LOOKING FOR A GOOD AGED CARE FACILITY? READ THIS FIRST.

SeniorsAloud regularly receives emails and whatsapp messages enquiring about nursing homes for a loved one. First, let me say that we do not operate a nursing home. Second, we are not working with any aged care facility or retirement home operator.

Most of the enquiries we receive lack details, so we can't advise even if we would like to help. Here's a typical one:

"Hi, I am looking for a suitable nursing home for my elderly aunty. Can you please recommend a good one? Thank you."

Not much detailed info for us to work on, is there?

We always recommend doing an online search first, and narrowing down the list to a handful of addresses based on location, fees and facilities. Next is to follow up with a visit to each of the homes. Never rely on website info alone to make a choice. Glossy images may belie actual reality. They are part of marketing strategy to attract and appeal to potential clients.

Here's a checklist of what to look for on your first visit to the home. Be sure to ask the right questions.

1. Is the home licensed? This serves as a good guide as certain conditions need to be fulfilled before a license can be issued. Operators of aged care facilities in Petaling Jaya, for example, should have two licenses - a business license issued by MBPJ and the other by Jabatan Kebajikan Masyarakat (JKM). Ask whether there is a proper admission procedure. Is there a board of trustees or at the very least a management committee to oversee the running of the home? Homes that are run by one or two individuals with little relevant experience or qualifications are likely to be unlicensed. There must be checks and balances to ensure proper and efficient supervision and management of the home.

A simple, uncluttered room that is clean, airy and well-lit. Would be better to have bed rails to prevent the elderly from falling off the bed. The bedside rug should be non-slip and the edges weighted down to prevent tripping.

A morning exercise session for the elderly residents.

2. Are the nurses and other staff trained? Remember, you will be leaving your loved one in their care 24/7. Do they treat the residents with respect and kindness? Do the staff include medical/health professionals e.g. doctor, physiotherapist? Do the staff look overworked or unfriendly? Are they mostly foreigners or locals? Are they able to communicate with the elderly to understand their needs? What are the provisions for emergencies e.g. falls, stroke, or worse, cardiac arrest? Do the staff keep you informed about your loved one when you are away? What is the staff/resident ratio? A rough guide would be:

• For semi-mobile residents who require some assistance with daily activities. Ratio is 1:8.
• For wheelchair bound or bedridden residents who may have mental sickness. Ratio is 1:4.
• For fully dependent residents who have mental or behavourial problems and are unable to cope with daily living on their own. Ratio is 1:2.

A nursing home with a garden scores a plus point. Residents can enjoy the outdoor sunlight and fresh air, or engage in some exercise, or in gardening.

3. What is your first impression of the facility? Clean? Odourless? Well-ventilated and well-lit? Elder-friendly furniture and fixtures? Quiet surroundings? Safe and comfortable environment? Any greenery? If it's a double-storey building, look for a fire escape outside. If the home looks uninviting from the outside, there really is no point in ringing the doorbell. It will be a total waste of your time.

Daily activities and planned meals at a home for the elderly.

4. Are there planned meals and activities? Is the menu changed daily? Are the residents left to themselves to watch TV most of the time? Does the home arrange for outings or for volunteer groups to visit regularly and entertain the residents? Do the elderly residents look neglected?

Karaoke session; Bingo. Some homes conduct handicraft and art therapy.

5. Ask about the fees. Is a deposit required? Are receipts issued for payments?  Be prepared to pay more if you expect a certain level of care and facilities. The range can be as low as RM2000 a month to as high as RM5000 or more, depending on the type of care required, single room or dorm, and services provided. What do the fees cover besides meals? Laundry? Diapers? Medication? Personal toiletries? Hair cuts? Personal grooming? Daily checks for blood pressure, etc? 

To meet the needs of a growing elderly population, operating an aged care facility, whether it is a nursing home or a daycare centre, has become a thriving business. Private nursing homes are a common sight in residential neighbourhoods. Most are housed in converted bungalows rather than in purpose-built facilities. Nearly all have attractive websites promising appealing surroundings and tender loving care. Don't be taken in by the hype.

Ask around for recommendations from friends who have a family member in a nursing home. Let your fingers do some research online to back up a recommendation. Then contact the home to arrange for a visit. If they say you are welcome to drop by anytime, it is a good sign that they are prepared to be 'inspected' at your convenience, and not theirs. Remember to ask the right questions during the visit, and make a mental note of everything you see, both good and not so good. 

