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MDM LOW MUI LANG, EXECUTIVE DIRECTOR
The Salvation Army Peacehaven Nursing Home
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 2
2011 : Summary of Recommendation
Strengthening Nursing Home (NH) sector as part of broader plans for ILTC sector
Upgrading NH capabilities, e.g. rehabilitation, so that suitable patients can return home and age in the community
Panel of Expert includes international team - Dr Elsie Hui, Consultant Geriatrician, Shatin Hospital, Hong Kong
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 3
Transitional Convalescent Care
• Hip fracture (i.e. non-weight bearing)
• Active trial to reduce care burden (e.g. weaning off of NG tube, indwelling catheter, etc)
• Post-surgical care to prevent re-admission to RH
• Musculoskeletal, neurological and de-conditioning
• Others: wound management, etc.
1 – 6 months
Limited Social Support
• Varying quality of maintenance exercise programmes
• Varying dementia care capabilities
> 6 months
Long-term Care
Limited EOL care in NHs
With Social Support
• Caregiver fatigue/stress
• Crisis management
Respite Care
2 weeks – 1 month
Estimated ALOS
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 4
Patient Profile Care Delivered
Rehab stream 1. Musculoskeletal (hip and
other fractures, amputees, arthritis), neurological (post-stroke) and de-conditioning
• Rehabilitative and nursing care • Caregiver training
Transition care stream 2. Active trial to reduce care
burden • Nursing care and therapy (where required,
e.g. wean off urinary catheter, NG tube) • Caregiver training
3. Post surgical care (e.g. post-abdominal surgery)
• Supervised recuperation and med administration to prevent RH readmission.
• Facilitate routine post-op follow-up at SOC
TCF: Patient Profile
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 5
Integration Partnership 24 hours Rehabilitation Wellness Prevention
Keys to Success
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 6
Integration
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 7
7
Eastern Health
Alliance
Na nal tio ni v ers y i t U H e a l t h S y s t e m
H e a h t l S e e
e a
r
r o p g n i
i v c s
S
Eastern Health Alliance
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 8
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 9
SingHealth and EHA Regions
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 10
Residents in the East
Changi General Hospital
Transitional Care
Deliver person -centric, seamless care
Facilities (Infrastructure)
GP First
Family Medicine
Centre & GPs
Community Health Centre
Well Acute illnesses / Chronic diseases / Functional decline
Advance illnesses/ End-of-life
ECHO Neighbours for Active Living
Programmes/services
Grassroots
Social support
VWOs
Day Centres / Rehabilitation
Community Mental Health
Healthy lifestyle
Prevention of diseases
Recovery / Optimum control / Rehabilitation
Medical and nursing support
Health Stratification
Medical Needs
Financial support; caregiver support Psychosocial Needs
SingHealth Polyclinics
St Andrew’s Community
Hospital
Peacehaven Nursing Home
Health Management Unit
GPCCP
P6B
Community Health and Social Services
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 11
1 3 2
Keeping You Healthy Making You Well Ageing Well
Transitional Care Programme
Grace Corner
Transitional Convalescent Facility (The Salvation Army)
Rapid Improvement Event Programme (SACH)
Valuedcare Hip Fracture Pathway (CGH-SACH)
SPICE
Health Wellness Programme
SACH Home Care
Programmes
EAGLEcare Heart Failure
TeleHealth Project
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 12
Partnerhip
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 13
Launch on 7 June 2012 by Minister Gan Kim Yong TCF Programme better known as Grace Corner
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 14
Values of Partnership with Changi General Hospital
Pre-admission assessment in the hospital
Medical : Geriatrician,Senior resident physician and consultation with various discipline
Hospital Medical Record Speech Therapist Laboratory Radiography Direct access to ward designated
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 15
24 hours Rehabilitation in a Home Like Environment
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 16
Intra-disciplinary care plan
Comprehensive medical review that would take into account all acute episodes; medical appointments re-organised
Nursing : Urinary and Bowel Continent, Skin Care, Medication Management
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 17
Support and counselling from social workers to assist client to come to terms with disability, Early engagement in care planning for client and family with Care giver training
Therapy : Activities of Daily Living, Transfer and Mobility, Dsyphagia Management, Assessment using Allen Cognitive Level screening tool- ACLS
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 18
Hydrotherapy (Changi)
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 19
Bedok Gym Tonic
Welmed (Gym Tonic) Exercise as medicine
Changi Gym Tonic
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 20
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 21
Nutrition – Modified diet to Normal Diet
Home leave to allow client to re-adapt to home environment : Home assessment, Home modification
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 22
Home visit 4 – 6 wks before discharge.
