As long as an older person is able to understand the risks of living alone and accept those consequences, they should be allowed to exercise their autonomy and decide for themselves, says Dr Tan. Photo: 123rf.com
Don't you dare send me to a retirement home, CK Ng’s 75-year-old father said to him.
But as an only child and someone who works long hours, even on weekends, Ng wasn’t able to properly care for his father who was recently diagnosed with Alzheimer’s Disease.
“I initially hired a full-time nursing aide to look after him. But the cost was exorbitant,” says the 45-year-old factory manager who is married to a schoolteacher, and has three children aged 14, 11 and eight.
Ng’s 38-year-old wife even considered staying home to look after their children and her father-in-law, but in her condition (she is expecting their fourth child), it was difficult. Also, it was not viable for a family of six, with one more on the way, to survive on just one person’s income.
Ng explored other options such as having a live-in maid, but none of the ones he hired lasted for more than a few months.
“I tried getting a full-time maid to look after him, but as my dad grew more irritable and reclusive, he would often lose his temper and scold or yell at the maid for no reason, and sometimes even threw things at her,” he laments.
After exploring all the available options, Ng finally decided to send his father to a private nursing home.
“It wasn’t something I wanted to do. It was the last thing on my mind because of ‘filial piety’ – we always thought he would live with us for a long time – but it was the most practical option. In fact, it was the only option we had,” he says.
Ethical issue
Dr Tan is a proponent of restorative and rehabilitative care rather than residential care. Photo: FilepicWhile Ng may have a valid reason for putting his aged father in a long-term residential care facility, not all older persons who are in such facilities are there ‘ethically’ or even legally, says University Malaya Medical Centre consultant geriatrician Prof Dr Tan Maw Pin.
Dr Tan cites the example of an older person who lived alone, had a fall, and was then put into a care facility after discussions between the family members and health professionals. However, the older person wasn’t consulted.
“That’s actually against the law. It’s called ‘depravation of liberty’. The older person must consent to be in the care facility voluntarily before they’re put there. As long as they have their full faculties, where they live should always be a choice and not forced,” she opines.
“Being in a ‘home’ or ‘residential long-term care facility often means institutionalisation and loss of independence or freedom for the older person. This is where there are ethical issues involved,” says Dr Tan.
“It’s against the law when they are put in a facility without consent. That’s one reason why a lot of these ‘homes’ have a very sad and gloomy emotional atmosphere because the people don’t really want to be there,” she says.
Different types of ‘homes’
The focus should be on helping these older persons lead independent lives and be active and healthy. Photo: PixabayAccording to Dr Tan, there are many different types of “homes for the aged” and even terminology for this.
“While some have a negative connotation such as ‘infirmary’ because it implies the person is “infirm” (not well), others are more positive.
“Although a lot of older people don’t like to be known as ‘old’, I think ‘old folks’ home’ sounds more ‘happy-go-lucky’ whereas ‘nursing home’ implies they are ill and need looking after,” she says.
“It’s all about perception because people tend to see anything associated with ageing or old-age as negative, and that’s unfortunate.
“In fact, none of these terms should be considered as derogatory. You can’t really replace the term ‘old’ or ‘elderly’ with ‘nicer sounding' euphemisms because whichever word you use, people will still feel offended because they don’t like being old. What really needs to be changed is people’s perception of older persons,” she adds.
Dr Tan says that the term ‘nursing home’ medicalises old age, hence it shouldn’t be used indiscriminately.
“Most older persons go to a ‘home’ because they need help with daily living but they don’t really need nursing care. They would only need a nurse and nursing care if they’re on tube feeding, have wounds, or need to use a catheter for urination.
‘But if they’re immobile, they need someone to feed them and help them move around, then that’s social care and they need a caregiver, not a nurse,” she says.
Risks and consequences
Older persons who have decided to live alone need to deal with certain things like meal arrangements, laundry and cleaning, because their children might not be around to help them, says Dr Tan. Photo: Pixabay
As long as an older person is able to understand the risks of living alone and accept those consequences, they should be allowed to exercise their autonomy and basic human right to make decisions for themselves, says Dr Tan.
But, they do need to realise and deal with certain issues.
“Firstly, they’ll need to make arrangements for their own meals, laundry, cleaning, etc. because their children will be working, and not be around 24-7,” she highlights.
“Secondly, if they fall or get injured while at home, there isn’t anybody to help them,” she says.
“So, they might need to look into alternatives such as catering their meals and hiring a maid or cleaner.”
Conversely, if an older person decides to be moved to a care facility, two things could happen, says Dr Tan.
“Firstly, they won’t be in danger of falling because the care home may not allow them to move around to minimise the risk – then they’ll become ‘disabled’. Or, if they do move around, they might be at an increased risk of falling because they’ve gone from a familiar to an unfamiliar environment,” she says.
Dr Tan advises older persons to consider what could happen in the future and make provisions for it.
She cites an example of an older person who lives with their adult children either because their home has been sold or they never had a home to start with.
“If the adult children no longer want the aged parent to live with them, they actually have nowhere to go. When you sell your house to move in with your adult children or to fund your children’s education, you need to take into consideration what could happen in the future,” she advises.
“All these things should be dealt with early on – before it happens, before you grow older – through ‘advance care directives’. Older persons need to have it written down and agreed upon by the family members so that there’ll be no disputes or disagreements later on how they want to be taken care of when they grow old,” she explains. “Often, they have ‘verbal’ advance care directives – they’ll make their children agree to never put them in an ‘old folks’ home’ – but these might not be as effective as a written one.”
Restorative and rehabilitative care
Dr Tan advises older persons to consider what could happen in the future and make provisions for it. Photo: Pixabay
Dr Tan is a proponent of restorative and rehabilitative care rather than residential care.
“The focus should be on helping these older persons lead independent lives and be active and healthy.
“Often, families think moving an elderly person to a care home is the safest thing to do, but if their faculties are all still functioning, it probably isn’t. They might become frustrated and depressed, then their condition deteriorates. This is why some older people’s condition – mentally, emotionally, physically – seems to deteriorate after they’re moved to a ‘home’,” she says.
“The best way for the elderly to be cared for is in their own environment and moving them to a long-term residential care facility should only be a last resort,” she adds.
“When an older person falls and becomes immobile, they need to be brought to the hospital and treated to restore them to their previous condition,” she says.
“If all this is done, they should then be able to go back and live with their family. It’s not just for falls but even stroke patients can be rehabilitated,” she adds.
“But, that’s not happening currently. Usually, they assume the older person needs to be placed in a care facility. In the long-term, this might be the most expensive solution because they might live for a long time and such facilities usually aren’t cheap,” says Dr Tan.
She points out that it might be more cost-effective to maintain the older person in their own environment in the long run.
Even if they’ve to go to a care home, it shouldn’t be permanent, she adds.
“Effort must be made to ensure they can return to their own environment after restorative care and rehabilitation.
“The government needs to fund restorative care. There needs to be places where seniors can go to for rehabilitation and maintenance of function, so that they can potentially return to their previous state,” she concludes.
