MODEL OF A WELL-MANAGED WELFARE HOME

Robin Stanley Augustin's recent article 'Caring for the elderly: Ensure welfare homes are regulated' in The Ant Daily drew attention to the sorry state of welfare homes in our country. It's high time the government devoted more resources to improving the quality of life for those living in welfare homes for the elderly. There is urgent need for reforms in this sector.

Here's what he wrote:

How we treat the older generation says a lot about us as a society.
Do we care about their welfare? Are they a priority to us and the government?
Are we pushing the authorities enough to ensure their best interests are taken care of?"

There are many privately-run retirement centres especially in housing estates all over the country. These centres, more commonly referred to as old folks homes provide shelter, food and care to the elderly whose families cannot or will not care for.

There is a real demand for the services provided by these homes due to the rising cost of living, the high cost of homes and the number of families in which both husbands and wives are both working full time.

Many members of the public are supportive of such homes, donating cash, food items and clothes, and while these are indeed good handouts, it alone does not guarantee that the welfare of the elderly are taken care of.

This is because many of these privately-run homes are unregistered and unregulated.

This is cause for concern and Universiti Putra Malaysia’s Malay­sian Research Institute on Ageing is calling on the government to address the situation.

Click here to continue reading.

Most homes, especially unlicensed ones, are understaffed and overcrowded. Care is minimal and facilities are basic and spartan.

Having visited close to 50 homes in the Klang Valley over the past five years, let me share what I have learned, and offer some advice based on my personal experience.

Facilities

• Visit the home personally and see it for yourself. Do not just rely on what you have heard from someone or have read in the advertisement. The home must meet your requirements. Nothing like seeing the place for yourself.
• Check if the home has age-friendly facilities e.g. grab bars in the toilet and bathroom, non-slip floor tiles/mats, and easy access for wheel chairs.
• The rooms should be well-ventilated, spacious and bright. Avoid homes that cram too many beds in each room.
• Beds should have side railing to prevent falls. Mattresses and pillows should not be lumpy or worn-out.

Administration and Management

• Talk to the administrator or nurse manager. Ask the right questions, For example, what's the staff-residents ratio? Are the carers trained/experienced? Are there regular visits by doctors? What are the provisions for emergencies?
• Ask about the administrative framework. Is there a board of trustees or at the very least a management committee to oversee the running of the home? I would hesitate to recommend a home that is run by one or two individuals who control everything. Such homes are likely to be unlicensed. There must be checks and balances to ensure proper and efficient supervision and management of the home.
• Find out about the daily program of activities, meals and visiting hours. Most homes leave the residents to their own devices. They end up feeling bored or depressed, or staring blankly at the tv screen or at the ceiling.

Daily schedule of activities and meal plan at a home for the elderly

Charges

• Most government welfare homes are free. However, places are limited, and facilities are basic.
• For private homes, charges vary depending on the facilities and services offered. Also how much care and what type of room is required. Generally, monthly charges can be as low as RM1500 and as high as RM5000 or more. Find out if there are extra charges for laundry, diapers, medicine, and physiotherapy.
• Most private homes require one month's deposit and one month's fees upon admission. Make sure they issue receipts. Find out about refunds, whether in full or pro rata.
• Visits to the government clinics are free for the elderly. Check that the home doesn't bill you for them.

Miscellaneous

• How can you tell if the home is registered and licensed? Well, ask the home manager when you visit and request for the name/business card. If he can't produce one, consider that a red flag.
• If it's a double-storey buidling, look for a fire escape outside. If there is none, the home is likely to be unlicensed.
• If the home looks uninviting from the outside, there really is no point in ringing the doorbell.
• In these days of social media, a well-managed home should have a website and/or an FB page. Do the online research first before visiting a home. Call to make an appointment to visit to ensure the home manager is there to show you around and answer your questions.

Here is one welfare home that stood out, and that should serve as a model for other welfare homes as well as privately-run homes for the elderly. The images below speak for the excellent work of the administrators in providing quality care to the residents of Ci Hang Welfare Home in Shah Alam, Selangor. It takes in mostly the elderly who are poor, abandoned and physically challenged.

I hope this article gives you a good idea of what to look for in a good home for the elderly. First impressions do count in this case. If the home is dirty, the furniture worn-out, and the staff look overworked or unfriendly, don't waste a minute longer at the place.

You will be surprised how many homes you will strike out from your To Check-out list before you finally find one that is the answer to your prayers.

SHARING AWARENESS ABOUT ALZHEIMER'S

September is World Alzheimer's month. We will be featuring articles that will help promote awareness of Alzheimer's and also share stories by carers on how they cope with looking after a loved one with Alzheimer's - the most common form of dementia.

