From Hospital Ward to Home Care: My First Palliative Care Case at YDCare

by YDCare Homecare Team | June 2,2026

After more than a decade working in public hospital wards, I had become accustomed to a fast-paced environment with constant patient turnover. Every day revolved around diagnosis, treatment, stabilisation, and discharge. Within such a system, there was often little opportunity to understand what happened to patients after they left the hospital, let alone provide ongoing emotional support to them and their families.

Recently, I decided to embark on a new chapter in my nursing career and joined YDCare as a Nurse Manager. This was the very first case I managed after joining the team.

A Different Approach to Nursing Care

My work at YDCare often begins with an online enquiry. After understanding a client's situation, I personally conduct a comprehensive home assessment.

Unlike hospital nursing, where clinical records are often the primary source of information, home care requires a much broader perspective. Beyond monitoring vital signs such as temperature, blood pressure, and oxygen saturation, I assess skin integrity, swallowing ability, mobility, medication management, and even the safety of the home environment.

Only by understanding the whole picture can we design a care plan that truly meets a patient's needs.

My First Challenge at YDCare

The patient was an elderly lady diagnosed with terminal-stage lung cancer. Her doctors estimated that she had only one to two months to live.

She lived with her daughter and a domestic helper and was experiencing chronic pain throughout her body. Her mobility had deteriorated significantly, and even simple movements such as turning in bed or sitting up required full assistance.

The wishes of both the patient and her family were very clear. She did not want any further invasive treatments and preferred to focus entirely on palliative care. Ideally, she hoped to remain at home for the remainder of her life.

However, after discussing the realities and emotional challenges involved, we worked closely with the family to develop an end-of-life hospital transfer plan. We also ensured that all caregivers understood when and how the plan should be activated if her condition deteriorated.

Supporting Both the Patient and the Family

In public hospitals, patients with advanced illnesses often experience repeated hospital admissions during the final stages of life.

As a Nurse Manager at YDCare, I had greater flexibility to tailor support around the patient's actual needs.

After assessing her condition, I recognised that nighttime was often when symptoms became more distressing and family anxiety peaked. I therefore recommended a 12-hour overnight one-on-one Registered Nurse (RN) service to provide clinical monitoring, symptom management, and reassurance during the most challenging hours of the day.

At the same time, I arranged for a geriatric physician to conduct home visits.

Beyond adjusting pain medications, we had practical and honest conversations with the family about future treatment goals through advance care planning. Together, the family decided that emergency hospitalisation would only be considered when absolutely necessary and that no invasive interventions—such as feeding tubes or intravenous infusions—would be performed.

Having these discussions early helped reduce uncertainty and allowed the family to make informed decisions before a crisis occurred.

Identifying Problems Hidden in the Details

The first major challenge emerged during the very first week of service. One of our Registered Nurses reported that although the patient's vital signs remained stable, she was experiencing severe urinary urgency during the night. She repeatedly requested assistance to use the toilet, yet each attempt produced only a very small amount of urine.

Drawing upon my previous hospital experience, I recognised that this could indicate either urinary retention or a urinary tract infection—both common but potentially distressing complications in advanced cancer patients.

I immediately discussed the situation with the attending physician, who recommended a bladder ultrasound examination and urine testing.

The following day, I visited the patient with a portable bladder scanner. The scan confirmed a significant volume of retained urine that she was unable to empty naturally. With the family's consent, we performed a one-time urinary catheterisation to relieve the retention and arranged for the urine sample to be sent to a laboratory for testing.

That very night, the patient's discomfort improved dramatically and she was finally able to rest.

Subsequent test results confirmed a urinary tract infection. We coordinated with the physician to prescribe antibiotics and arranged medication delivery directly to the patient's home through our integrated care network.

The ability to identify an issue quickly, coordinate multiple healthcare professionals, and implement treatment within a short period of time significantly improved her comfort and quality of life.

Managing Symptoms Through Team-Based Care

During the second week, our nursing team observed worsening incontinence-associated dermatitis (commonly known as diaper rash) alongside increasing pain levels. Recognising the need for specialist intervention, I arranged for YDCare's Wound Care Specialist Nurse to conduct a home assessment the following day.

Based on the specialist's recommendations, we developed a clear care protocol for our nursing team to follow. Within one week, the patient's skin condition showed significant improvement. At the same time, I consulted the physician regarding her increasing pain. Her pain medication was adjusted accordingly, and our nurses were instructed to closely monitor her symptoms throughout every shift.

These small but important interventions helped maintain her comfort and dignity during an extremely vulnerable stage of life.

Balancing Quality Care and Financial Considerations

By the third week, the patient's symptoms had become relatively stable. However, her family privately shared that the ongoing cost of care was beginning to place financial pressure on them.

One aspect of community-based care that I value greatly is the flexibility to adapt services according to changing needs.

After carefully reassessing the patient's condition, I determined that her primary care requirements at that stage involved routine personal care and skin management rather than intensive clinical nursing.

To help reduce costs without compromising care quality, I recommended transitioning from Registered Nurse support to an experienced Health Worker who had relevant palliative care experience.

This adjustment allowed the family to continue receiving appropriate care while easing some of the financial burden they were facing.

Continuity of Care Until the Very End

By the sixth and seventh weeks, her condition began to deteriorate as expected. She developed a high fever and increasing shortness of breath.

I immediately informed the physician and arranged for a home oxygen concentrator to help relieve her breathing difficulties.

Given the increasing complexity of her condition, we also transitioned her care back to Registered Nurse support. Following another home medical consultation, additional end-of-life medications and antibiotics were prescribed.

I spent time with the family reviewing each medication, its purpose, and how it should be administered, ensuring they felt prepared and supported.

Then, during the eighth week, our nurse observed a sudden drop in blood pressure, a rapid heart rate, and a significant decline in the patient's level of consciousness. After consulting me and obtaining the family's agreement, an ambulance was called immediately.

Throughout my years in public hospitals, I cared for countless patients. Yet due to the nature of hospital practice, I rarely had the opportunity to follow an individual throughout their entire healthcare journey.

Home care was different.

From the initial assessment and ongoing reviews to symptom management, care coordination, and eventual hospital transfer, our nursing team had accompanied both the patient and her family every step of the way.

When she arrived at the hospital, our nurse was able to provide a detailed clinical handover to the receiving medical team, including her condition over the previous eight weeks, medication history, and the family's wishes regarding palliative care.

This allowed the hospital team to quickly understand her situation and continue care in accordance with the goals that had already been discussed and established.

The patient passed away peacefully two days later.

Afterward, her daughter expressed heartfelt gratitude to our team. She shared that having a single point of contact and coordinated support had saved the family countless hours of arranging services themselves and allowed them to focus on what mattered most—spending precious time with their mother during her final days.

Reflections on Home Nursing

As a Nurse Manager transitioning from public hospital practice to community healthcare, this case profoundly changed my understanding of what nursing can be.

While we cannot change the length of a person's life, we can influence the quality of the time they have left.

Through professional care, flexible service arrangements, and close collaboration among healthcare professionals, we can reduce uncertainty for families, relieve suffering for patients, and help individuals approach the final chapter of life with comfort, dignity, and peace.