Multi-disciplinary team assesses home environment: OT, NA/TA, MSW, patient and caregiver.
OT engages retro-fitting and other services (e.g. walking aids, beds, commode chair)
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 23
Conditions % of Clients
Fracture 40%
Stroke 30%
Medical 10%
Musculoskeletal, neurological & de-conditioning 20%
Total 100%
No of Admissions No of Discharges
420 ( total admissions including existing clients)
Admissions & Discharges 1 December 2011 to 30 April 2017
Profile of Discharged Clients
Discharge Details Discharge Destinations % of Clients
Home 70%
Hospital (Re-admission) 17%
Voluntary Nursing Home 10%
Private Nursing Home
Sheltered Home 3%
Total 100%
Referral to Community Based Services Services No of Clients Integrated Home and Day Centre (IHDC) 20%
Others (day rehab, day care, transitional care, geriatric day hospitals, home care services)
60-70%
Transitional Convalescent Facility
Provide slower stream lower intensity rehabilitation and transitional care
What
Enhance patients’ ability to return and live in community
Why?
RHS – Eastern health Alliance (EHA) Changi General Hospital to Peacehaven Nursing Home
Where?
Exit coordination / case management
Average length of stay (ALOS): 3 – 6 months
Tigh
t gat
ekee
ping
Home
(with IHDC support/comm services)
How?
More time needed to assess rehab potential
24
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 25
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 26
Wellness
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 27
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 28
• Pilot we did
• Result
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 29
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 30
WELMED + interRAI WELMED + interRAI Baseline assessment
Control N = 15
Treatment N = 15 Randomisation
(Total N = 30)
WELMED + interRAI N = 11
WELMED + interRAI N = 15
Post-intervention assessment
Intervention
Progressive strength training 2x/week
Intervention phase (12 weeks)
Treatment As Usual
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 31
Abdomen/Back
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 32
Those in intervention group more likely to see improvement in depression symptoms. In general, no worsening of symptoms across both groups.
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 33
Those in intervention group benefited from increased leg muscle strength (median change = +10.9%) Those in control group less likely to see improved leg muscle strength. (median change = -2.6%)
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 34
Those in intervention group had marked improvement in 5TSTS (median change = -25.8%) Those in control group less likely to have improvement (median change = -0.1%)
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 35
BP taken before and after exercise
Saves manpower
Saves time 9 exercise stations = 30
minutes
1 Exercise Therapist
2 Persons With MODERATE Dementia
1 Exercise Therapist
3-4 Persons With MILD Dementia
OR
One trainer, multiple users
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 36
1. Positive effects on mood 2. Improvement in functional measures
(e.g. FTSTS) 3. Improvement in muscle strength
(e.g. leg extension) 4. More efficient user of manpower Larger sample size needed for better statistical inferences and trending
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 37
Effective method to slow down aged related sarcopenia and other triggered problems
Proven and widely adopted method in developed countries like Japan and Finland
Plethora of benefits Mobility + independence ( functional years) Balance ( fall risk) Relief from arthritis ( pain) Stronger bone density ( fracture risk) Weight management ( chronic disease) Sleep quality ( energy) Healthy heart muscle ( heart health) Overall well-being
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 38
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 39
Prevention
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 40
Day Centres
Changi and Bedok
MDM LOW MUI LANG, EXECUTIVE DIRECTOR 41
Most clients attending 1-3 days have caregivers (family member or maid) available at home but will benefit from medical/nursing support, maintenance rehabilitation and respite on some days
Clients attending 4-5 days mostly have caregivers at home only at night and on weekends
Clients attending 6-7 days either have no caregivers at all, or caregiver work on weekends as well
Programme : Integrated Home and Day Centre
MDM LOW MUI LANG, EXECUTIVE DIRECTOR
42
• 88yr old, Chinese female (CGH
pt with a referral for Nursing Home)
Upon admission:
• Total dependencies on ALL
activities of daily living
• No capable caregiver in the day
Currently:
• Enrolled into SPICE in Oct 2010
• Undergoing daily rehabilitation,
social activities and receive
nursing and personal care
• Now able to walk, feed and
shower with minimal assistance
MDM LOW MUI LANG, EXECUTIVE DIRECTOR