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Tuesday June 16, 2009

Nurses on call

Home nursing, though relatively new in the country, provides a much sought after service for patients and care-givers alike.

WHEN Ardy Susanto’s mother was diagnosed with Parkinson’s disease 15 years ago, she knew it would be a long road ahead. Her mother’s deterioration was gradual but eventually, she lost all mobility and could not even feed herself.

In the last five years before she passed away, Ardy and a maid had to help her with the most basic of needs. This included feeding her through a tube (that had to be changed every three months), and helping her with physiotherapy and occupational therapy every day.

Real helping hand: Mohd Naim Mohammad (left) and a nurse from Home Nursing Providers helping his mother, Wan Maimunah Wan Hassan, into a wheelchair at his house in Shah Alam.

Ardy, 48, became a part-time nurse as she learnt how to change, feed and attend to her mother’s other needs. She also learnt how to operate a suction machine used to help extract phlegm.

“My mother had to go to the hospital quite often. Sometimes we would get a doctor to come over. A general practitioner could also see to her medical needs but then that would be no different from making the trip to the hospital,” says Ardy, a senior manager in a publishing company.

That was when she discovered a network of nurses and even therapists, who were willing to make house calls. The private hospital which treated her mother as well as a shop that sold medical supplies recommended a list of places where she could find these “freelance” nurses.

“This was a boon to working mothers like me as it cut down travelling time. It saved the hassle of transporting my invalid mother and queuing at the hospital,” she says.

“These were nurses who had either retired or left their jobs at the hospital. I also managed to get a therapist working at a medical college to drop by after working hours. A nurse helped with the physiotherapy, phlegm extraction and changed the dressing (when my mother had bed sores). They were very helpful and taught my family some of the procedures so that we could do them ourselves to minimise hospital expenses and nurse visits.”

Mohd Naim’s father Mohd Che Leh, a stroke patient, being cared for by a nurse.

Costs varied between RM50 and RM80, depending on the procedure required and this, says Ardy, was reasonable as most private nurses usually charge between RM12 and RM17 per hour for their services.

Placing his aged parents in a nursing home was not an option for Mohd Naim Mohammad, 45, who’s in the construction line.

“I feel it’s our filial duty to take care of our parents. Besides, it’s better to have family members to take care of them and provide company rather than strangers,” he says.

Mobile nurses come in on a daily basis to attend to his mother, 74, who suffers from diabetes and since August last year, has to go for dialysis twice a week. Apart from bathing her, they check her blood pressure and sugar level, and attend to her other medical needs.

A doctor also drops by to provide physiotherapy three times a week for his father, also 74, who had a stroke in 2000. Although he is wheelchair-bound, he is quite independent, and eats and bathes by himself.

“My father is still quite jovial and I think interacting with the family helps keep his spirits up. A friend introduced us to Home Nursing Providers (HNP) and my father has been using their services since 2003 while my mother, who’s now bedridden, started last year,” says Mohd Naim.

Based in Selangor, HNP extends its services to other parts of the country as well. The company offers a team of medical professionals, nurses, physiotherapists and nursing aides. Its core values are geared towards improving the quality of life of the sick, disabled and elderly, and facilitating patient rehabilitation and empowerment.

“My siblings and I take turns to take my mother to the hospital for dialysis, and my children help their grandparents whenever they can,” adds Mohd Naim, who has six children aged five to 14.

“My mother is quite weak but still conversant, and although the two maids help spoonfeed her, we make it a point to eat together with her at the dinner table as a family.”

Although the standard of healthcare in Malaysia is admirable compared to our Asian neighbours, the concept of home nursing is relatively new in Malaysia. Nursing homes or rehabilitation centres differ from mobile nurses as patients usually opt for daycare or long-term stay. The main focus is basic and companion care whereas mobile nurses offer professional medical care. Mobile nursing services is usually made available through:

> A community outreach programme, often initiated by the government;

> Part-time individual agents providing part-time nurses (sometimes foreign nurses) or caregivers;

> Nurses who work full-time in hospitals and make house-calls on their own personal time;

> Private hospitals that extend their services to their own patients as a follow-up service.

