How hospitals and others are making experiences senior-friendly in Singapore

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SINGAPORE – To ensure an 85-year-old patient was able to communicate with care staff clearly, advanced practice nurse Jessie Tan gave him a set of headphones and spoke into a microphone.

 

Mr Gan Chwee Tin was then able to converse with her and others in the ward at Yishun Community Hospital. After speaking with Ms Tan for some time, he consented to walking around the ward with assistance.

 

Mr Gan had been warded for high creatinine levels, which had initially impaired his cognition and made him resist care. However, Ms Tan has been trained in a care methodology called Humanitude, which she says works “like magic” on difficult patients.

 

Humanitude prioritises clear communication and establishing a rapport with patients. Developed in France in 1979, Humanitude has been scientifically proven to help caregivers aid patients who are cognitively impaired or otherwise frail and vulnerable. It also reduces caregiver stress and burnout.

 

Similarly, building relationships to improve communication with seniors and service outcomes is the focus of many organisations in Singapore, as the population transforms into a super-aged society. By 2026, 21 per cent of Singapore’s population will be aged 65 or older.

 

In his National Day Rally speech, Prime Minister Lee Hsien Loong pointed out the “massive social and economic implications” of a super-aged society. To help seniors age well, plans are ongoing to improve healthcare and make places and precincts more senior-friendly.

 

Senior-friendly practices include easy-to-read signage and barrier-free access, with ramps or lifts for wheelchair users.

 

Organisations from hospitals to hotels are also improving soft infrastructure, ensuring their services are accessible to older people and meet their needs.

 

Caring for the vulnerable

 

Seniors who are well and independent may still face health challenges in the future, and healthcare is adapting to a growing number of older patients.

 

At Tan Tock Seng Hospital (TTSH), senior staff nurse Jasvin Kaur used to find it challenging to manage geriatric patients in her ward, where patients are warded for heart issues.

 

Geriatric patients might be confused or delirious and resist care. In July, she opted to take a two-day course offered by the hospital to learn more about the needs of such older patients.

 

The course, offered by TTSH since 2014, helped her understand what could cause patients to resist care, and how to work with other healthcare professionals such as physiotherapists, dietitians and speech therapists to ensure geriatric patients receive holistic care.

 

“I didn’t have the background to manage these patients before,” says Ms Kaur, who has been in nursing for 12 years. “I wanted to learn how to manage them.”

 

Under the right circumstances, even frail or otherwise impaired seniors can do better than expected.

 

At Yishun Health, where many of the patients are older, frail and may have dementia or other cognitive impairment, associate professor Philip Yap saw Humanitude training at a local nursing home and realised that it would benefit his patients.

 

The care practice makes it easier to care for difficult patients and improves long-term health outcomes by focusing on patients’ capabilities. Humanitude trains caregivers on how to look at, talk to and touch their charges, and how to mobilise them in a safe, dignified manner. In the long term, this can reduce a patient’s dependency and improve his or her mobility.

 

To date, 360 staff at Yishun Health – which runs Yishun Community Hospital and Khoo Teck Puat Hospital – have been trained in Humanitude.

 

Humanitude trainer Joao Partel Araujo, 37, says 40 seconds is enough, on average, for a trained caregiver to engage a person with cognitive impairment. Building trust between caregiver and patient helps improve health outcomes for both.

 

Dr Yap, who is a senior consultant at Khoo Teck Puat Hospital’s geriatric medicine department, says: “Because patients have dementia, because they have difficulty communicating, we assume they can’t do things. With the right approach, these patients can walk, with different levels of assistance. They don’t have to be bed-bound.

 

“The breakthrough comes, but it takes a lot of hard work.”

 

Silver market

 

As Singapore ages, customers are getting older, which means that businesses have to rethink their service practices. Some seniors are tech-savvy, while others prefer to be served by humans.

 

Many older customers are of sound mind, but may have some trouble with their hearing or eyesight. To cope with this, insurer Singlife has since 2015 had a standard operating procedure in place to ensure that staff communicate clearly with seniors. These practices include checking their preferred language, speaking slowly and pausing to check back that customers comprehend the information provided.

 

Customers aged 62 or older are also offered the option to receive hard copies rather than online documents. Where possible, regular customers are served by staff whom they have known for a while.

