration
Nursing Home (NH) registered under the Hospitals Nursing
Homes and Maternity Homes Registration Ordinance (Cap 165)
Hostels Care and attention homes (CampA) and private RCHEs are registered under the Residential Care Homes Ordinance (Cap 459)
9
Section 4 Coroner Ordinance
According to the Section 4 Coroner Ordinance (CAP 504) ndashldquoit is a reportable death of a person where the death occurred in any premises in which the care of persons is carried on for reward or other financial consideration (other than in any premises which comprise a hospital nursing home or maternity home registered under the Hospitals Nursing Homes and Maternity Homes Registration Ordinance (Cap 165))rdquo
10
Hence it is a reportable death if it occurs in RCHEs where the residents need to pay a certain fee
Even in care and attention (CampA) homes run by non-government organization (NGO) the residents still need to pay a certain sum of money to the CampA homes
Reporting of Coroners cases are mandatory
Failure to report can be subject to a fine andor imprisonment (2 weeks)
11
Consequence of reportable deaths at home or RCHEs
Reporting to the Coroner will involve reporting to the police and a police report would have to be made
The body will then need to be certified dead before it is transported to the public mortuary
Police will then inform the next-of-kin the place and time for an interview with the forensic pathologist
Interval between death and interview varies but may be as early as within 24 hrs to several days
12
The disadvantages of current practice of sending all advanced dementia patients to hospital for EOL care
Huge burden to hospital system
Inappropriate use of acute hospital services
Unnecessary transport of ill elderly to die in an unfamiliar environment
Difficulty of acute ward staff to handle family bereavement
Difficult in offering a ldquogood deathrdquo in the acute medical wards
Lack of choice for the elderly and his family
It is not in line with the concept of aging in place and continuity of care
13
Dying in hospital not the only choice
In Singapore performed a retrospective study
10399 decedents aged gt65 years in 2006 were examined
31 of elderly passed away at home
(Beng et al 2009) 14
JOINT PROTOCOL FOR EXPECTED PLANNED HOME DEATHS IN BRITISH COLUMBIA
A dream comes truehellip
December 2006
httpwwwhealthgovbccahccpdfexpected_home_deathpdf
15
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Section 4 Coroner Ordinance
According to the Section 4 Coroner Ordinance (CAP 504) ndashldquoit is a reportable death of a person where the death occurred in any premises in which the care of persons is carried on for reward or other financial consideration (other than in any premises which comprise a hospital nursing home or maternity home registered under the Hospitals Nursing Homes and Maternity Homes Registration Ordinance (Cap 165))rdquo
10
Hence it is a reportable death if it occurs in RCHEs where the residents need to pay a certain fee
Even in care and attention (CampA) homes run by non-government organization (NGO) the residents still need to pay a certain sum of money to the CampA homes
Reporting of Coroners cases are mandatory
Failure to report can be subject to a fine andor imprisonment (2 weeks)
11
Consequence of reportable deaths at home or RCHEs
Reporting to the Coroner will involve reporting to the police and a police report would have to be made
The body will then need to be certified dead before it is transported to the public mortuary
Police will then inform the next-of-kin the place and time for an interview with the forensic pathologist
Interval between death and interview varies but may be as early as within 24 hrs to several days
12
The disadvantages of current practice of sending all advanced dementia patients to hospital for EOL care
Huge burden to hospital system
Inappropriate use of acute hospital services
Unnecessary transport of ill elderly to die in an unfamiliar environment
Difficulty of acute ward staff to handle family bereavement
Difficult in offering a ldquogood deathrdquo in the acute medical wards
Lack of choice for the elderly and his family
It is not in line with the concept of aging in place and continuity of care
13
Dying in hospital not the only choice
In Singapore performed a retrospective study
10399 decedents aged gt65 years in 2006 were examined
31 of elderly passed away at home
(Beng et al 2009) 14
JOINT PROTOCOL FOR EXPECTED PLANNED HOME DEATHS IN BRITISH COLUMBIA
