THE TEMASEK TIMES

News and views from an unique perspective

Grandmother deprived of rehabilitation due to ‘low rehab potential’

Posted by temasektimes on September 20, 2012

I would like to raise my concern with regard to the emerging challenges of old age care in Singapore.

My grandma is 78 years old and have Parkinson. She had a fall 2 months ago and underwent 2 surgeries. The last one being a Total Hip Replacement done last Tuesday, she was admitted straight to the High Dependence Ward for 4days due to massive loss of blood during the surgery. Thankfully, the team of doctors and nurses managed to stabilized her condition which I am eternally grateful for.

Understood few days ago that Alexandra Hospital is eager to have her discharged and places like St Luke is not willing to take her in, due to “no/low rehab potential”.

I wonder how was the conclusion of “no/low” rehab potential reached without patient being given a chance?

Prior to the fall, my grandma was attending a Daycare Centre for elderly and is brought home to be cared by family members at nights, on a rotation basis amongst us. Now that she is wheelchair bound and low/no chance of being accepted back into any regular daycare, we are at a total loss as we have no mean of caring for her in the day. We definitely do not want to succumb to current situation and have her sent to old folks home – the easy way out chose by many. This so called “easy way out” will no doubt break a traditional woman like my grandma. Old folks home = abandonment.

Our wishful thinking from the start was that grandma will be referred from AH to probably a rehab hospital (example. St Luke) for at least a couple of months of rehab. She will regain some of her mobility and be considered again by daycare, we can continue to care for her the way we used to.

Due to a simply-reached “no rehab” or “low rehab” potential, she was deprived the chance.

We want to care for my grandma the way she would prefer most but how? Hands, unfortunately, have to keep working to feed the mouths? We can’t simply quit our job and be a full time carer. Hire a helper? Now what about the helper who was hired to care for that old lady and ended up murdering her? Can anyone guarantee lady luck blessed us with a good helper or have a bet with lady luck, courtesy of my grandmas’ safety? And why would I choose an inexperienced helper over experienced nurses in a rehab hospital? All we need is a couple of months, give my grandma the chance she deserves before the “no rehab” potential and really “low rehab” potential does not equal “no”. Why, I have to ask again, is my grandma deprive the opportunity?

My heart aches whenever I see my grandma. What have years put on her appearance, mind and health? Beside the physical pain she have to endure, there’s the pushing game going on.. no decent place to keep her till she is better to be back where she wants most.. home.

 

With utter disappointment,

Adel

18 Responses to “Grandmother deprived of rehabilitation due to ‘low rehab potential’”

  1. Gina said

    I experienced the very same thing myself, when my mother who was also in her seventies, was discharged to home to die, with two bags of medications to assist her breathing, and with no follow up by the National Heart Center.
    My mother had undergone a heart bypass previously and had Chronic Obstructive Lung Disease. She was still able to move around, to eat well and required very minimal assistance. Yet because of her age, the decision was not to continue further treatment with no necessity for a follow up appointment anymore.
    I am a trained nurse and thus very aware that my mother had still many years left in her i was very angry and called up the NHC to query them. Subsequently with the consumption of several supplements, together with her medication, she lived on for half a decade, before passing away early this year.
    Do not just take it sitting down – your grandmother has a right to Life as everybody else. If need be, approach your local Member of Parliament. Perhaps she dn be referred to Ang Mo Kio Community Hospital. She does need long term care, and would require a live-in maid to tend to her care. During your grandma’s stay in any hospital, the maid can observe and learn to take care of your grandmother.
    As for the maid, treat her with respect and do not overwork her.

    • Copycat Chan said

      Doesn’t the fact that your mum lived on for half a decade vindicates the fact that the hospital sent your mum home without a need for a follow up. Seems like the hospital is right and U getting emo.

    • Adel said

      Dear Gina,

      It is sad indeed what older patients are deprived here in Singapore due to their age, isn’t it? I was shocked when I was told that priority will be given to younger patients with the same condition. I remembered myself asking the social worker if she meant that older patients should be left to die.. I stayed in the UK for 4years and this wasn’t the case as far as I can remember. Everyone are given the same opportunity, as long as you have that desire to life.

      Your mother is very lucky to have you and your medical knowledge. So many times I looked at grandma, I wished I could do more for her.

  2. P Koh said

    In Singapore you cannot afford to grow old unless you are loaded with cash. Also you cannot afford to fall sick and again unless you have cash. This is a Cashful and Stressful country. How nice if the government can build a facility to look after old folks instead of losing billions in investments on the international scene. We do not expect handouts but helpouts and I am sure family members of the old and sick will definitely appreciate what ever the State can do to ease off part of the heavy burden of healthcare in these circumstances.