 

Singlife’s customer service executives are also trained to be on the alert for elder abuse or customers with cognitive impairment. They may check on whether the older customer appears to be unduly influenced by a third party when making financial transactions, for example. A spokesman says: “The team lead plays a pivotal role in ensuring customers possess the mental capacity to request changes that might adversely impact policy benefits.”

 

Staff at One Farrer Hotel and its associated Farrer Park Hospital find that the person-to-person touch is preferred by older customers. “New technologies such as robots and self-check-in counters to aid in service delivery cannot substitute for experienced professionals with keen observation and empathy,” says its spokesman.

 

Visitors to the hotel often check in because they or their family members are receiving treatment at the nearby Farrer Park Hospital. This means that staff often deal with special dietary requests or help suggest appropriate outings for guests during their stay.

 

One senior guest refused to use the guest lifts and electronics due to religious restrictions, the spokesman said. The guest stayed for a week, during which a member of staff accompanied him up and down the stairs. “Our team member also had to switch on the lights and lower the blinds to the guest’s desired level,” said the spokesman.

 

Welcoming spaces

 

Ageing does not automatically mean frailty and cognitive impairment. With the right medical and social interventions, seniors can live healthy and productive lives in their later years.

 

Research has shown that seniors benefit from exercise as well as activities that stimulate them mentally and help them form social bonds.

 

Active Ageing centres around Singapore will have activities such as karaoke, dance classes or a cafe corner for bonding, as PM Lee mentioned at the National Day Rally.

 

Heritage and art spaces are also providing engagement and outreach activities for seniors, as well as training its staff and volunteers to serve older visitors.

 

Ms Alicia Teng, deputy director (community and access) at National Gallery Singapore, says that visiting the art museum in groups can help seniors build social bonds and address loneliness. It works with partners such as eldercare centres to arrange senior-friendly visits.

 

Volunteers and staff are being trained in dementia awareness and how to engage appropriately with older visitors after assessing their needs. This could mean speaking slower and louder, or guiding them to places where they can rest.

 

A spokesman for the National Heritage Board said that under a masterplan for heritage and the museums sector introduced in 2018, heritage spaces and museums have worked on improving accessibility, including for seniors.

 

At the National Museum of Singapore, since 2019, volunteers known as care facilitators have been trained to support accessibility and care initiatives. They are trained in basic dementia awareness. “They are also equipped with skills to guide, listen and elicit stories and experiences from senior visitors using the museum’s artefacts as conversation starters, to trigger memories and engage them in meaningful conversations when they join our senior programmes,” its spokesman said.

 

Earlier in 2023, the museum launched Reunion, a dedicated space for social activities and workshops to engage seniors and help them socialise. Reunion is a collaboration with philanthropic organisation Lien Foundation and hosts an eight-week programme designed to support the well-being of seniors with early- to mild-stage dementia. Caregivers have reported that their charges with dementia show improvements in mood and communication thanks to such initiatives.

 

The National Museum and National Gallery Singapore are served by a number of older volunteers, the spokesmen say. Ms Teng says that many mature volunteers are training to help other aged visitors. “They have a hunger to learn and be useful, and give back to society.”

 

Tapping seniors’ talents

 

More than 50 per cent of the volunteers at Tan Tock Seng Hospital are over the age of 50, says Ms Koh Ming Hui, an executive for the hospital’s Centre for Health Activation which manages such volunteers. One of the oldest is 92 and works with a group that makes arts and crafts for sale to raise funds for the hospital.

 

Older volunteers want to “create meaning and fulfilment” through volunteering, she says, and are a valuable resource.

 

To tap this talent pool, training has been customised to fit their needs. A step-by-step guide was created to help seniors log into online training platforms. Some sessions are done in person and training materials are printed in large font, with more graphics and illustrations for easy understanding.

 

Volunteering opportunities are also matched with the seniors’ physical capabilities. “We let them know if they will be standing for long periods of time. The volunteers decide for themselves if they are all right with these requirements and may even try the programmes before committing,” Ms Koh, 26, says.

 

She adds that senior volunteers have much to teach her and her team from their lived experiences. “Working with them has been amazing,” she says. “It’s mind-blowing how much they care about our patients and the causes that they volunteer for, and how much they have achieved.

 

“As our population ages, our volunteers are also ageing. The important thing is to keep empowering these volunteers by providing them with the opportunities, resources and support that they need to step up and continue making a difference.”

 

 

Source: The Straits Times © SPH Media Limited. Reproduced with permission.

 

 

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