A dream comes truehellip
December 2006
httpwwwhealthgovbccahccpdfexpected_home_deathpdf
15
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Hence it is a reportable death if it occurs in RCHEs where the residents need to pay a certain fee
Even in care and attention (CampA) homes run by non-government organization (NGO) the residents still need to pay a certain sum of money to the CampA homes
Reporting of Coroners cases are mandatory
Failure to report can be subject to a fine andor imprisonment (2 weeks)
11
Consequence of reportable deaths at home or RCHEs
Reporting to the Coroner will involve reporting to the police and a police report would have to be made
The body will then need to be certified dead before it is transported to the public mortuary
Police will then inform the next-of-kin the place and time for an interview with the forensic pathologist
Interval between death and interview varies but may be as early as within 24 hrs to several days
12
The disadvantages of current practice of sending all advanced dementia patients to hospital for EOL care
Huge burden to hospital system
Inappropriate use of acute hospital services
Unnecessary transport of ill elderly to die in an unfamiliar environment
Difficulty of acute ward staff to handle family bereavement
Difficult in offering a ldquogood deathrdquo in the acute medical wards
Lack of choice for the elderly and his family
It is not in line with the concept of aging in place and continuity of care
13
Dying in hospital not the only choice
In Singapore performed a retrospective study
10399 decedents aged gt65 years in 2006 were examined
31 of elderly passed away at home
(Beng et al 2009) 14
JOINT PROTOCOL FOR EXPECTED PLANNED HOME DEATHS IN BRITISH COLUMBIA
A dream comes truehellip
December 2006
httpwwwhealthgovbccahccpdfexpected_home_deathpdf
15
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Consequence of reportable deaths at home or RCHEs
Reporting to the Coroner will involve reporting to the police and a police report would have to be made
The body will then need to be certified dead before it is transported to the public mortuary
Police will then inform the next-of-kin the place and time for an interview with the forensic pathologist
Interval between death and interview varies but may be as early as within 24 hrs to several days
12
The disadvantages of current practice of sending all advanced dementia patients to hospital for EOL care
Huge burden to hospital system
Inappropriate use of acute hospital services
Unnecessary transport of ill elderly to die in an unfamiliar environment
Difficulty of acute ward staff to handle family bereavement
Difficult in offering a ldquogood deathrdquo in the acute medical wards
Lack of choice for the elderly and his family
It is not in line with the concept of aging in place and continuity of care
13
Dying in hospital not the only choice
In Singapore performed a retrospective study
10399 decedents aged gt65 years in 2006 were examined
31 of elderly passed away at home
(Beng et al 2009) 14
JOINT PROTOCOL FOR EXPECTED PLANNED HOME DEATHS IN BRITISH COLUMBIA
A dream comes truehellip
December 2006
httpwwwhealthgovbccahccpdfexpected_home_deathpdf
15
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
The disadvantages of current practice of sending all advanced dementia patients to hospital for EOL care
Huge burden to hospital system
Inappropriate use of acute hospital services
Unnecessary transport of ill elderly to die in an unfamiliar environment
Difficulty of acute ward staff to handle family bereavement
Difficult in offering a ldquogood deathrdquo in the acute medical wards
Lack of choice for the elderly and his family
It is not in line with the concept of aging in place and continuity of care
13
Dying in hospital not the only choice
In Singapore performed a retrospective study
10399 decedents aged gt65 years in 2006 were examined
31 of elderly passed away at home
(Beng et al 2009) 14
JOINT PROTOCOL FOR EXPECTED PLANNED HOME DEATHS IN BRITISH COLUMBIA
A dream comes truehellip
December 2006
httpwwwhealthgovbccahccpdfexpected_home_deathpdf
15
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Dying in hospital not the only choice
In Singapore performed a retrospective study
10399 decedents aged gt65 years in 2006 were examined
31 of elderly passed away at home
(Beng et al 2009) 14
JOINT PROTOCOL FOR EXPECTED PLANNED HOME DEATHS IN BRITISH COLUMBIA
