Caring for the elderly

  • Health
  • Sunday, 11 Dec 2005

MANY of us with elderly parents or relatives have a difficult time caring for them, particularly if they have a chronic illness. 

Some are dependent on us almost round-the-clock for their physical needs, while others require constant medical attention and rehabilitation. Even if we are willing to carve time out in our lives to care for them, it is a taxing job. 

In such situations, one should consider a long-term care facility that can provide the kind of medical and rehabilitative services that are required. 

“A long-term care facility is required during the intermediate phase after a patient (with a stroke or fracture) is stabilised and needs some form of rehabilitation to get back to his/her daily life,” explains Dr Ramnan Jeyasingam, chief executive officer of Columbia Asia Nursing and Rehabilitation Centre. 

Patients who need long-term care, especially with regard to nursing and rehabilitation, include stroke survivors, accident or fracture victims, Alzheimer’s or Parkinson’s disease patients, terminal cancer patients or those in a coma. 

“About 70% of our patients are stroke patients,” says Dr Ramnan, quoting the centre’s statistics from the previous year.  

A long-term care facility provides specialised nursing care, rehabilitationand helps patients get back on theirfeet, says Dr Ramnan Jeyasingam, seen herespeaking to an elderly patient.

Most patients are referred by their specialists to long-term care facilities, where they can receive proper chronic care that an acute care hospital may not be able to provide. A distinct advantage that long-term care facilities have over hospitals is that there are fewer hospital-acquired infections and cross-infections in the former. 

A long-term care facility is different from the conventional old folks’ home or nursing home. The old folks’ home caters for “the elderly who are not ill and do not need close medical attention,” he explains. 

“The nursing home, which is usually run by retired nurses or someone with nursing qualifications, has patients who may have some medical problems, but are usually manageable at the nursing level. 

“The long-term care facility provides hospital services. There is a lot of skilled (care) involved ? we go beyond the scope of a nursing home,” he adds. 

A long-term care facility also accepts patients outside the geriatric age group, such as children with cerebral palsy or adults who have been involved in accidents and require physiotherapy.  

Patients do not have to be “warded” in the facility, as they can come in as day-care patients or go home to their families during the weekends. 

Such centres make an effort to provide a pleasant social setting for the patients. As part of the daily routine, patients can sit out in the courtyard for fresh air, watch television and have communal meals. 

“We try to get people back on their feet,” Dr Ramnan remarks.  

A long-term care facility is equipped to deal with medical conditions, as opposed to a nursing home. For instance, there is an in-house physician, a team of staff nurses, an occupational therapist, a physiotherapist, a speech therapist, and a dietitian. 

“Each patient has different needs ? we provide individualised care,” says Dr Ramnan. Depending on the patient’s condition, his/her medication, nutritional and daily care needs have to be assessed individually. For example, a patient may not be able to take solid foods, so he/she may need nutritional formulas or pre-digested liquid foods for tube feeding.  

Most stroke patients need specialised nursing care. “They need someone to help them with all their activities of daily living, including transferring in and out of bed, feeding, grooming, dressing and bathing,” he says. 

“We also plan the patient’s management based on (the family’s) budget,” he says. 

The patient’s family, and their ability to cope with the patient at home, is the most important part of the equation.  

“There are many patients who are dependent on people to carry out their activities of daily living ? and the family just cannot manage them at home,” he says, using patients with Alzheimer’s disease or dementia as examples. 

These family members need not burden themselves with guilt, as it is only natural to feel the pressure. “When you are taking care of a very handicapped or ill person, the stress on the caregiver/family members is much more than on the patient itself,” Dr Ramnan commiserates. 

He hopes that people will come to accept the role of long-term care facilities, and be open to the idea of placing their loved ones in such centres. 

The important thing, he notes, is for families to be well-informed of the patient’s condition. The idea that one will “lose face” or be perceived as irresponsible is a misconception that can be laid to rest.  

Putting your parent or relative in a long-term care facility is “an opportunity for the patient to get better and improve his/her quality of life,” Dr Ramnan points out. 

In the initial stage, a lot of the patients may be depressed because they think that their families have dumped them in the centre. 

“But we explain to them that the reason they’re here is to get better. They also see that there are others suffering, and when they see the next person getting better, that gives them some hope,” says Dr Ramnan. 

In fact, most of the patients receive visits from their families almost every day. Some sit in the room with them, while others follow them to physiotherapy and rehabilitation. Family members who are not in the country keep up to date with their relative’s progress through email and telephone. 

“We allow family members to visit anytime. They can come and be with the patient, so that they know what is happening,” he says. 

This sort of transparency is one of the criteria of a good long-term care facility or nursing home. A good facility will also document every patient’s progress, keep proper medical records, and be in constant communication with the patient’s kin, particularly if any incidents occur. 

However, when it comes to choosing a good place for your loved one, start with the patient, not the place. 

“You start by assessing the needs of the person,” Dr Ramnan advises. “What does he need? Does he need a place to stay, intensive medical care or intensive physiotherapy and rehabilitation? Once you’ve identified the needs, then you can assess the place.  

“Think about how much you can afford. Then look at the services or facilities available – what will serve in the best interests of the patient?” he lists several other considerations. 

Many of Dr Ramnan’s patients have gotten well and gone home to stay with their families. 

“What we do here is to make their transition a bit better (from acute care to full recovery), and for terminal patients, to maintain their dignity,” he concludes. 


Note: This article is courtesy of Nestle Nutrition. 

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