THE DECISION to place your loved one in a home can be emotional and guilt-ridden. The last thing you need at such a time is additional stress trying to find the right home, visiting each one and being uncertain of how to choose one.
Norashikin Cheong Abdullah, head of Training and Quality Assessment at the Aged Care Group, says that placing a loved one in a nursing home or any other type of home is something we dread.
“If we can, we would like them to age at home. However, sometimes, there comes a stage when the caregiver can no longer take care of the loved one themselves as the elderly’s condition or disease progresses and becomes more chronic. I think if we really cannot handle taking care of the elderly, then that is the stage we have to decide whether or not to send them to a home. The home will have the facilities and trained staff to take care of our loved ones,” says Norashikin.
In Malaysia, there are a few options when it comes to homes for the elderly:
- Retirement home
- Care centre
- Nursing home
A retirement home is for the elderly who are still independent and mobile. However, their home may not be elderly-friendly, or they may be lonely. This is where residents live as they would in their own home, but with added benefits such as regular social activities, an increased sense of security, a 24-hour emergency call service, access to communal facilities, and home / garden maintenance services.
Care centres are those registered with the Department of Welfare of the Ministry of Women, Family and Community Development. They are meant for residents who need a low level of care.
Nursing homes are those regulated by the Private Healthcare Facilities & Services Act 1998 and registered with the Health Ministry. Generally, nursing homes are for seniors who require a higher level of care, whether it is 24-hour monitoring or medical assistance.
According to Norashikin, there are many factors involved when choosing a home for your loved one.
Here are some factors to consider:
What type of care does your loved one need?
Does he require 24/7 care for any of the following?
– Medication(s) by injection every 24 hours
– Artificial (Ryle’s tube) feeding /PEG (percutaneous endoscopic gastrostomy) feeding
– Immobility – need assistance with complex prosthesis or walking supports i.e., unable to weight bear at all
– Intensive rehabilitation following surgery, stroke or complex illness
– Physical and pain therapies
– Palliative care for cancer
Financial capabilities and sustainability
The charges would normally include the room, laundry, personal care and meals. It typically excludes milk formula for tube feeding. There are extra charges for medication, clinical services and therapy visits.
Prices vary depending on where you go and what your needs are.
Services offered by the home
Generally and optimally, the following services should be provided by care centres and nursing homes:
- 24-hour supervision and security
- Daily meals
- Maintenance repairs, including appliance, safety, and living repairs and updates
- Health and exercise programmes
- Activities and entertainment
- Social programmes
- Access to medical services
Medical care available
Depending on the type of nursing home, the medical care available varies. Those providing high care might have an attending doctor 24/7 or there might be an arrangement for medical care with the nearest hospital.
Those providing middle to low care need not have an attending doctor, but they might have a doctor who visits monthly to check on the health of the residents.
Distance of home from the family
This is entirely up to the family. Some may prefer to have the home nearby so they can visit often or drive over if there is an emergency or any issues to be sorted out. Others may prefer to opt for a “better” home even though it is a bit farther.
Quality of staff
By regulation, all nursing homes must be looked after by at least one registered nurse on a 24/7 basis, supported by trained caregivers.
The registered nurse-resident ratio should be:
High care – 1:8
Low to medium care – 1:18
Since care centres and nursing homes are registered with the government, they must meet the staff ratio regulations set by the authorities.
Besides having enough trained staff, homes should also have staff who are friendly, courteous, polite and treat the residents well.
Design and layout of the home
Families should also check out the home, have a look at the rooms, bathrooms, dining area and living room – are there steps, is it brightly lit, are the corridors wide enough, are there grab bars in the toilet, are there anti-slip tiles?
A good indication of any home is its residents. Do they look happy and healthy? Are they well taken care of? Do they look bored or grumpy? Are the terminally ill lying in the corridors? You could even speak to the residents and ask them how they like staying there.
“Loved ones with Alzheimer’s Disease and dementia should preferably be at a Special Care Unit (SCU) designed to meet the specific needs of individuals with Alzheimer’s and other dementias. SCUs can take many forms and exist within various types of residential care. Such units most often are cluster settings in which persons with dementia are grouped together on a floor or a unit within a larger residential care facility,” explains Norashikin.