    • THE SINKING Sg JUNK! said

      I think what you’ve mentioned is merely fat hopes because they have voiced out openly that Singapore is NOT a welfare state…so my understanding is that you are expected to live your life on whatever you have in your CPF (with little dignity!) . When you’ve finally expended your resources but are still alive, then perhaps they’ll do something for you!

      • P Koh said

        Perhaps with plentiful of noises from many quarters and the next GE in sight, there could at least be some light at the end of the tunnel for the poor souls who really need help one way or another. As far as Welfare State is concerned, not everybody in their twillight years need the government’s help as many have filial children who can afford to look after their old folks. It is for the really poor and destitutes that a call for help should be listened to. It does not cost an arm or a leg and instead of helping IMF to bail out the PIGS – Portugal, Italy, Greece and Spain helping our own citizens would be a better cause. Fat Hopes yes! and didn’t PM Lee say that we should have Hope, Heart and Home and shouldn’t he be looking into this HOPE for the needy unless he really does not mean what he says,

  3. Copycat Chan said

    This statement

    no/low rehab potential

    doesn’t seem to register:

    when she claimed that

    Our wishful thinking from the start was that grandma will be referred from AH to probably a rehab hospital (example. St Luke) for at least a couple of months of rehab. She will regain some of her mobility and be considered again by daycare, we can continue to care for her the way we used to.

    Totally contradicting herself.

    Although I feel for her, I think it’s best to have that extra bed space for someone who needs it more and transfer her grandma to a place where she can get better care. If she is afraid the grandma might feel abandoned, all she needs to do is visit her every day.

  4. NoEgoNoPride! said

    Dear all…isn’t it an obvious contrast between the haves and the have-not…the above mentioned story simply shows how we, the ordinary Singaporeans will have to face in time like this…and I suppose we’ll just have to make-do with whatever resources we have and NOT expect any help from the Government. This government are run by the few privileged elites…and they are not obligated to help anyone. We should not expect anyone to help us…we should help ourselves! We can blame no one but ourselves…too bad we’re not the elites…just too bad!

  5. Rehabilitator said

    Adel, the aim of rehabilitation is to slowly bring a recovering patient back to his/her premorbid functional status. It will only benefit patients who are cognitively normal and are fairly independent in their activities of daily living before their illnesses.

    Fitness for rehabilitation is usually assessed by experienced nurse clinicians or rehab physicians to ensure proper use of the limited facilities.

    From your own description it sounds like your grandma required a fairly high level of care before her illness. You have already provided one reason why she has low or no rehabilitation potential. The commonest reason why elderly folks are rejected by rehab facilities is poor cognitive status.

    If you and your other relatives can’t afford the time for her and are unwilling to hire maids, the proper place for her is a nursing home, not any rehab hospital.

    To put her in a rehab hospital (instead of a nursing home) so as not to upset her is misuse of public facility.

  6. -Our Cabinet Ministers and PM are the highest paid in the world. They are all in Forbes 10, displacing even Bill Gates. They chose not to reveal their fortunes for fear that it may enrage Singaporeans and create a civil war in Singapore. The ISD will ensure that there is no civil war in Singapore

  7. KageV said

    Hi Adel, I believe that the healthcare professionals at AH must have assessed your grandma thoroughly before coming to such a decision. I am saying this because I’m coming from a healthcare professional background (Not from AH though).

    From your description, your grandma is already 78 y.o. with parkinson disease. From here, it is clear that there is already a physical deficit which will decline over time (PD is a degenerative disease). With the 2x surgery that she went through, one being THR and other not specified, it is already another limitation to her lower limb mobility.

    From a personal point of view, have you spoken to your grandma how much she want to achieve out of rehabilitation? Do you have an idea how much hard work and pain she has to go through to regain mobility with the very least – a walking aid e.g. walking frame? For an elderly of 78 y.o. with PD and THR, it will be a blessing for her if she can perform wheelchair mobility independently. From a rehabilitation point of view, her co-morbidities are actually limiting her potential to return to pre-morbid (which i presume she can walk with at least a walking aid). Even if she is willing to go through the hard way and pain to improve, she might even be walk with standby assistance from her caregiver.

    Ask yourself this. With her fall history, will you be confident enough to put her homebound independent?

    I see the point of having no caregiver and everybody has to work. I am also one who don’t agree on throwing elderly into nursing homes. From my experience, you should have a medical social worker or care coordinator in the team of healthcare professionals to assist the family with such a complicated discharge planning. Talk to them and the therapists and doctors. There are day care centers (I’m not saying day rehab centers) which allow elderly with wheelchair independence to hold them for the day when there is no caregiver around.