This was one of the best aged care facilities I have visited. Pity it had to close due to the location - too far for families to visit daily.

I hope this article gives you an idea of what to look for in a good home for an elderly. You will be surprised how many homes you will strike out from your list before you finally find one that could be the answer to your prayers.

(Note: Images of homes featured in this post are the property of SeniorsAloud. Permission is required to use the images.)

EXPORTING GRANDMA AND GRANDPA

IS GRANDMA DESTINED FOR EXPORT TO JB?
by Janice Tai, Straits Times, April 9, 2015

LAST month, The Straits Times reported on the growing number of infirm Singaporeans who have been admitted to nursing homes in Johor Baru.

I was one of the reporters involved. Back home, I had a hypothetical discussion with my grandma on considering that as one of her retirement options.

Across the Causeway, you can get a room in a bungalow for half the price here. The elderly person can tend to the spacious garden outside instead of being cooped up in an eight-bedded ward reeking of stale air, or worse, urine.

Grandma, usually cheerful and mild-mannered, snapped in Hokkien: "I'd rather jump from this building than go there."

Despite her visceral objection, the fact of the matter is that more people in Singapore will soon need to have this discussion on nursing home care for elderly family members.

Sending Grandma to JB is, of course, not the default option.

But the economic case is compelling. Cheaper land, construction and labour costs in Malaysia can halve the cost of nursing home care.

Singapore is also short of nursing home beds, with an average waiting time of several months to be placed in a nursing home. That's because many homes here have been full for years and beds are freed up only when occupants die. All 401 beds at Peacehaven nursing home, for instance, have been occupied for at least the last 10 years.

Aged sick: The new export

THE idea of sending the old and sick to low-cost neighbouring countries may attract unease, as in 2009 when then Health Minister Khaw Boon Wan suffered much flak for suggesting it as an option.

But, in fact, the idea has taken off in other developed countries, where there is a shortage of qualified nurses and facilities amid soaring costs and a rapidly greying population.

But is this arrangement what our elderly folk and their caregivers really want?

My colleague and I spoke to three old people in JB nursing homes who thought they were still in Singapore. Dementia patients make up about half the elderly residents in local nursing homes.

But senior social worker Jasmine Wong at Hua Mei Centre for Successful Ageing says that dementia patients benefit from being in familiar, not strange, surroundings: "Persons with dementia retain old memories while struggling with recent events - so being in a familiar place helps relieve their anxiety and familial visits play an important part in that assurance."

Some research links family involvement and visits to better life satisfaction and early discharge back into the community.

So while nursing homes in JB may make sense as cheaper options, they are at best a niche solution for some. For one thing, their cost is not subsidised. Even a bed in a shared home in JB costs $600 a month - beyond the reach of poorer families.

For the masses in Singapore, there is no running away from the challenge of having affordable, quality nursing homes, especially as the population ages rapidly.

The cost of care

MOST nursing home patients in Singapore pay about $450 to $500 a month for a place, after government subsidies. Nursing home fees in Singapore range from $1,200 to $3,500 a month. This is before government subsidies of between 10 per cent and 75 per cent.

Nursing home operators cite rising labour and land costs as one reason for fee revisions. Econ, for example, raised fees by 10 per cent three years ago. This year, fees went up another 10 per cent, or between $220 and $440 a month. In that same period, wages went up 16 per cent.

What can be done to keep fees low?

SINCE 2012, the Health Ministry (MOH) has operated a new Build-Own-Lease (BOL) model where it builds and owns nursing homes and leases them to operators who have to bid to run them.

This puts downward pressure on fees because affordability is a key evaluation criterion in awarding such leases. Appointed operators are held to their proposed fees for the duration of the bid.

The BOL model also helps to reduce the capital outlay for operators. However, it will apply only to most of the 19 homes coming up over the next five years. There are 66 nursing homes now.

Another way is to incentivise existing operators to keep fees down in exchange for grants. This has worked to slow down fee increases in the childcare sector, where "anchor operators" have to satisfy fee requirements in order to get grants.