According to her, the security at such units would be heightened so as to prevent residents from wandering out of the home.
While there are homes which are specifically for Alzheimer’s and dementia residents, their number is limited.
Norashikin advises families to check if the home is licensed with the authorities, insured, and registered with the Fire and Rescue Department (for adherence to safety regulations).
“Selecting a nursing home with certification may give you some peace of mind to the extent that at least that home is registered.
“The most important is the certification of building safety as regulated by the Fire and Rescue Department, meaning the building is safe for occupancy,” explains Norashikin.
When visiting a home, there are certain things to watch out for. Here are some things that should set off warning bells:
- Frequent arguments or tension between the caregivers themselves.
- No respect or frequent shouting between the caregivers and support staff of the home.
- Staff not instantly responding to resident’s call-bell.
- Insufficient staff.
- Staff showing disrespect to any resident.
- Unkempt residents, with mismatched or untidy clothes.
- Residents left alone too long, meaning unattended throughout your survey visit at the home.
- Most of the residents are coughing or having runny nose – this implies an unhygienic air supply or environment resulting in residents developing upper respiratory infection.
- Residents with Plaster of Paris, signs of fractures – could be a sign of negligence resulting in falls.
- Residents look unhappy and quiet, preferring to sit in isolation.
- Too many residents compared to available facilities and staff.
- No attached bath and toilet.
- Place looks dirty with remnant foods on the tables, floors, etc.
- Residents of different gender sharing a room.
- Place shows no signs of activity, lifeless during the visit.
- Place appears rundown, there is a stench or unpleasant smell, flies, or roaches. Worst case scenario – sight of rats.
- Utility room, kitchen/dining area not clean.
- Medication trolley in a room and kept unlocked.
- No space for resident to meet with family members.
- No recreation or entertainment space.
- Beds placed along corridors or unusual areas – sign of overcrowding.
For those who already have a loved one in a home, Norashikin suggests doing spot checks.
“If you notice a change in behaviour in your loved one, or if your loved one suddenly appears unhappy or even becomes depressed, something is amiss. Check to see if there are bruises on your loved one’s body/hands/legs. These are signs of abuse or ill treatment or minor knocks due to falls or staff negligence or the effects of using restraints. Is your loved one complaining of pain? Look into it urgently. Take them for a check-up or consult the resident doctor,” says Norashikin.
Families should not be afraid to switch homes if their loved one is not happy or if they are dissatisfied with the quality of care.
“It is your right to change homes because you are paying for it. You have your loved one to protect. The elderly should be happy in whichever home you place him or her in.”
It is not necessarily true that the expensive homes will be better than the cheaper ones. The services provided must be good, above all else.
For those who are reluctant to send their elderly family member to a home, there is the option of adult day care.
This is ideal for working adult children who have nobody to be at home with their elderly parents. They can send their elderly parent to the centre when they go to work and pick them up on their way home.
There is no overnight stay. The centre would arrange for social activities and also take care of the elderly’s medication and meals.
Depending on the adult day care centre you choose, they might take immobile elderly, too, and there are specialised centres for Alzheimer’s and dementia patients, too.
Adult day care centres would normally charge about RM25 an hour, inclusive of meals and activities.
Speak to the experts
Before you step into a home, you should do your research online, check out the home in person and talk to the elderly who are already staying there.
This can involve quite a bit of work and time.
Alternatively, you can go to ACG’s wholly-owned subsidiary Managedcare Sdn Bhd, which offers care services, including home assessments for your loved ones. When you register, Managedcare would find out your requirements and your loved one’s needs. The company would assess your loved one and come up with a care plan and provide suggestions for where they can be placed. If your loved one doesn’t need high care, they shouldn’t be placed in a facility that offers high level care. This will bring the cost down a bit.
Managedcare will be able to tell you if the nursing home you have your eye on is registered with the Fire and Rescue Department, and what services and facilities it has.
Norashikin’s advice to those shopping for a home for their loved one is to be realistic about the care/services offered. She points out that the local scenario is unlike what you might see in American TV programmes.