Here's one story published in Alzheimer's Association blog that will resonate with those of us caring for an elderly parent with Alzheimer's. It provides some answers to questions such as:

• How do we cope? 
• Is Alzheimer's hereditary? 
• How should we prepare for our future if tests show that we carry the Alzheimer's gene?

Be the Change You Wish to See in the World
by Daisy Duate

Five years ago, after being diagnosed with Alzheimer’s, my mom Sonia moved from Chicago to Missouri. She lived with my brother for a month and then with my sister for about a week. It was soon obvious that I had to take over the responsibility of being her primary caregiver. We were always inseparable, but now we are more inseparable than ever.

Due to a very long history of Alzheimer’s in my family, I was asked if I wanted to take part in a clinical study, which included a test to see if I carry the gene for early-onset familial Alzheimer’s.* I didn’t think twice. My brother and sister chose not to take it, but the minute it was brought to my attention, I wanted to do it. It was in my head from the beginning – what if I have Alzheimer’s and it is exposed at age 42 or 43? I am almost 40. Who is going to take care of my mother? Who is going to take care of me? I had to prepare myself.

I worked on getting all of my ducks in a row, taking all the proper measures and precautions.  I got life insurance right away so that someone would be able to take care of my mom and not have to put her in a nursing home. In addition to taking care of mom, I had to be willing to accept whether or not I will have the disease. Three-quarters of my family has passed away with Alzheimer’s. I am the only one of my siblings that wanted to be tested. I would like to think that I inspired my cousins – who are now interested in finding out if they carry the gene – as their mother was recently diagnosed as well.

As for me? The test came back positive. One day, I will have Alzheimer’s.

I don’t think of it; I simply shrug it off. I just see what my mom is going through and know I need to take care of her. In my younger years, I was a bit of a party animal – I owned a sports bar – and now my mom is my main focus in life. How can I be a caregiver to someone I love so much and not stand up for her and her needs as someone with the disease? She is what matters the most.

My typical day is very different from what it used to be. I wake up, make coffee and then wake up Mom. I often have to strip the bed and then take her to bathroom and get her into the shower. Then I brush her teeth, dress her and do her hair and makeup. I take her to work with me at my sister’s restaurant, and she is with me all day until I get off work. We often go on a walk to get some ice cream and go to the park. I end the day by taking her home and making her dinner. After she goes to bed, I go to sleep, and I do everything again the next day. It’s a whole new life.

The Alzheimer’s Association has been there for me every step of the way. I had already been on team Sonia’s Angels in the Walk to End Alzheimer’s for the past few years in support of my grandma and my mom. When I was diagnosed by my genetic counselor, I received information about grieving, counseling and caregiving from the Association. In my previous life, I had never been an activist; I was the quiet one. Now I advocate for my mom. If you wish to see a change in the world, you have to step up.

My involvement in the Dominantly Inherited Alzheimer Network (DIAN) study means that I take a variety of medications and skills tests. Although the whole group is supportive and loving, the medication is physically very painful for me. All the same, if my participation helps find a cure for someone in the future – whether it’s me or my nieces and nephews – I will take all of the pain. I try to stay positive. Everything happens for a reason, and life is too short to just mope around.

I help spread awareness because there is a stigma surrounding age and Alzheimer’s. People always tell me that I look 21 years old and can’t imagine that I could develop this disease at any time. The truth right now is that Mom has the disease; I have the gene, but I don’t have the disease yet. That is why I try not to dwell on it.

There is simply not enough money or exposure for Alzheimer’s. We have to get the word out in order to save the future for others. The more awareness we can raise, the better it is for the disease. We need to find – and fund – a cure. Alzheimer’s is currently the 6th leading cause of death; we must make strides to end it now.

*Younger/Early-onset Alzheimer’s caused by a genetic mutation is rare and the vast majority of early-onset and late-onset cases cannot be determined by a genetic test. Health professionals do not currently recommend routine genetic testing for Alzheimer’s disease, although testing for APOE-e4 is sometimes included as a part of research studies. For more information on Genetic testing, click here.

About the Author: Daisy Duarte, 39, is a caregiver for her mother Sonia, 59. Daisy speaks to colleges and other groups to raise awareness in the fight to end Alzheimer’s. Daisy and Sonia live in Missouri.