New approaches to care

BEYOND cost, there is much that can be done to raise quality. Chief executive of Lien Foundation Lee Poh Wah considers the state of nursing homes here dismal. "I view most of them as cold, clinical factories housing warm bodies which are awakened, cleaned and fed on a regimented schedule. There is an institutionalised absence of life and joy."

Single rooms are the norm rather than the exception in countries such as Australia, Japan and Britain. It is the reverse here, he said, with most people housed in six-bed to eight-bed wards.

To bring back the "home" aspect in the nursing home, the Lien Foundation is setting up a new $15 million building for elderly dementia patients next year.

Besides having single or twin rooms with en-suite toilets, the home will feature a rooftop garden, hair salon and grocery store. Residents can engage in social and recreational activities whenever they wish instead of adhering to fixed schedules.

More operators could develop care models that create homely environments where residents can choose their own schedules, not adhere strictly to regimented ones.

The time is right for a revolution in nursing home care.

One area crying out for a change is facilities for dementia patients. One in 10 of the older adults already has the brain disorder. But many nursing homes here are not purpose-built for them and they can often be seen wandering aimlessly along the corridors.

With a spike in the number of nursing homes, there should also be a way to assess the quality of homes, and publish these ratings, as the United States does.

Already, Singapore is one of the fastest-ageing countries in the world. As of last June, there were more than 430,000 people in Singapore aged 65 and above. That is a whopping 100,000 more elderly folk than just four years earlier.

The numbers are likely to rise to nearly one million by 2030.

It is clearly not feasible to think about exporting Singapore's elderly en masse to low-cost neighbouring towns.

In the end, sending Grandma to JB is not the best solution to the issue of providing aged care.

jantai@sph.com.sg

(The full article is available only to subscribers of Straits Times. Get a copy today or subscribe.)

CHOOSING A NURSING HOME

There may come a time when caring for your AD or Dementia afflicted relative at home is no longer feasible. So with great reluctance, anxiety and apprehension you face the inevitable - the need to transfer your loved one to a Nursing Home. Today, an ever increasing number of us face this sad situation owing to the lack of available suitable helpers or family members to care for our aging relatives at home.

To meet this growing need Nursing Homes have become a thriving business and a common feature in most suburbs. Most are established in remodelled existing bungalows rather than in purpose-built facilities. Nearly all have attractive websites promising appealing surroundings and tender loving care.

How then do you choose a Home for your beloved relative? Simple answer – be informed. Disregard the website promises: visit the Homes, observe and investigate. Most importantly, ask the right questions.

Assuming that you are checking out a licensed Home that fits your budget and is easily accessible, the following is a brief list of what to look for, and questions you need to ask the Home Administrator and/or Nurse in Charge before you entrust your relative to any Home.

Staff should not only be qualified and experienced, but also be caring.

THE NURSING HOME STAFF

Investigate this aspect very carefully as you will be leaving your loved one in their care 24/7. Observe how they interact with residents, whether they address residents with respect and kindness, whether they seem more interested in their phones/iPads or TV rather than attending to residents.

Questions to ask: 
What is staff/resident ratio? How many nurses/carers/helpers? Are nurses and other staff trained for AD/Dementia care? How they are trained? Do they attend ADFM’s or other courses? Do they watch training videos? Are they given handouts/guidelines on how to handle problematic behaviour? Ask to see these guidelines. Ask how they would handle the specific problem behaviour that your relative may have, e.g. wandering, aggression etc. Ask about the Home’s policy regarding use of restraints.

A clean, spacious and airy dorm with enough sunlight coming in. Note the attached bathroom and toilet.

THE FACILITIES

(Indoors): Is it clean? Odour-free? Cheerful? Have a pleasing decor rather than an odd assortment of cheap, worn-out furniture? Are upholstered chairs stained by food, urine etc? Are rooms spacious enough for the number of beds in them? Do all rooms have windows? Are rooms air-conditioned and not gloomy, hot and stuffy? Are there handrails in the hallways and bathrooms? Are there emergency call bells in each bathroom and beside beds? Are residents’ rooms and public areas safe, e.g. no slippery rugs, nothing on top of cupboards? Are there private areas for residents to be in when family and friends visit? Is there a table for residents to work or play at, do art, craft or puzzles, use iPads, play cards, etc?
(Outdoors):  Is there a garden with seating areas and paths for walking or exercise? Is the outdoor area obstacle-free with no open drains, stones and other hazards nearby?

