Dementia has memorably been portrayed in Channel 8 dramas by actors playing the pitiful-looking senior who repeatedly says “给我一点吃的吧” (“Give me something to eat”) even though he/she has already eaten, who goes missing after wandering out of the family home, or who views family members as unrecognizable strangers. But what is dementia, really? And if you are unable to care for your family member who has dementia, who can you “outsource” the care-giving to?
Dementia cases are on the rise in Singapore (by 2030, some 80,000 people aged 60 and above would suffer from it) and so, when I was offered the opportunity to ‘job shadow’ a nurse who works with elderly clients (some of whom have been diagnosed with dementia), I jumped at the opportunity to find out more about this illness which 1 in 10 of our elderly folks suffer from. Nurse He Li Jun shared more than just tips for caregivers, but also gave me an insight into her job and the importance of maintaining healthy parent-child relationships.
I was told that some people send their parents to these centres and when the nurses ask them about their parents’ likes, dislikes and hobbies, the children are clueless. Some might say “My mother is a housewife; she has no hobbies” and the nurses go on to discover that the elderly lady loves to sing and write, etc. And the children get a surprise when they discover their parent’s beautiful singing or stunning penmanship. What does this say about the state of our parent-child relationships these days? Would YOU be one of these clueless children? 😉
By the way, if you think dementia is a “normal” part of ageing, think again. Nurse Li Jun emphatically pointed out to me that dementia is anything but normal – it is a brain-related illness, and it leads to memory loss, changes in personality and even a decline in intellectual ability. An early diagnosis can be very helpful in combating (but not curing, sadly) this illness.
Nurse Li Jun is one of many outstanding individuals who are employed by NTUC Health to care for the seniors at their various centres. NTUC Health runs 12 Silver Circle day and senior care centres in Singapore. I visited the centre in Jurong West which has just over 60 clients and was greeted by a sight I did not expect:
The centre was very well-lit with ample sunlight coming in from the windows. The sofas and dining area chairs are in bright, cheery colors and there were makeshift ‘stalls’ with items the elderly would recall from their youth. On the walls are sensory boards with items like cooking utensils and various kinds of fabric. New clients often gravitate to these sensory boards with items that are familiar to them, and this helps them settle into the ‘new’ environment. Those who like caring for their grandchildren will also take to the dolls prepared for them – apparently cradling these dolls in their arms help calm them.
And if you’re wondering, nope I did not encounter anyone who came up to us with the plea of “给我一点吃的吧” but I did meet one gentleman who kept asking me “how many brothers and sisters you have at home?” – I would provide him my answer, he’d talk about something else, and then he’d ask me the same question again. Nurse Li Jun told me that he is known for having a bad temper (which I did not get to experience, thankfully), likes to sit on the same sofa everyday and not participate in group activities, likes to tell her that he wants to marry her (and yes, I witnessed that happen), and that he might sometimes watch people walk past him and critique their appearance (oh dear).
Throughout it all, the nurse was full of good cheer, very patient and it was clear to me that keeping their clients happy and healthy is of utmost importance to the staff at Silver Circle. Watching the supposedly-fiery gentleman looking almost bashful as Nurse told him “I treat you to lunch, ok?”, I realized that it is possible to provide good care to people who suffer from dementia. You just need lots of patience, a good sense of humor, and the ability to cajole, comfort and convince them you have their best interests at heart. One elderly lady was invited to help out in the pantry to towel-dry some already very clean and dry cutlery because she will say she wants to go home if she’s not occupied with a task. Of course, when they return home, they may have forgotten what went on during the day, and tell their family members that the centre provided neither food nor activities for them. 😀 (This is why the centre has to sometimes take photographs to show ‘proof’ that their clients are fed, engaged and generally well cared for)
During my half-day at the centre, I watched some seniors play mahjong, sing 月亮代表我的心 (a Teresa Teng classic), and participate in various activities. Some of them are suspected to have dementia, but the condition is not formally diagnosed.
Nurse Li Jun shared with me 5 tips for people with elderly folks at home who have either been diagnosed with dementia or who are suspected to be showing early signs of dementia…
- Get an early diagnosis. Treatment can help slow down the progress of dementia.
- Validate feelings, not facts. Even if the patient is saying something which doesn’t make sense, it’s ok as long as he/she is happy.
- Be patient and spend time with your parents. Get to know their likes and dislikes, their hobbies, etc.
- Keep your home safe for the elderly. For those who like to cook, it can be dangerous if they leave the cooking unattended.
- Caregivers need rest too. In a week, schedule 2 to 3 days for breaks. Even a half-day respite would be most beneficial. Thus, Silver Circle centres provide ‘respite care’ for seniors who come in two to three times a week; during this time, their caregivers can take a break.
In the picture above, you see the elderly folks participating in a group song / exercise activity. Many of these seniors are wheelchair-bound, and they reach the centre via a van which can take up to 6 wheelchairs at a time. Starting from 7.15am, the van ferries batch after batch of these elderly clients to the centre and work begins for Nurse Li Jun and her colleagues. There are about 16 staff at this centre and only 2 of them are foreigners. Nurse Li Jun herself hails from Hubei, China, and she has been working and living in Singapore for 18 years. I was particularly impressed by how proficient she is at reading and conversing in English. English language proficiency is definitely a prerequisite for her job as she has to do an assessment for each client, and the assessment can be 30 to 40 pages long. It’ll cover the client’s medical history, “life story”, etc in detail.
Nurse Li Jun used to work at NUH (she spent 8 years there) and her current job at Silver Circle can involve anything from assisted feeding, diaper changing, to dressing of wounds. And even though each client has a nametag with his/her name, picture and other details, the nurses know them all by name, and regularly communicate among themselves regarding which clients to particularly look out for each day.
For instance, there is a client with dementia who is prone to hoarding. He would frequently attempt to bring items from the centre home. Nurses have found him taking toilet paper as well as food home in the bag he brings with him to the centre. And when he arrives at the centre, he’ll look for newspaper. I asked if it’d be a good idea to simply prepare a copy for him. But the nurse told me that it’s better that he walks around looking for newspaper and in the process, communicate with the staff.
All in all, I think Silver Circle staff are very creative in the way they engage their elderly clients (with or without dementia) and appear to be a special breed of people who have superhuman patience. Looking after 1 person with dementia is tough enough. But they care for over 60 seniors in one centre. Thankfully, they also have a passionate group of volunteers who help in the day-to-day operations.
To support the efforts of the staff, their employer also has to be understanding towards their needs. For instance, Nurse Li Jun shared with me that working at NTUC Health has been a joy and a relief for her as she was allowed to work part-time, half-day or 4-day weeks when she has to take care of her two young children. These flexi-work arrangements are definitely helpful for those with kids, and even for those without kids but who simply require adequate breaks to rest and recharge.
Do you have friends who lament about how tired they constantly are now that they have kids? If you have children of your own, do you remember how taxing it is to care for them and how prone they are to asking certain questions incessantly? I think there are similarities when it comes to caring for children and caring for elders with dementia. And in both cases, you have to be extra patient while being very observant as their moods, and even their likes and dislikes can change from day to day. And above all, take some time out of your busy schedule to really get to know your parents as people. Because there is a possibility that one day, they may not remember you due to dementia, but you should be able to recall what their hobbies are, what life experiences they’ve shared with you, and when the nurse has to complete the 30 to 40 page assessment with your input, it should be a breeze and not a bother.