Hospice care sector needs more sustained efforts for development, say experts

Hospice care, which had a relatively late start in China, is now seeing rapid development and strong momentum, but still needs more sustained growth efforts, experts said.

Hospice care, which aims to tend to the physical, emotional and sometimes spiritual needs of the terminally ill and help them die with dignity, is now catching attention.

Statistics released at a national hospice care pilot promotion meeting held in Chengdu in June showed that in 2018, 283,000 patients nationwide benefited from hospice care. Compared to the situation in October 2017, when the country's first batch of hospice care pilots were launched, institutions that offer hospice care increased from 35 to 61, the number of beds surged from 412 to 957, and practicing physicians in the sector grew by 113 percent to 204 in number.

In October 2017 and May 2019, the central government launched two batches of hospice care pilots in the country, aimed at exploring the development mode and the working mechanism of the sector, to care for the terminally ill and increase their quality of life.

Qin Yuan, director of the hospice ward at Beijing Haidian Hospital, said that currently, China's hospice care service is developing rapidly. However, according to the World Health Organization standards, many problems still remain.

"Industry access standards, medication specifications, training courses, and quality management systems are still under construction, and supporting monetary and regulatory policies are needed. In addition, the concept of hospice care, or using just enough medication to alleviate pain so that people can die in a gentle, dignified way, is not popularized enough in universal education. There is still a long way to go," she said.

According to Jing Jun, director at the Research Center for Public Health of Tsinghua University, around 9 million people die in China every year, 75 percent of which are chronic deaths. However, only 20,000 people get palliative care, or hospice care, in institutions.

Zhou Zhengshun, executive secretary general of the Palliative Care Council of China Association of Gerontological and Geriatrics, said: "Currently, there are more than 12 million totally disabled senior citizens in China. However, the average number of beds for hospice care in pilot hospitals is in single digit. The demand gap is huge."

Wang Yue, a professor at the School of Health Humanities at Peking University, suggested that a guarantee system of hospice care should be established, to include necessary hospice services in the primary healthcare insurance system, and that an online registration system of medical living wills should be set up, so that patients' living wills are recorded in the national medical big data.

Civil institutions are also taking active steps. According to Jiang Mingyin, from the YiYang Rehabilitation Nursing Care Center in Beijing, the center is now connected with 3A-grade hospitals and rehabilitation centers, so that the terminally ill can be sent from those medical institutions to the center for hospice care.

"Physicians, nurses, social workers, nutritionists, psychological consultants, and healthcare aides, are all involved in the hospice care process, in order to care for the patients physically, emotionally and spiritually. Relatives of the patients are also attended. We give full support to them, and offer psychological counseling to the relatives after the patient passes away," Jiang said.

On Nov 1, the National Health Commission, the National Development and Reform Commission, and six other governmental departments jointly issued a guideline on improving the country's senior healthcare service system. The guideline stipulated that on the basis of the principle of "keeping patients fully informed and voluntary", related medical institutions should reinforce hospice care services.

Specifically, beds for hospice care should be increased, hospice care centers should be established if conditions permit, and the standardized construction of the industry should be accelerated. Hospice care services in communities and homes should be promoted, and a smooth referral system between medical institutions, communities and homes should be established.

In addition, universal education about hospice care is necessary. Life education should be included in the health curriculum of primary and secondary schools, so that the concept of hospice care can be widely recognized and accepted by society, said the guideline.

On Nov 3, the Palliative Care Council of China Association of Gerontological and Geriatrics was launched in Beijing, with an aim of promoting the academic research, practice exploration and standardization of the sector, to guarantee the dignity and quality of life of the terminally ill.