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

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

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

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

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 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

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

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

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

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

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

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

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 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

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

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

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

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

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

END

29