Your local Alzheimer's Organization:

Malaysia
Alzheimer's Disease Foundation Malaysia (ADFM)
14, Lorong Utara A, 46200, Petaling Jaya, Selangor, 46200
Phone:03-7958 1522

Alzheimer's Caregivers Network Malaysia

Singapore
Alzheimer's Disease Association Singapore
New Horizon Centre - Toa Payoh
Blk 157, Toa Payoh Lorong 1
#01-1195, Singapore 310157
Tel: 6353 8734

Dementia Helpline (Singapore): 6377 0700 (Mon to Fri, 9.00am - 6.00pm)

BEYOND DENTISTRY AND STOPPING DEMENTIA

August seems to be a popular month for seminars. I attended three, and had to skip two as they clashed with other commitments. Some of the information I picked up from each of these seminars is of relevance to seniors. I am sharing these slides and images below in the hope that our blog readers will benefit from the information given by the distinguished speakers.

Sat 15 August - Seminar on "Beyond Dentistry: More Than Teeth" presented by Channel News Asia and Specialist Dental Group of Singapore

Who would want to pay S$10 and spend Saturday afternoon listening to a group of dental and medical specialists talk about tooth decay, gum disease, etcetera? The answer: 500 people! Dental talks can be most boring, but the six specialists certainly knew how to inform, impress and entertain the audience with their lively presentation of the latest advances in dental care. 

A packed ballroom at the dental seminar. (Image from Specialist Dental Group blog)

While every one of the six speakers had good advice to offer on how to maintain dental health and ensure our teeth last a lifetime, the talk that resonated most with me as a senior citizen was 'Better Teeth, Better Years' delivered by prosthodontist Dr Neo Tee Khin. 

Remember how we dreaded going to the dentist during our childhood days in the 1950s and 60s? Qualified dentists were a rare breed then, especially in the small towns. Those we had were men in white who had learned their trade from other men in white before them through a period of apprenticeship. The fastest remedy for a persistent toothache in those days was an immediate extraction. That's how many ended up losing good teeth and having them replaced with ill-fitting dentures.

Thank goodness dentistry today has gone far beyond those dark days of terror in the dentist's chair. Dentists, like doctors, are sworn to save our teeth. Extraction is always the last resort. If you have a choice and if you can afford it, go for implants rather than dentures. They fit better, function and look like natural teeth, and last a lifetime if you practise dental hygiene diligently.

The speakers. Very impressive qualifications and credentials.  Click here for their biodata. 

Poor dental hygiene can lead to health problems like diabetes, hypertension, heart disease/stroke, lung infections, stomach ulcers, cancer and even erectile dysfunction. To maintain strong teeth and healthy gums, visit your dentist every six months, brush your teeth twice a day (also after meals if you can), and FLOSS, FLOSS, FLOSS!

For more about each of the talks and the speakers, click here.

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Thurs 13 August - Symposium on "Ageing in Malaysia: From Molecules to Community" organized jointly by Universiti Kebangsaan Malaysia (UKM), Universiti Teknologi Mara (UiTM) and Universiti Putra Malaysia (UPM)

Sat 22 August - Seminar on "The Rising Tide - Dementia - Can we stop it?" organized by the Gerontological Society, Singapore

Both seminars focused on dementia and shared similar findings from the research studies done although the racial demographics differed. Some images of slides taken from the talks:

Both Malaysia and Singapore will have an ageing population by 2050. This will see a rise in the number of people with dementia. 

As the population ages, we are seeing a dramatic rise in cases of dementia among the elderly. What are the signs of dementia? Is it preventable? Curable? Inheritable? How can caregivers deal with the stress of looking after a dementia patient 24/7? What are the costs involved in dementia care? These were some of the questions that the three speakers addressed.

A/Prof Dr Rathi Mahendran reported on the Jurong Ageing Study (JAS), conducted to find out how interventions of mindfulness, art, tai chi and music reminiscence can help the elderly with mental health problems. Click here to view a video of Prof Kua Ee Heok taking about the study.

Pay heed to the risk factors. 

Immediate Past President of the Gerontological Society of Singapore, A/Prof Goh Lee Gan shared on the Dementia Prevention Program. He called for volunteers to be trained to assist with conducting the program. Click here to view related video of Prof Kua Ee Heok explaining the program.

A briefing session for volunteers on the components of the program. Interested? Please contact Ms Chan Hui Yu at chan_hui_yu@nuhs.edu.sg

The Health component of the program in detail

The same advice for both Malaysians and Singaporeans on how to reduce the risks of getting dementia

With Prof Kua Ee Heok. We hail from the same hometown of Batu Pahat, and share a common interest in dementia. An Oxford-Harvard graduate in psychiatry, Prof Kua has written many books on the subject and is a much sought after speaker on ageing and mental health issues. 

HOGEWEY - A PLACE LIKE HOME FOR THOSE WITH DEMENTIA

Thanks to an unexpected birthday gift of a return air ticket to Amsterdam, I had the opportunity to visit Hogewey Village. It has been on my wish list since I first read about the place two years ago, and watched CNN's Dr Sanjay Gupta's insightful documentary 'Dementia Village'. Now I can happily strike Hogewey off my wish list.

