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Mdm O: Nursing home to Home Sweet Home

Story contributed by: 

Siti Norwani

Tan Tock Seng Hospital

Community Health Team

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Image by Lea Böhm

Prologue: Main Character 

Basic Information

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Supporting Characters

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Main Story

Madam O was just admitted to TTSH from a nursing home (NH) where she stayed in for the last 6 months. Madam O refused to return to the NH and was adamant about returning to her own home. Previously, Madam O was unable to get along well with any of the helpers that her daughter had hired to care for her. Her daughter had to change a few helpers, which became a financial burden to daughter. In the end, the family was left with no choice but to send Madam O to a NH.

 

Madam O complained that she was kept bedbound for 24 hours in the NH. Every other staff in NH had avoided attending to her due to her weight (100+ kg). As a result, Madam O had deteriorated from her chairbound status to being bedbound. Eventually, Madam O’s daughter agreed to bring her home and employ another helper. The Transitional Care Team was then referred to support Madam O, her new helper and daughter in making sure that she transits home well.

 

The OT visited Madam O one week post discharge from TTSH. She was still managed with bedbound care as she did not trust the new helper who had started working with her for only 2 days. Madam O had a bariatric mobile commode and second-hand hospital bed, which she had initially refused to use due to ‘pantang’ (superstitious beliefs). The OT started caregiver training to the new helper (and son) on transfer skills and showering. Madam O was so happy that she finally showered after 6 MONTHS of bed sponging. This elevated Madam O’s positive experience with the new helper and OT. With this newly formed trust and rapport, the OT was then able to convince Madam O to sleep on her second-hand hospital bed, which greatly reduced family and helper’s burden. The family was also able to position Madam O’s bed in the living room on the ground floor, next to the windows, so that she could resume her favourite past time to people-watch.

 

By the third visit, Madam O was sitting up more often. Madam O had also resumed her “cooking” role though in a slightly different manner. She took on an advisor role, in which she would decide the menu of the day for the household and guide the helper. She would teach the helper how to cut the vegetables and the recipes for some of the dishes. 

 

Although Madam O’s ultimate goal was to be able to go out to her favorite kopitiam to have her coffee and people-watch, she was limited by the 5 steps at the main entrance of her apartment unit. Due to design flaws of the unit, it was not feasible for ramps to be built. The application for a stair-climber had also been rejected due to a lack of financial and care commitment from family. 


But for now, Madam O is happy and contented being back home. She could sleep under her own roof, get to see and spend time with her family daily, share a chat, or sometimes bicker over their favorite TV show, and enjoy her favorite food as and when she likes it. Madam O said: “At least now I feel like I have a choice, even if it’s just deciding the clothes, the food or the time I eat. Ultimately I’m in my own home and I’m happy with this for now”.

Synopsis

Participation Goal(s) of Client

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  • Return home

  • Be with family

  • To be able to shower

  • People-watch

Facilitators to Participation

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  • Supportive home equipment

  • Good working relationship with new helper

  • Opportunity to resume previous role

Barriers to Participation

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  • Poor motivation to exercise or to participate in rehabiliation to optimise function

  • Unsupportive built environment

  • Nil extra family member to render physical help

Strategies to overcome barriers and support participation by OT(s) and Stakeholders

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  • Positive experience to gain patient’s trust and confidence

  • Pacing of patient’s readiness for change

  • Working with the medical social worker, the family, and the vendors to trial various ways and means to help the patient achieve her goal

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