Generally, charges are probably cheaper than a hospital visit but if you need a night nurse or nursing aide for longer stays, it may add up to quite a bit. But it’s still more cost-effective than being admitted into hospital (depending on the medical problem).

Some government hospitals offer home nursing services, whereby patients are allowed to recuperate at home under the watchful eye of family members with regular visits from appointed nurses. Hospital Universiti Kebangsaan Malaysia has a home nursing programme – available at a nominal fee of RM10 per visit – but this is only for patients within a 20km radius of the hospital.

Ailments vary from terminal illness to accident cases, and apart from handling medical needs like changing bandages, inserting or removing catheters and feeding tubes, and administering injections, these nurses on call also teach family members how to give emotional support and get the patient’s confidence going.

The home nursing team is chosen from different disciplines. Since the programme involves making important decisions, only senior nurses with at least five years’ experience are chosen.

Private companies that offer mobile nursing services, however, are few and far in between. This niche market is one sector that both the government and private sector should explore to improve healthcare services for the public.

One of the largest healthcare groups in the country, Kumpulan Perubatan Johor (KPJ), the Healthcare Division of Johor Corporation, offers such a service.

Another company, Nurses@Home in Sunway, Petaling Jaya, operated by Sunmed@Home Sdn Bhd (, is hospital-linked and prefers to be called “a nursing solution provider”. It offers simple follow-up visits to comprehensive care plans that include nutrition, physiotherapy, carer training and other disciplines to help the patient achieve full recovery.

“The biggest difference between us and free agents is that we work together with the doctor as part of the treatment cycle (whereas they have no obligation to report to the doctor). We also work closely with pharma-companies by giving progress reports and monitoring the patient (for reaction and side-effects),” says general manager Asok Nair.

Almost 80% of its patients are recommended by various hospitals.

Nurses@Home provides clients with an alternative to prematurely sending aged relatives to nursing homes. About 40% of its services is geriatric care.

The company was set up in 2002 and its work processes are built on healthcare practices in Britain, the United States, Australia and Singapore.

Basically, two main plans are available: Home Visit Plans in which nurses make hourly visits, particularly for patients who need wound management, procedures such as feeding tube changes, catheter changes and even elderly care; and Personal Care Plans, when patients need extended care.

Only patients who are under the care of a physician are accepted.

“Their ages range from infants who are a few weeks old up to a 103-year-old patient. There were instances when our nurses had to accompany sick patients abroad,” Asok adds.

Better known as home health nursing (or clinician) in the United States, the service is usually recommended for hospital patients who are required to stay for a length of time, such as in post-cardiac surgery or trauma (accident) cases.

Devi Ramphal-Edwin, 44, who hails from Trinidad, worked as a registered nurse in the United States before going into mobile nursing in 2000.

“I opted for home nursing after I had my son, as it offered flexible hours. Usually, the nurse takes the lead in such cases and decides on the medical course for the patient – whether his or her condition has improved or deteriorated; needs more or different medicines; and the following course of action. Then she informs the doctor after one or two hours of evaluation,” she explains.

However, the patient must have a clinical problem and be home-bound to qualify for the service.

“Home nursing is seen as the third option after hospitalisation and nursing home or rehabilitation centres. For certain patients, for example, someone who’s had joint replacement, it’s better to be in a home environment. Nurses can easily make a call if the patient gets into distress.

“It’s also good to have a nurse to come around to have a look at mothers after a Caesarean, rather than going to the hospital with a newborn baby and risk infection,” says Devi.

Home health services range from blood testing to dressing wounds, and inserting or removing tubes, or physical therapy.

Home nursing cuts down the need for revisits, risk of infection from the hospital, and medical problems are sometimes detected faster. If there are complications or a higher level of care is needed, then the patient can be re-admitted.

Probably the most significant point to note in the American medical system is that the insurance companies call the shots there, without which optimal medical attention would be difficult to obtain.

“Home nursing doesn’t include geriatric care, unless the patient is certified to have a clinical problem,” adds Devi. who now resides in Malaysia and has since given up home nursing.

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