    Another option which i wanna bring up is the possibility of employing a domestic helper to assist in caring of your grandma. If $$ is an issue, do explore government grant or talk to your MSW. It sure beats the idea of throwing her into the NH when her wish is to spend her rest of the days at home.

    Hope I have made you feel better with my opinion and suggestions.🙂

    • Adel said

      Dear KageV,

      Thank you very much for the time taken to advise me & family. Your reply touches me in a way.

      We might have indeed neglected the possible huge amount of hard work & pain required on grandma’s end to regain even basic mobility. Our thought were more along the line of better quality of life with whatever mobility she can achieve out of rehab than being permanently bed-bounded. Yes, we understand that Parkinson is a progressive disease but we also know for a fact that she is not yet at the stage where she have to spend all her times in bed (opinion given by my grandma’s Parkinson’s doctor in SGH). The most upsetting part really is that her chance of achieving whatever is possible is deprived without the chance being given even.

      I have spoken numerous times with the social worker assigned for us and were told numerous times that she do not think there is any day care centers for wheelchair-bound elderly. Our only option was to get a domestic helper. Fyi, I was also warned by the social worker that AH might even start charging my grandma on a private ward rate based on “overstaying” if we do not discharged my grandma soon. Yes, private rate despite the fact that my grandma is in a 6bedded non air-con subsidized ward.

      Anyways, good news I received now is that the team of doctors had finally agreed to write a referral letter for my grandma to do rehab. Fingers crossed that she will be accepted soon in a rehab hospital. We will keep in mind your advice of the hardship grandma might be going thru. Really, all we wish is for her to achieve whatever is possible within her means.

      As for domestic helper, beside the above point I mentioned about not wanting a domestic helper, my uncle who is the decision maker was dead against the idea as well. Another good news I received today is that my uncle had also finally agreed on a domestic helper. Toes crossed now, we get a good one for grandma.🙂

      PS: I would really appreciate if you could advise on the few daycare you mentioned that welcome wheelchair bound elderly in case domestic helper do not work. Cheers!

      • KageV said

        Hi Adel,

        Just manage to come online to catch your reply. I’ve checked with a few of my colleagues, they couldn’t give me the exact names of the day care centers receiving referrals for w/c bound patients. But they confirmed their existence. They shared that the coordinating agency, Agency for Integrated Care (AIC) is dealing with such stuff. They have the whole list of existing day care center in Singapore. You may want to try this out. But they will still need a doctor’s report for such a referral.

  8. What does anyone expect? Parkinson’s has no known cause and is incurable.

  9. Lim said

    Polyclinics have their secret standard and non-standard drug list – the more expensive but necessary drugs they ask them buy outside and pay themselves. Too many poor patients and they not going to build enough polyclinics and employ more doctors, they push them to Community Health Assist GPs where they pay them $18.50 but restricted to 3 visits a month and next time when prices go up it is no more their problem but the GPs – outsource. If this grand ma is grandmother of a minister, you think St Luke dare to reject due to `no/low rehab potential’ ? These heartless compassionless mercernaries who help run this blood-sucking system will get their just desserts in a matter of time.

  10. Adel said

    Dear all,

    Thank you for all your comments. I would like to emphasize the purpose of my letter, it is not to start a hate thread more to create awareness of what many elderly and their families are possibly going through.

    Personally, I have contacted many daycare with the the hope of one with the acceptance for wheelchair-bound, high dependency elderly and was rejected by all I have contacted. Social worker have also doubts that such daycare existed. It left many families with no choice but to send their loved ones to Nursing home or Old folks home. Now, KageV is saying that such daycare do exist in Singapore.. Shouldn’t there be more transparency? It would be good if patients and their families know what are all their options available.

    I visited a nursing home while trying to find an alternate option for grandma and left with a heavy heart. There, I saw elderly being tied to their bed or chair and one old lady was even pleading me to untie her. I asked the carers why they have to tie her up and was told that she is a dementia patient and will run around if untied, also they were given permission by the family to have her restrained. Yes, I understand it is not easy for these carers but really is there a need for these dementia elderly to be restrained 24/7 and abuse the authority given by their families? One other elderly I noted was tied up even when she was sleeping.

    Called up few private nursing home as well and 99% of the tele-convo was the constant repeating of the deposit and monthly payment. It is business these days. Whatever happened to the basic human’s qualities? Love & compassion..

  11. Beenthereseenit said

    Sadly, in Singapore the elderly are given no dignity, they are just diminished economic digits. PAP has failed Singaporeans except the elites.

  12. Amanda said

    Sad as it is Adel, this is a wide spread issue. As we get more cures for illneses people are gettin older and older. Working in the care sector I can only advise that you keep on at them and don’t give up. your gran is lucky to have such good family. xxxx

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