Support for caregivers frees up hospital beds

Support for caregivers frees up hospital beds
Ms Rose Kong is able to take care of her 88-year-old mother at home with support from the National University Hospital. When she is unsure of what to do, she can call a senior staff nurse for advice.

Ms Rose Kong cares for her 88-year-old mother who has had a fractured leg, suffers from dementia, and needs to be tube-fed five to six times a day.

The National University Hospital (NUH) helped her get a hospital bed for her mother at their Hillview home, so she can be raised easily to sit at a 45 degree angle for feeding.

And Ms Kong, who is retired and in her 60s, has called senior geriatric staff nurse Sharifah Beebi several times for advice.

When her mother developed a rash, for instance, nurse Sharifah told her what to do and the cream to apply, saving her a trip to the doctor.

Another time, when her mother developed a fever and a swollen leg, the nurse said she needed to be hospitalised. "Instead of taking her to the emergency department and waiting a few hours for a bed, she arranged for a bed so my mother could go straight to the ward," recalled Ms Kong. "It is a real benefit. I don't feel so lost when something happens."

Public hospitals have been able to free up hundreds of much-needed beds by helping family members like Ms Kong to care for chronic patients in their homes. This means they are less likely to have to rush to hospital, and the effort has been lauded by patients and their families alike.

Associate Professor Reshma Merchant, a geriatric specialist at NUH, said the scheme started earlier this year with 30 patients who had been hospitalised at least twice in the previous three months. A nurse would visit their homes the day after discharge, to make sure that the caregiver was doing things right, medicine was stored properly and any fall risks were identified and removed, she explained. The caregiver was also given the nurse's phone number, which she could call any time, day or night.

In the three months before they went on the scheme, the 30 patients had a total of 87 admissions, said Prof Merchant.

But in the same period afterwards, this was slashed to five admissions. "It has proven to be really effective," she said. "It has reduced the number of long-staying patients by half."

Not only are readmissions down, but the scheme has also reduced the demand for nursing home care, as patients' families feel they are able to cope with the hospital's help which is only a phone call away, she added.

In March, the scheme was extended from the two pilot wards to 11 wards in the hospital.

Tan Tock Seng Hospital (TTSH) has a similar scheme, where it works with voluntary welfare organisations, and has managed to cut hospital readmissions by one-third.

Geriatric specialist John Abisheganaden noted that even when patients do have to be admitted, their stay is generally two to three days shorter.

About 160 TTSH patients have benefited from the scheme, and Associate Professor Abisheganaden hopes to see it expanded to about 2,000 patients.

Such efforts are still in their infancy, however, and whether they are here to stay will depend on changes to government funding.

Today, hospitals are paid to look after patients in the hospital, but to enhance such home care schemes, more funds will have to be extended to discharged patients, said doctors.

Responding to queries from The Straits Times, a Ministry of Health (MOH) spokesman said: "MOH is working closely with our health-care clusters to monitor the total cost of care per patient, as well as care outcomes under pilot programmes, and the evaluation will then advise future reviews of our funding model for health-care services."

salma@sph.com.sg

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