A good nursing home should have a daily programme of activities and a well-planned daily menu.

QUALITY OF LIFE

A necessary feature of any care facility is a range of activities to keep residents active and happy to counteract the inevitable sense of isolation and insecurity they would feel away from their families.

As you are touring the building, notice if the residents appear to be doing something other than sitting on front of a TV. Look for a weekly activity schedule, which should be posted. If it isn’t, ask for one. Is there a games room or even a table for games? A library or even a bookshelf?  Computer work stations? Internet access? Any musical instruments/CD player?

Questions to ask
Are special activities available for those confined to their rooms or wheelchairs? Are volunteers encouraged to visit and/or provide programs? Any excursions, weekend and evening activities? Does the activity calendar reflect the interests of the residents? Ask to see the weekly schedule of activities. Are brain-building or memory-testing games available?

Singing and Bingo are popular activities at dementia care facilities..

QUALITY OF CARE

One of the first things to note is the overall well-being of residents. Determine if they seem alert and happy, and see if they look clean, well taken care of and properly groomed.

Questions to ask
Does the Home have a doctor on call? Does the doctor make regular visits to check on general health of residents? Are in-house services provided for residents’ hair, beauty and podiatry needs? How are residents’ dental/vision/hearing needs attended to? Are rehabilitation services available, such as occupational therapy, physical therapy, speech therapy or recreational therapy? Do residents get enough morning sun and daily exercise? Does the Home keep a record of the residents’ backgrounds, e.g. their past life; their relatives; their likes/dislikes; what upsets them; what causes/triggers problematic behaviour etc? Ask to see sample record if possible.

Meal time at a nursing home. Photo: Straits Times

NUTRITION

Nutrition is a vital part of your loved one’s good health. Nursing Homes are first and foremost a business, so make sure cost-cutting measures do not mean your relative gets sub-standard and poor nutrition. Plan unscheduled visits during mealtimes if possible.

Does the food that is being served look and smell attractive and appetizing? Does the food appear to be nutritionally balanced? Are tables attractively set with proper utensils, cutlery and napkins instead of pieces of a toilet roll? Are residents interacting socially during meals? Are residents who need help being fed with patience and care?

Questions to ask 
Are there options for residents to choose from at mealtime? Ask to see the weekly menu. Does a dietician plan the menus taking into account the special needs of residents? Can relatives eat with their loved one occasionally? Are nutritious snacks available during the day and evening?

Once you have made your decision, stay vigilant. Voice your reservations to the Home Administrator about any indifference, inattentiveness, and lack of proper care of your loved one that you notice. Make sure your concerns are attended to. Here’s what a former US Nursing Home administrator says,

“There are good and bad administrators. What do I mean by “bad”? They listen with a smile as residents and families complain — then do nothing because they don’t want to make waves with nursing staff and Management. Their job is to simply keep costs down... period.”

Do not leave your beloved relative in the hands of a bad administrator.

(The above article was submitted by guest contributor Renee Tallala. The images were added by the editor.)

THE SAD TRUTH ABOUT GROWING OLD IN MALAYSIA

I hope the article will help draw attention to the plight of the urban elderly, especially those in their 70s and 80s who require assistance with activities of daily living (ADL). Not only is there an acute shortage of decent and affordable nursing homes and retirement homes, but also daycare centres where trained caregivers can keep an eye on the old folks while their adult children are at work.

For adult children, it is a huge risk to leave an elderly parent alone at home. What if Dad falls and hurts himself? What if he has a heart attack, or a stroke? What if Mom who has Alzheimer's wanders out and can't remember how to go home?

The sad truth about growing old in Malaysia
By Raphael Wong
Thursday, 10 Oct 2013, 07:15 PM

Where do you go when you grow old? In Malaysia, there are not many choices, especially for those from middle-class families.

The rich and affluent can afford the top of the line nursing or retirement homes, some of which costs upwards of RM8,000 a month. The poor can look to the government for assistance, mostly through the Welfare Department and get a place in an old folk’s home.

But those in the middle class will be left to fend for themselves. They cannot afford the high-end nursing or retirement homes, and neither do they qualify for government assistance – a problem that will persist and have a major social impact as the Malaysian population begins to age rapidly.

