LET’S GO BEYOND EMPTY WORDS OF DEBATE IN AGEDCARE

In Malaysia, there is this newfound debatable topic in ageing, the key words that flowed through the debaters’ lips are professionalism, knowledge, training and guidelines.

In all these debates, many people argued from a very self-contextual point of view and not one with a wholistic view of the benefits, business or trials and tribulations of operating agedcare centres.

Doctors and nurses kept pointing out that caregivers without a medical qualification must not administer treatment nor conduct any procedures for the elderly. I agreed, to a certain extend but medical is only a part of the entire ecosystem of ageing. It is an important part but not the only ingredient.

A friend once quipped that homes with trained nurses and doctors are better. So, I candidly asked him in what ways are they better. He replied that they can deal with diseases and emergencies. Of course, I agree that having doctors and nurses is a plus, but it is not the only thing. In my 20 years of involvement in elderly care, I can tell you that there are only a few types of emergencies and diseases that we need to deal with, and I can also say that eventually, no doctors and nurses can prevent the ultimate result, death.

You see, nurses and doctors are trained to keep patients alive and heal them and statistics had shown that over 90% of hospital patients do go home alive. But the opposite is true to elderly centres, where over 90 percent will not see their own home again, alive.

The most often question I get was, “what if the residents die?” My question to them will be, “You mean they will not die if there is a doctor around?” My other question I like to ask my friends and inquirers, “Then can you explain why people died in hospitals, in the hands of doctors and nurses?” I just like to do that to see the changes in the faces of the inquirers.

I have personally watched residents catching their last breath, closed their eyes and carried their remains to the holding room or place. Over my 20 years I can definitely say that most never leave my place alive, I know it sounds like a bad line from a horror movie, but that is the truth.

I just like to point out that there are at least two differences in perspective in managing patients in hospital and managing residents in an elderly care centre.

The first is that hospitals deals more in healing and saving lives while elderly centres we deal with certain death, pain, emotional and mental deterioration.

Hospital see the patients for a few days and some a few months, while elderly centres live with the residents from a few months to as much as 15 years.

We are in the business of managing death. Our job is like a pilot. We keep the plane in the air as smoothly, as comfortably and as long as we can. But like all planes, it will eventually land, our job is not to stop the landing but to land it smoothly with as little bumps as we can.

Therefore, when I sit in conferences, meetings and discussions, hearing words without meaning like professionalism, training, knowledge and guidelines gave an empty resounding cacophony without accepting the fact that in agedcare, it is about dealing with death.

Recently at a Rancangan Malaysia Kedua Belas meeting or twelfth Malaysian plan, it was revealed that there are over 1627 elderly care centres in Malaysia, but according to the Welfare website there are only 382 registered centre in the list and I know for a fact that about another 100 in the process of application. So, what happened to the 1100 that are not registered with the Welfare department, are they illegal?

There are many reasons why they are not registered, in fact, there are too many to be listed in this blog here. But, let me share with you just one reason why they are not registered as several of them are good homes and I knew a few of them. They do not wish to be part of the system and be judged by professionals with their own set of knowledge, context and guidelines. They just want to serve quietly, providing the level of care needed for the price affordable to their selected target market.

Professionals from both private and public sectors are generally quick to judge but offer no solutions. If ever there are solutions, it is to close the centres down. Effectively denying the needy, both residents and family members of the only affordable solution in a location and community that serve their needs.

If ever all the 1100 centres are closed, there will be over 20,000 elderly residents displaced without any solutions in sight.

In my battle to make this industry better, I can only do one thing at a time, make sure I give my best and be professional, design systems and operations to make sure what I do is the best. I tried not to judge other centres, if ever I have to, I will help them to be better. I urge readers of this message to start giving your best and help out with centres without judging them but with love and understanding that all centres do their best in the only way they can, with the knowledge they have and against unfriendly guidelines that focus on correctness of rules and self-justifications by little napoleons in the each location.

If it is within my capability, I would like to propose to the Ministry to offer a general conditional amnesty to all centres, so that they can operate above board. I would like to see that to happen so that we can take a step by step help to make the ageing industry much better.

Let us not stop at empty meaningless superlative words, but take action in your location and in your community.

NO BEDS AT ACCIDENT & EMERGENCY AT PPUM

Let me start by saying that PPUM ((Pusat Perubatan Universiti Malaya) did not do anything wrong, their A & E was packed.

On Tuesday at 11.30 pm I received a call from my nurse that one resident was having difficulty breathing.

The vitals showed her SPO was low. My nurse had administered oxygen for her but the resident still have difficulty breathing. After discussion with my nurses we decided to admit her. Following our procedure we called a private ambulance , which usually is faster than calling 999 because they don’t ask too many questions and transfer the call.

Ambulance came at 12.30am and two of my nurses who had already packed all the essential items and documents for admission went on the ambulance to accompany the resident to hospital. On arrival at PPUM 5 minutes later, the person in charge at PPUM A & E (Accident and Emergency) told my nurses that there was no bed available.

We immediately diverted her to Assunta Hospital, a private hospital, A & E. At Assunta, the medical team stabilized her condition and did some diagnostic tests. My nurse informed me that everything was fine.  But I told her to call me back later, because I knew it is not over yet.  Remember I said Assunta is a private hospital? Well this was where I expected problems to arise.

A little bit more about the resident, she was single and the person caring for her financially is her 70-year-old sister who lives in Kuching. Her niece was fast asleep and her phone was off.

At 1.45 am, my nurse called the sister in Kuching and the Kuching sister called me in return.  The problem was Assunta told my nurse that the resident must be admitted in high care unit. But first we must pay a deposit of RM5,000. Now I must point out Assunta did nothing wrong here because this is the procedure at a private hospital.

So, her Kuching sister panicked and called me to help, now I live in Klang and I don’t like the idea of driving to Assunta to sort things out. So, what shall we do? How shall we solve this problem? Shall we transfer the resident to General Hospital KL? But it was too far. Here is the good news. I had the experience of managing a 24-hospital admission call centre for 12 years besides managing nursing homes and 10 clinics. 

I asked the nurse to let me talk to the admission unit and I asked the person one question, “Can we do online transfer to Assunta?”  He said ,”yes.”  Great . The next question is , “If we transfer the money to you will definitely admit her?”  He replied, “Yes.”

So that was done. The resident was admitted and I told the sister in Kuching, “not to worry, we have sorted the issue and now she is now admitted.” A side noe here, the sister in Kuching did not know that we can do online instant transfer, she relied on her accounts staff.

Government hospitals running out of beds is a possibility. After all, most people try to get the best care at the lowest possible cost or no cost at all. Private hospitals need deposit that’s a reality.

My key message is that we need to prepare in terms of finance and the people who can manage odd situations. It was a good thing that this resident is staying at our place with me and team who can deal with this situation or else it will be a long Tuesday night.