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The invisible angels among us

For the past three years, Ms Felicia Chan has been making regular visits to a family living in a Housing Board flat in Bedok. Most of the family’s neighbours pay little attention to her, assuming that she is there to visit relatives.

But with her hair tied loosely in a bun, and wearing an olive jumpsuit, Felicia is at work. The staff nurse from Changi General Hospital calls on the family whenever necessary to check on the condition of the elderly lady with dementia.

As Felicia takes her temperature, she asks the lady, who has difficulties in completing basic daily activities, (e.g. showering, eating, swallowing, communicating verbally and understanding people), whether she has eaten and how she is feeling.

After checking her vital signs, Felicia asks the patient’s family whether she slept well the previous night and goes on to teach the family’s new helper how to assist the elderly lady get around the house. This ensures her patient’s time at home is comfortable and equips her family and helper to provide support where necessary.

It’s just another day in the office for the 31-year-old, who is part of CGH’s Community Psychogeriatric Programme (CPGP). As part of her job, she makes regular home visits to elderly people with mental disorders such as dementia. There are about 25 patients under her care.

The CPGP is a community outreach programme that aims to improve the mental health of older persons staying in the east, enabling them to have a better quality of life.

The programme is part of the Health Ministry’s broader efforts to cope with the impact of an ageing population. With the number of seniors aged 65 and above set to almost double from around 500,000 today to around 900,000 in 2030, the Government has been building new hospitals, nursing homes and polyclinics to cope with the rising demand for healthcare.

At the same time, it is also going beyond hospitals to the community as Health Minister Gan Kim Yong elaborated in the Ministry of Health’s Committee of Supply Debate 2018. The priority is to anchor care firmly in the community, helping seniors to age-in-place gracefully, close to their loved ones for as long as possible.  The capacity growth in hospitals must therefore be coupled with efforts to transform the care model to leverage on strong primary and community care.

Primary care is the first line of care in the community, such as polyclinic or clinics run by private general practitioners. Home and community care such as community nursing and the newly announced Pharmaceutical Care Services pilot bring healthcare a step closer. Government bodies, voluntary welfare organisations and volunteers also provide crucial support alongside family, for example through the Community Network for Seniors.

This approach of shared responsibility helps ensure the healthcare system is sustainable and affordable. It also allows families to live with their loved ones for longer and ensures seniors are more at home and engaged.


Extending healthcare beyond the hospital

When CGH started its CPGP in 2007, it only had two staff for nursing. Today, the manpower for nursing has doubled to four.

Ms Norhayah Md Noor, a senior nurse clinician who was one of the founding members of CPGP, said the objectives of the initiative were multi-fold.

For one thing, CPGG helps ensure that “healthcare extends beyond acute care in hospital.”

“We see the reality of patients at their home environment, assess their mental state, check their medication compliance and safety around the house, how family is coping and address any other psychosocial issues that they may have,” she said.

Another goal is to allow patients to get cared for at home, a place in which they are most comfortable.

“Most of the elderly patients with mental disorders have multiple medical conditions such as stroke, other neurological diseases or even mobility problems. This makes it a challenge for them to travel to hospital for a doctor’s appointment,” she added.

“Programmes like CPGP alleviates the issue of patients not attending regular follow-ups by providing home-based assessment and treatment.”

At the Bedok flat, apart from checking on the patient, Felicia also supports and answers any questions or concerns that the family has with regards to her patient’s care. She also has to remain contactable most of the time.

“When the patients’ family is stressed out over certain behaviours, or when the patients can’t sleep well and have certain irritability, they will contact us. If we can’t guide over the phone, we will go down,” said Felicia, who has been a nurse for 11 years.

The job is challenging both physically and mentally but Felicia finds great meaning in it.

She says of her job: “I didn’t like this feeling of being helpless and frustrated, and hope I can help other people as much as I can. That was why I became a nurse.”

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