According to the Statistics Department, there were 1.4 million Malaysians aged 65 years and above, or about 5% of the total population in 2010. This number is set to soar to an estimated 2.2 million by 2020, accounting for 6.8% of the population.

Given that the middle class make up 40% of the population, there will be a huge portion of the population who will end up growing old either with not enough money to have a decent retirement or not poor enough to be entitled to state care.

How then do these people cope? There is the old Asian tradition of living off your offspring but even that is wearing thin. The other is to find an affordable retirement home, but there is no guarantee that they will offer the right kind of care and services.

Do our nursing homes provide adequate care? Find out on page 10 + 12 of The Heat.

THE TRUE COST OF AGEING WELL

Staying active: For RM1,800 a month, residents of 
St Mary’s Nursing Home receive care and take part in 
activities  such as a race aided by staff.

(This article first appeared in The Star on 23 May 2013. It is well worth reading to get an idea of how much it costs for us to remain healthy, active and looking good as we age. If you wish to know how much it costs to keep an elderly parent in a private nursing home, you can read the full article here.)

BY 2020, the Statistics Department states 3.4 million individuals will be able to tell their younger counterparts, “I have eaten more salt than you have rice.”

Within this group, the number of elderly people over the age of 75 will reach 1.1 million. The perks of being a senior citizen may include 50% discounts when it comes to bus fares, air tickets and train rides, but to enjoy these discounts, one needs to be financially and healthily sound.

So how much does one need in preparation for their golden years?

On the cosmetic front, Malaysian Hairdressing Association (MHA) president Billy Lim reckons some 50% of 60-year-olds in urban areas will resort to colouring their hair in the bid to keep appearances fresh.

By some estimates, about 840,000 individuals will spend between RM100 and RM200 a month in salon colour procedures, which will enrich the hair industry by RM168mil nationwide on a monthly basis.

This will not include additional hair treatments for hair loss, repair and texture improvement which will cost an additional RM80 to RM200 per customer, depending on individual condition.

On medical bills, consultant physician and geriatrician Dr Rajbans Singh, concurs this will depend on how one is ageing.

“Someone who is ageing well will not need much. I have patients who only see me once a year for a regular check-up and the cost will just be a few hundred ringgit,” said Rajbans, 53.

This low-expense scenario, however, changes dramatically with the onset of disease.

“If one has multiple pathologies and is on multiple medications and requires frequent visits to the doctor, the cost could go up to almost RM1,000 a month in the private sector, up 10 times if the patient needs hospital admission.

“The cheaper option would be to resort to government healthcare, but the waiting time can be longer and the hospitals much busier,” he said.

Keeping each other company: Khoo Soo Bee, 74, (left)
and the oldest resident at St Mary’s, Tan Li Ping, 91,
became friends at the home.

For those who believe in setting up an umbrella before it rains, there is an option in DNA profiling. This can allow physicians to identify potential diseases that may occur. In seniors. Rajbans points out this can be used for more accurate prescription of supplements for health and wellness instead of relying on guesswork.

Depending on the number of genes and number of consultations, this can cost between RM2,500 and RM4,000, but it will be a one-off as genes don’t change.

Rajbans points out there is no quick-fix solution to the goal of ageing well and keeping medical costs low.

“A healthy lifestyle is the key. I tell patients that wellness is proactively doing things every day to prevent disease, whether it is in terms of nutrition, exercise, stress management or avoiding toxins,” he said.

Leading by example is Professor Emeritus Datuk Khairuddin Yusuf, the former department head of obstetrics and gynecology in Universiti Malaya Medical Center (UMMC) and author of Aging: A Beautiful Journey, published by UiTM Press.

Now 74, Khairuddin’s journey towards his current state of fitness began at age 32, two years after obtaining his fellowship from the Royal College of Surgeons in Scotland during the late 1980s.

The workload of applying for grants, writing books, conducting research and learning Chinese so that he could communicate with his patients filled his briefcase to the brim.

“I began to notice my health was far from good. So, I decided to get some exercise by going for regular swims at the pool in Kelab Syabas (now PJ Palms Sports Centre) for under RM2 per session,” said Khairuddin.

For all of life’s challenges, Khairuddin’s answer was not to turn to drink or drugs, but exercise. When he lost his first wife to cancer, he took up yoga. To combat the stresses of work, he took up judo. Both activities cost RM20 a month each.

