The Salvation Army Peacehaven Nursing Home MDM LOW MUI LANG, EXECUTIVE DIRECTOR

The Salvation Army Peacehaven Nursing Home MDM LOW MUI LANG, EXECUTIVE DIRECTOR

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 2

Estimated ALOS 2 weeks 1 month With Social Support 1 6 months Limited Social Support > 6 months Respite Care Transitional Convalescent Care Long-term Care Caregiver fatigue/stress Crisis management 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 readmission to RH Musculoskeletal, neurological and de-conditioning Others: wound management, etc. Varying quality of maintenance exercise programmes Varying dementia care capabilities Limited EOL care in NHs MDM LOW MUI LANG, EXECUTIVE DIRECTOR 3

TCF: Patient Profile Patient Profile Rehab stream 1. Musculoskeletal (hip and other fractures, amputees, arthritis), neurological (post-stroke) and deconditioning Transition care stream 2. Active trial to reduce care burden 3. Post surgical care (e.g. post-abdominal surgery) Care Delivered Rehabilitative and nursing care Caregiver training Nursing care and therapy (where required, e.g. wean off urinary catheter, NG tube) Caregiver training Supervised recuperation and med administration to prevent RH readmission. Facilitate routine post-op follow-up at SOC MDM LOW MUI LANG, EXECUTIVE DIRECTOR 4

Keys to Success Integration Partnership 24 hours Rehabilitation Wellness Prevention MDM LOW MUI LANG, EXECUTIVE DIRECTOR 5

Integration MDM LOW MUI LANG, EXECUTIVE DIRECTOR 6

Eastern Health Alliance Eastern Health Alliance Na tio nal U ni v ers i t y H e a l t h S y s t e m S i n g a p o r e H e a l t h S e r v i c e s 7 MDM LOW MUI LANG, EXECUTIVE DIRECTOR 7

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SingHealth and EHA Regions MDM LOW MUI LANG, EXECUTIVE DIRECTOR 9

Community Health and Social Services Grassroots Healthy lifestyle Social support VWOs Day Centres / Rehabilitation Residents in the East Health Stratification Well Acute illnesses / Chronic diseases / Functional decline Advance illnesses/ End-of-life Medical Needs Prevention of diseases Recovery / Optimum control / Rehabilitation Medical and nursing support Psychosocial Needs Financial support; caregiver support Facilities (Infrastructure) SingHealth Polyclinics Programmes/services Family Medicine Centre & GPs Community Health Centre Changi General Hospital St Andrew s Community Hospital Peacehaven Nursing Home P6B ECHO GPCCP GP First Transitional Care Deliver person -centric, seamless care Health Management Unit Community Mental Health Neighbours for Active Living MDM LOW MUI LANG, EXECUTIVE DIRECTOR 10

Programmes 1 2 3 Keeping You Healthy Making You Well Ageing Well Heart Failure TeleHealth Project Grace Corner Transitional Care Programme Transitional Convalescent Facility (The Salvation Army) Rapid Improvement Event Programme (SACH) Valuedcare Hip Fracture Pathway (CGH-SACH) SACH Home Care SPICE Health Wellness Programme EAGLEcare MDM LOW MUI LANG, EXECUTIVE DIRECTOR 11

Partnerhip MDM LOW MUI LANG, EXECUTIVE DIRECTOR 12

Launch on 7 June 2012 by Minister Gan Kim Yong TCF Programme better known as Grace Corner MDM LOW MUI LANG, EXECUTIVE DIRECTOR 13

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 14

24 hours Rehabilitation in a Home Like Environment MDM LOW MUI LANG, EXECUTIVE DIRECTOR 15

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 16

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 17

Hydrotherapy (Changi) MDM LOW MUI LANG, EXECUTIVE DIRECTOR 18

Welmed (Gym Tonic) Exercise as medicine Changi Gym Tonic Bedok Gym Tonic MDM LOW MUI LANG, EXECUTIVE DIRECTOR 19

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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 21

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 22

Admissions & Discharges 1 December 2011 to 30 April 2017 Conditions No of Admissions No of Discharges 420 ( total admissions including existing clients) Profile of Discharged Clients % of Clients Fracture 40% Stroke 30% Medical 10% Musculoskeletal, neurological & de-conditioning 20% Discharge Details Discharge Destinations % of Clients Home 70% Hospital (Re-admission) 17% Voluntary Nursing Home 10% Private Nursing Home Sheltered Home 3% Total 100% Total 100% Services Referral to Community Based 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% MDM LOW MUI LANG, EXECUTIVE DIRECTOR 23

Transitional Convalescent Facility What Provide slower stream lower intensity rehabilitation and transitional care Why? Enhance patients ability to return and live in community Where? RHS Eastern health Alliance (EHA) Changi General Hospital to Peacehaven Nursing Home How? More time needed to assess rehab potential Tight gatekeeping Average length of stay (ALOS): 3 6 months Exit coordination / case management Home (with IHDC support/comm services) 24

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Wellness MDM LOW MUI LANG, EXECUTIVE DIRECTOR 26

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Pilot we did Result MDM LOW MUI LANG, EXECUTIVE DIRECTOR 28

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Randomisation (Total N = 30) Baseline assessment Control N = 15 WELMED + interrai Treatment N = 15 WELMED + interrai Intervention phase (12 weeks) Treatment As Usual Intervention Progressive strength training 2x/week Post-intervention assessment WELMED + interrai N = 11 WELMED + interrai N = 15 MDM LOW MUI LANG, EXECUTIVE DIRECTOR 30

Abdomen/Back MDM LOW MUI LANG, EXECUTIVE DIRECTOR 31

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 32

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 33

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 34

BP taken before and after exercise Saves manpower 1 Exercise Therapist 1 Exercise Therapist 2 Persons With MODERATE Dementia OR Saves time 3-4 Persons With MILD Dementia 9 exercise stations = 30 minutes One trainer, multiple users MDM LOW MUI LANG, EXECUTIVE DIRECTOR 35

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 36

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 37

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Prevention MDM LOW MUI LANG, EXECUTIVE DIRECTOR 39

Day Centres Changi and Bedok MDM LOW MUI LANG, EXECUTIVE DIRECTOR 40

Programme : Integrated Home and Day Centre 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 MDM LOW MUI LANG, EXECUTIVE DIRECTOR 41

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 42 MDM LOW MUI LANG, EXECUTIVE DIRECTOR

MDM LOW MUI LANG, EXECUTIVE DIRECTOR