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MDM LOW MUI LANG, EXECUTIVE DIRECTOR The Salvation Army Peacehaven Nursing Home
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Page 1: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR

The Salvation Army Peacehaven Nursing Home

Page 2: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 2

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

Page 3: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 3

Transitional Convalescent Care

• 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 re-admission to RH

• Musculoskeletal, neurological and de-conditioning

• Others: wound management, etc.

1 – 6 months

Limited Social Support

• Varying quality of maintenance exercise programmes

• Varying dementia care capabilities

> 6 months

Long-term Care

Limited EOL care in NHs

With Social Support

• Caregiver fatigue/stress

• Crisis management

Respite Care

2 weeks – 1 month

Estimated ALOS

Page 4: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 4

Patient Profile Care Delivered

Rehab stream 1. Musculoskeletal (hip and

other fractures, amputees, arthritis), neurological (post-stroke) and de-conditioning

• Rehabilitative and nursing care • Caregiver training

Transition care stream 2. Active trial to reduce care

burden • Nursing care and therapy (where required,

e.g. wean off urinary catheter, NG tube) • Caregiver training

3. Post surgical care (e.g. post-abdominal surgery)

• Supervised recuperation and med administration to prevent RH readmission.

• Facilitate routine post-op follow-up at SOC

TCF: Patient Profile

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MDM LOW MUI LANG, EXECUTIVE DIRECTOR 5

Integration Partnership 24 hours Rehabilitation Wellness Prevention

Keys to Success

Page 6: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 6

Integration

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MDM LOW MUI LANG, EXECUTIVE DIRECTOR 7

7

Eastern Health

Alliance

Na nal tio ni v ers y i t U H e a l t h S y s t e m

H e a h t l S e e

e a

r

r o p g n i

i v c s

S

Eastern Health Alliance

Page 8: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 8

Page 9: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 9

SingHealth and EHA Regions

Page 10: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 10

Residents in the East

Changi General Hospital

Transitional Care

Deliver person -centric, seamless care

Facilities (Infrastructure)

GP First

Family Medicine

Centre & GPs

Community Health Centre

Well Acute illnesses / Chronic diseases / Functional decline

Advance illnesses/ End-of-life

ECHO Neighbours for Active Living

Programmes/services

Grassroots

Social support

VWOs

Day Centres / Rehabilitation

Community Mental Health

Healthy lifestyle

Prevention of diseases

Recovery / Optimum control / Rehabilitation

Medical and nursing support

Health Stratification

Medical Needs

Financial support; caregiver support Psychosocial Needs

SingHealth Polyclinics

St Andrew’s Community

Hospital

Peacehaven Nursing Home

Health Management Unit

GPCCP

P6B

Community Health and Social Services

Page 11: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 11

1 3 2

Keeping You Healthy Making You Well Ageing Well

Transitional Care Programme

Grace Corner

Transitional Convalescent Facility (The Salvation Army)

Rapid Improvement Event Programme (SACH)

Valuedcare Hip Fracture Pathway (CGH-SACH)

SPICE

Health Wellness Programme

SACH Home Care

Programmes

EAGLEcare Heart Failure

TeleHealth Project

Page 12: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 12

Partnerhip

Page 13: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 13

Launch on 7 June 2012 by Minister Gan Kim Yong TCF Programme better known as Grace Corner

Page 14: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 14

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

Page 15: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 15

24 hours Rehabilitation in a Home Like Environment

Page 16: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 16

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

Page 17: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 17

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

Page 18: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 18

Hydrotherapy (Changi)

Page 19: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 19

Bedok Gym Tonic

Welmed (Gym Tonic) Exercise as medicine

Changi Gym Tonic

Page 20: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 20

Page 21: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 21

Nutrition – Modified diet to Normal Diet

Home leave to allow client to re-adapt to home environment : Home assessment, Home modification

Page 22: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 22

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)

Page 23: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 23

Conditions % of Clients

Fracture 40%

Stroke 30%

Medical 10%

Musculoskeletal, neurological & de-conditioning 20%

Total 100%

No of Admissions No of Discharges

420 ( total admissions including existing clients)

Admissions & Discharges 1 December 2011 to 30 April 2017

Profile of Discharged Clients

Discharge Details Discharge Destinations % of Clients

Home 70%

Hospital (Re-admission) 17%

Voluntary Nursing Home 10%

Private Nursing Home

Sheltered Home 3%

Total 100%

Referral to Community Based Services 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%

Page 24: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

Transitional Convalescent Facility

Provide slower stream lower intensity rehabilitation and transitional care

What

Enhance patients’ ability to return and live in community

Why?

RHS – Eastern health Alliance (EHA) Changi General Hospital to Peacehaven Nursing Home

Where?

Exit coordination / case management

Average length of stay (ALOS): 3 – 6 months

Tigh

t gat

ekee

ping

Home

(with IHDC support/comm services)

How?

More time needed to assess rehab potential

24

Page 25: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 25

Page 26: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 26

Wellness

Page 27: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 27

Page 28: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 28

• Pilot we did

• Result

Page 29: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 29

Page 30: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 30

WELMED + interRAI WELMED + interRAI Baseline assessment

Control N = 15

Treatment N = 15 Randomisation

(Total N = 30)

WELMED + interRAI N = 11

WELMED + interRAI N = 15

Post-intervention assessment

Intervention

Progressive strength training 2x/week

Intervention phase (12 weeks)

Treatment As Usual

Page 31: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 31

Abdomen/Back

Page 32: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 32

Those in intervention group more likely to see improvement in depression symptoms. In general, no worsening of symptoms across both groups.

Page 33: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 33

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%)

Page 34: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 34

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%)

Page 35: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 35

BP taken before and after exercise

Saves manpower

Saves time 9 exercise stations = 30

minutes

1 Exercise Therapist

2 Persons With MODERATE Dementia

1 Exercise Therapist

3-4 Persons With MILD Dementia

OR

One trainer, multiple users

Page 36: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 36

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

Page 37: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 37

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

Page 38: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 38

Page 39: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 39

Prevention

Page 40: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 40

Day Centres

Changi and Bedok

Page 41: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR 41

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

Programme : Integrated Home and Day Centre

Page 42: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR

42

• 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

Page 43: The Salvation Army Peacehaven Nursing Home · The Salvation Army Peacehaven Nursing Home . ... Comprehensive medical review that would take into account all acute episodes; medical

MDM LOW MUI LANG, EXECUTIVE DIRECTOR


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