A dream comes truehellip
December 2006
httpwwwhealthgovbccahccpdfexpected_home_deathpdf
15
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
JOINT PROTOCOL FOR EXPECTED PLANNED HOME DEATHS IN BRITISH COLUMBIA
A dream comes truehellip
December 2006
httpwwwhealthgovbccahccpdfexpected_home_deathpdf
15
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
No need of death pronouncement at home in BC
Physician completed a Notification of Expected Death form verifies that
The death is a natural expected one The death is expected within the next days or few weeks
The family waits for at least 1 hour after breathing has
stopped then calls the funeral home directly to remove the body Family should not call 911 The physician agrees to be available to sign the Physicianrsquos
Medical Certification of Death within 48 hours of the time of death
16
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Taiwan
ldquoRush Back Homerdquo services
Terminal cases are allowed to send back home from palliative care hospital to die at home
17
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Elderly Wishes in HK RCHE residents
CampA homes in 2007 on advance directive - 288 wish to pass away in RCHE instead of hospital (Luk JKH Chu LW Chan FHW Sham
MMK Szeto Y Law PK)
Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong
35 would prefer to die in their nursing homes Chu LW Luk JK Hui E Chiu PK Chan CS Kwan F Kwok T Lee D Woo J
Am Med Dir Assoc 2011 Feb12(2)143-52
HOH Nursing Home A pioneer program - residents are allowed to pass away in the
nursing homes - nearly 30 of all deaths occur in the nursing home
18
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Dying in nursing home is not a new concept in many Western societies
Proportion of older people dying in RCHE
Belgium 28 (Van Rensbergen et al 2006)
UK 20 (Gomes amp Higginson 2008)
USA 20 (Iwashyna amp Chang 2002)
Australia 20 (Maddocks et al 1996)
Western Countries
19
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
End of Life Program in Residential Care Homes for the Elderly of HKWC ndash
a pilot project
Hong Kong West CGAT
TWGHs Fung Yiu King Hospital
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Program Details
Commenced 29th Sept 2009
Weekly EOL clinic session
Target 40 cases selected in 2 CampA homes under
TWGHs
21 21
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Cancer
Organ failure (eg severe CHFCOAD CRF etc)
Advanced dementia
Degenerative neurological diseases
Selection Criteria
22
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
23
EOL program in RCHE
FYKH Pathway
Arrange elderly
admit to FYKH for
EOL care via
expedite pathway
AED Pathway
Elderly stay in RCHE
until the last moment
Transported to AED and
stay there at last journey
of life instead of
admitting to acute wards
(Letter to ambulance
man prepared)
N B - Dying in RCHE required mandatory
report to the Coroner CAP 504 Coroner
Ordinance Section 4- Reportable Deaths ndash
item no 16
Expected outcomes
Decreased AED Acute Hospital
Admissions
Better QOL Good Death
Elderly Option
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Way forwardshellipto fulfill the dreams
More effort is needed to change the death taboo in Chinese culture
More public education is needed to enhance peoplersquos readiness to talk about death - build into secondary school curriculum
Government policy support Training of RCHE staff and general practitioners Change RCHE registration to Nursing Home registration Change in Coronerrsquos rules ndash may take another 17 years
24
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Promotion in Hong Kong
HKMJ 201016235-236
25
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Dreams and Reality of End-of-Life Care in Hong Kong
Felix Chan (COS Med FYKH)
Luk JKH (CONS FYKH)
WC Ng (UM ICS)
Athena Liu (Dept of Law HKU)
Philip Beh (Forensic Pathologist
Dept of Pathology HKU)
In press
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
TWGHs Medical Social Collaboration-
Towards a dignified dying process 「東華三院医社合作新里程臨終関懐耀晚晴」
Date 12th March 2011
Time 9 am to 1 pm
Venue Hong Kong Convention and Exhibition Centre
Officiating Guests Dr CH Leong Mr Patrick Nip Dr CC Luk
Speakers Prof Cecilia Chan Dr Athena Liu
Dr Michael Sham Dr Philip Beh Dr Felix Chan
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29
Our health care system
Bottom line ndash
The quality of our health care system is reflected in the quality of EOL care provisionhellip
28
END
29