DESK REVIEWS | 07.02.01.02.05. Palliative and end-of-life care services

DESK REVIEW | 07.02.01.02.05. Palliative and end-of-life care services

Yes, they are beginning to be implemented, but not specifically for people living with dementia.

Less than 1% of patients have access to palliative care in India and existing services are predominantly available for persons living with cancer (Rajagopal et al., 2015). The state of Kerala is an exception with a large community-based model for palliative care (Kumar, 2007).

Recently, the Ayushman Bharat-Health and Wellness Centres are working on expanding the range of care services provided at a primary level including elderly and palliative care services which are relevant to persons with dementia (MoHFW, 2019).

References:

Kumar S. K. (2007). Kerala, India: a regional community-based palliative care model. Journal of pain and symptom management, 33(5), 623–627. https://doi.org/10.1016/j.jpainsymman.2007.02.005

Ministry of Health and Family Welfare (2019). Ayushman Bharat: Health and Wellness Centre.

Rajagopal, M. R. (2015). The current status of palliative care in India. Cancer Control, 22, 57-62. Available from: http://www.cancercontrol.info/wp-content/uploads/2015/07/57-62-MR-Rajagopal-.pdf

 

Palliative care was first established in Indonesia in 1992. Expansion of programmes has been slow as services are concentrated in big cities (Putranto et al., 2017), leading to a lack of palliative care services in community-based and primary healthcare facilities. An example of palliative care in community-based service can be found in the Puskesmas Balongsari in Surabaya, East Java. A team of medical doctors, psychologists, nurses, and volunteers provides Palliative care services in the outpatient setting on Mondays and Wednesdays (Saleh et al., 2008). However, this is not dementia specific. Palliative care in Indonesia is mostly linked to cancer (Putranto et al., 2017) and in general is regulated by the Ministry of Health (Kementerian Kesehatan Republik Indonesia, 2007). There continues to be a lack of research evidence and initiative towards developing palliative care for people with dementia in Indonesia.

References:

Kementerian Kesehatan Republik Indonesia. (2007). Minister of Health Decree 812/2007 on Palliative Care Policy (Keputusan Menteri Kesehatan Republik Indonesia No. 812/2007 tentang Kebijakan Perawatan Paliatif).

Putranto, R., Mudjaddid, E., Shatro, H., Adli, M., & Martina, D. (2017). Development and challenges of palliative care in Indonesia: role of psychosomatic medicine. BioPsychoSocial Medicine.

Saleh, M. S., Danantosa, T., & Kusumawardhani, C. (2008). Perawatan Paliatif di Puskesmas Balongsari Surabaya: Upaya Mendekatkan Layanan Rawat Jalan Kepada Pasien Kanker Stadium Lanjut.

These are provided at referral county and private hospitals by mostly psychologists (only in Makueni County for public health facilities) and/or social workers in addition to doctors and nurses team (Hospice Care Kenya, 2018; International Association for Hospice & Palliative Care, 2019). Not all county hospitals have put in place the scheme of service for social medical workers. The medical social workers are supposed to contribute to improvement of health care services and provide counseling to patients and relatives in institutions/hospitals, psychosocial rehabilitation, home based care, and placement of patients. Other roles include providing support services to curative/hospital based, primary, preventive and promotive programmes, and activities (Republic of Kenya, 2009). Private hospitals e.g., the Aga Khan University Hospital have also social workers in their palliative care team (International Association for Hospice & Palliative Care, 2019). In most cases, people with dementia receive these services especially those at advanced stages.

References:

Hospice Care Kenya. (2018). Paving the way for universal access to palliative care in Kenya.  https://www.hospicecarekenya.com/other-news/paving-the-way-for-universal-access-to-palliative-care-in-kenya/

International Association for Hospice & Palliative Care. (2019). Global directory of palliative care services and organizations. https://hospicecare.com/global-directory-of-providers-organizations/

Republic of Kenya. (2009). Scheme of Service for Medical Social Workers. Permanent Secretary Ministry of State for Public Service, Office of the Prime Mininster. Nairobi, Kenya. https://www.health.go.ke/wp-content/uploads/2015/09/SCHEME%20OF%20SERVICE%20FOR%20MEDICAL%20SOCIAL%20WORKERS.PDF

 

In Mexico, the inclusion within the Federal Legislation, of palliative care for individuals with terminal conditions took place in 2009, specifying the need to attend the care of those individuals “with illnesses that have no cure and are in an irreversible condition of health deterioration”, but people with dementia are not included as a specific group. However, very little advances have been made and public services for palliative care are almost inexistent. No private services offering support for palliative care could be identified and only two non-profit organisations in the country were identified providing these support services for any individual/illness.

The two-tiered system of community-based care referred to above provide these services at a cost.