By the time he turned 50, the expenditure for his sporting activities would match his “work hard, play harder” motto for this was when Khairuddin discovered the joys of mountain climbing.

One of his climbs would include forming an expedition to Mount Kilimanjaro that would cost the team US$20,000 (RM 60,469.90) as mountaineering gear at that time was mostly imported.

To better his skills, he also enrolled in the Himachel Pradesh Mountaineering School in India for personal tuition, paying RM2,000 to prepare himself to scale Mount Aconcagua in Argentina.

By the time he was near 60, the father of four children, who had also taken to competing in triathlons, would be the proud owner of a RM30,000 Velo bicycle.

But one angioplasty later, the former government servant who paid just RM17 for a procedure that would have easily come up to RM40,000 if done at a private hospital, was forced to decide on something a little more sedate by his loved ones.

Beauty regime: Way Tow enjoys a manicure in the comfort
of her own home attended by an Indonesian helper as
Ee Hup looks on.

As the golden rule of happy ageing revolves around pursuing things that make one happy, Khairuddin took private dancing classes, paying up to RM100 per session.

By the time he was ready to show off his twirls at dance competitions at age 68, he was paying the instructor up to RM800 a month in training sessions at his home.

It was worth it as out of 20 competitors, Khairuddin and his partner, a mutual friend of his second wife, came seventh in an international event.

Sandwiched between mountaineering, triathlons and dancing classes, Khairuddin also managed to slip in vocal lessons where he showed off his talents as an operatic tenor, singing in Spanish and Italian.

At one event, after his rendition of Beautiful Maria with the Puchong Orchestra in Shah Alam, some 20 girls came running after him for his autograph.

By the time, he was 70, the people from the Selangor Orchestra were requesting for him. Rising to the challenge, Khairuddin promptly engaged a voice coach. RM2,000 and eight months later, he was ready to give them his Spanish rendition of My Way.

Today, Khairuddin reckons that in addition to his fitness club fees of RM150 a month, an additional RM100 goes towards gym gear, which is equivalent, if not more than, the amounts that may go to maintaining a nicotine or booze habit with zero health benefits.

What of the elderly who will need care?

For Mei Heon, 39, who has opted to care for her parents Heon Ee Hup, 86, and So Way Tow, 83, it is their medical bills that make up the bulk of the expenses.

About two years ago, Heon’s father, Ee Hup suffered a stroke which took place in the same year her mother, Way Tow, sustained a fractured hip after slipping in the kitchen in the wee hours of the morning.

The bill for Way Tow’s private-hospital bill came up to RM18,000, the total for a two week stay. This would not include the cost of Ee Hup’s RM5,000 hearing aid and his monthly insulin injections and eye drops, which come up to some RM200 a month.

Incidentally, when Ee Hup came down with stroke, he was on holiday in Tibet, which meant he had to be treated there before flying back to Malaysia. In all, Ee Hup’s medical bill and air fare cost another RM20,000.

Though Heon is fortunate enough to work flexible hours as a wealth-accumulation adviser, she has to engage the services of a full-time maid for about RM700 a month to look after her parents when she is at work.

As the youngest of six siblings, Heon is able to share the expenses with her brothers and sisters.

But the crucial factor that would allow Ee Hup and his wife, Way Tow, to live in relative comfort in the cool interiors of their bungalow in Taman OUG is the former’s prudent habits with money as a businessman in his younger days.

“If my father had not invested his money in property, it would have been very hard for us his children financially,” said Heon who felt that people should seriously consider having medical insurance.

But for this doting daughter, it is not the expense, but the quality time with her folks that matters. No matter how busy, she makes time to take her parents for their morning exercise at the nearby park every Tuesday though she has bought both exercise bikes at home.

“For me, there will be no question of sending my parents to a nursing home, not after all that they have done for me,” said Heon who obtained her degree in actuarial science in Australia.

But when care for the elderly has to be centralised, owner of St. Mary’s Nursing Home, Sonia Jagit Kaur, 60, gave a frank calculation.

For RM1,800 a month, 12 workers ensure residents are given five square meals daily, that medication is managed and dispensed accordingly and residents are kept active and entertained with games and activities.

Those who can afford up to RM2,300 a month are entitled to a single room with a television, air-conditioning, attached bathroom and a double bed.