The prime mover behind this innovative concept is co-founder and former nurse Yvonne van Amerongen. I had emailed her earlier requesting permission to visit the facility with Marianne Abbink Lankhorst, my Dutch friend. She wrote back to say we were both welcomed to visit anytime. Excellent!

So there we were at Hogewey on a warm Thursday afternoon of 29 July 2015. Visitors enter and exit via the sliding door which is controlled by the receptionist. The door remains closed to the residents. They are not allowed out of the facility on their own.

We were given a map showing the layout of the place, and several information sheets about Hogewey. We had the freedom to move around and explore but were reminded to respect the privacy of the residents. In other words, no peering into their living quarters or taking their photos without their permission. But we were welcome to use the information and images provided on the Vivium website.

Front view of Hogewey

The homes and the courtyards. So much greenery and flowering shrubs, and benches everywhere.

The Indonesian lifestyle corner. Indonesia was once a Dutch colony.

As we had no access to the homes, this composite image is taken from internet sources. It gives you an idea of the different lifestyle settings. Residents are housed in groups according to the lifestyle they are familiar with. 

Hogewey is the world's first village built specifically for people in the advanced stage of dementia. The concept for it is based on the belief that dementia patients can still enjoy a relatively normal life if they live together with like-minded people in an environment that is familiar to them.

Residents share a common dining room and living room (Images: Daily Mail)

There are currently 152 residents at Hogewey, with six to seven housed in each of the 23 homes. grouped into seven distinct lifestyle settings: urban, homely, cultural, traditional, Gooi (well-to-do), Indonesian and Christian. Residents have their own bedrooms but share a common living room, dining room and kitchen. Each home has one or two staff to look after the residents and do the cooking.

Another view of the homes. 

The staff at Hogewey outnumber the residents 4:1. You will see them as housekeepers, shop assistants and minders, but you won't find them in staff uniform. Volunteers are identified by a nondescript badge they wear. Hogewey takes great pains to avoid any resemblance to a hospital or a nursing home. Instead, it strives to make Hogewey as close as possible to a small gated neighbourhood complete with its own supermarket, cafe, restaurant, beauty salon and theatre. There is a large central square and smaller ones or courtyards with benches and chairs where residents can sit and soak in the sunshine, weather permitting.

(When we were there, there was intermittent rain. That explains why you don't see any residents outdoors in the photos.)

Join me as I take you on a tour of Hogewey.

The main boulevard, with shops flanking both sides.

The cafe is the first outlet you see on your left as you walk along the boulevard.

This is probably where the residents go to work their muscles and limbs.

There's even a repair shop in case anything needs fixing.

Inside the beauty salon. We didn't get to enter so this image is taken from the Daily Mail.

This is The Passage - a spacious hall where the residents gather to enjoy group activities. There is always music playing in the background as the elderly love music from the old days. Expect to see some of them dancing too. We did.

That's Marianne at the door of the Rembrandt Room. This is where the residents enjoy art and craft activities.

The supermarket at Hogewey is well-stocked. Every item carries a price tag. The cashier issues a receipt for purchases but no cash changes hands. All transactions are covered in the residents' payment scheme.

There are no locks anywhere. Doors and elevators open and close as you step on the weight-sensitive floor panel. Residents have the freedom to move around and participate in the daily programme of activities if they wish to. The objective is to make life in Hogewey as normal as possible, and as close to what they are accustomed to.

No need to press any button or turn any door knob. Doors open when you step on the floor panel in front of it.

According to Yvonne in the CNN interview, the concept works. Residents do not need as much medication, they seem happier and are living longer. The Hogewey model has been replicated in Canada, Switzerland and the UK, and that's evidence of its success, aside from the awards it has won since 2010. Apparently those on the waiting list have to wait at least a year before there is a vacancy. That only happens when a resident has passed on. Hogewey is where those with severe dementia come to live out their remaining years in peace and with dignity.



The residents I met while strolling around Hogewey gave me friendly smiles and nods. Except for one resident in a wheelchair cuddling a doll, visitors would not know that the elderly folk enjoying activities in The Passage have Alzheimer's. A group was happily playing a board game, another was setting up pins for bowling.

To the outsider, Hogewey is a microcosm of a make-believe world. But to the residents, it is a reality that is a continuation of life as they know it, in a setting that they are familiar with.

Programme of activities in Dutch, of course.

The burning question readers might want to ask is: How much are the fees? Around USD3600 per resident per month. It's heavily subsidized by the Dutch government, otherwise it would cost upwards from USD8000 a month. At such figures, only the super rich with dementia in Malaysia and Singapore can afford to live out their final days in this utopia.