Costs are higher for bedridden patients who need full-time nursing care. A ripple mattress to help minimise bedsores can cost up to RM50 a day. Adult diapers are an extra RM300 a month, and changes are done three times a day. Those on tube feeding and urine catheters are charged RM60 per change.

Sonia said the rates are expected to rise in the next 20 years in line with inflation, though the challenge is not in keeping the books in the black or the residents content but in assuring relatives their loved ones are well cared for.

“Today’s generation is well-educated and they are naturally more demanding,” said Sonia who reports annual revenue of RM600,000 a year for the home.

Of the 58 residents residing in the 28-year-old nursing home, more than 20 are bedridden, six are Parkinson’s patients and another two, need round-the-clock care as they are in the advanced stages of Alzheimer’s.

Sonia cited reasons why children see the placing of their elderly in a nursing home as a safer option. In serious cases, an elderly patient may be bedridden and require nursing and constant care, a daunting task for untrained care-givers.

“Rather than leave them home alone, they see it as a safer option to bring the elderly here. In some cases, the frightening experience of having a parent falling and hurting themselves while they are away at work has made them come to us,” she said.

For Tung Tong Sin, 79, it was the worry of his wife, Lim Char Boh, 78, an Alzheimer’s patient, wandering out of their home and getting lost that made him put her in St Mary’s.

“There are many things she does not know now. I worry she may get hurt when I have to go out,” he said.

Sonia also observes that certain parents, anxious that their children’s careers should progress, are adamant that they do not become the cause of interruption. Some have also expressed preference to be with their own age group as they feel staying home alone cuts them off socially.

CAREGIVERS WHO DON'T CARE A DAMN

This video caused a furore in Singapore when it was first screened on Channel 8 news Thursday night. After conducting an investigation of the nursing home in question, the Ministry of Health (MOH) has issued an order for the home to stop admitting new residents.

Outraged citizens have expressed shock and disgust at the abusive treatment meted out to the 75-year old woman in the video. According to the news report, the woman was made to sit naked for 30 minutes under the full blast of a ceiling fan, and then flung onto her bed. When she groaned, one of the caregivers slapped her on the mouth.

Since the news broke, people with elderly parents at the home have come forward to relate similar incidents. Obviously this is not an isolated case.

Close-circuit cameras at a nursing home to monitor the staff and ensure all's well. (Source: Straits Times 11 June)

Elderly folks can be cranky, obstinate and verbally abusive. It takes a lot of patience to look after them, more so if they are mentally or physically unable to take care of themselves. You have to feed them, bathe them, change their diapers, accompany them to the toilet, give them their medicine and make sure they do not hurt themselves. Not everyone has what it takes to be a caregiver. When caregivers are overworked, the stress can translate into mistreatment of the very people they are supposed to look after.

This is not meant to defend errant caregivers, but rather, to place the onus on nursing home operators to ensure better supervision of their staff. For one, they should adopt MOH's guidelines on staff-resident ratio to ensure that the staff are not overworked and taking it out on the residents. This ratio varies depending on the category of residents:

Category One: physically and mentally independent residents who require less attention. Ratio of staff to residents is 1:30.

Category Two: semi-mobile residents who require some assistance with daily activities. Ratio is 1:8.

Category Three: wheelchair bound or bedridden residents who may have mental sickness. Ratio is 1:4.

Category Four: fully dependent residents who have mental or behavourial problems and are unable to cope with daily living on their own. Ratio is 1:2.

Lunch time at one of the better managed nursing homes I have visited.

I have visited enough nursing homes in the past weeks to know that many of the staff are overworked and underpaid. At one home for the aged in Petaling Jaya, I saw how one of the caregivers was feeding an elderly woman. The latter was still chewing the food when the next spoonful was shoved into her mouth. It's a wonder she didn't throw up. That particular caregiver was in a hurry as she had several other residents to feed. At another home, wheelchair-bound residents were left in front of the TV set where they would sit and stare blankly at the screen for hours. There was no programme of activities to occupy them.

One of the many privately-run homes in Petaling Jaya.

So before you register your loved one in a nursing home, do all the necessary checks. You can't rely solely on the information contained in promotional brochures or websites. Or even what the staff tells you. Drop in unannounced for a surprise visit, say, during meal time. You will have a better picture of how the residents there are treated and how well the place is managed. Be prepared for some depressing sights.