ISSUE - Agency for Integrated Care · a Peritoneal Dialysis Nurse ... In Showcase, find out how leading organisations have ... The fluid circulates through the abdomen to draw impurities

Translating VisionTo Action:ILTC QualityFestival 2015PAGE 6

SHOWCASE

coming together as one

A Publication for Community Care Providers by the Agency for Integrated Care

JAN

201

6

24ISSUE

NEW!

ANDMORE

PAGE 8

Interview withhospice care

movement veteran:Dr Seet Ai Mee

REFLECTIONS

SPOTLIGHTA Day In the Life of ... PAGE 4

WELCOME TOmosAIC...2016 promises to be a milestone year for the Community Care sector with the implementation of the Enhanced Nursing Home Standards. Nursing homes are not the only ones making greater strides towards better care provision. Senior Care Centres and Home Care providers are also taking steps to improve, with the publication of the Implementation Guides that complement the Ministry of Health’s Developmental Guidelines for Centre-based and Home Care services. In Bulletin, find out some of the considerations made by industry-led workgroups as they collaborated to produce these Implementation Guides.As the sector ramps up its quality of care, one of its challenges will always be how it achieves patient-centred care. Discover in Spotlight how Zalinah Rozali,a Peritoneal Dialysis Nurse from the National Kidney Foundation, and Joy Cruz, a Senior Occupational Therapist providing care coordination in Man Fut Tong Nursing Home, do this.Amplifying the efforts of individuals, how can organisations foster a culture of continuous improvement? In Showcase, find out how leading organisations have translated their visions for continuous improvement into action as werelive the highlights of ILTC Quality Festival 2015.We also invite you to read our new section, Reflections, where we speak tothe sector’s pioneers and leaders. For the inaugural interview, we caught up with Dr Seet Ai Mee, who candidly shared her recollections of helming thework of the hospice care movement since the 1990s.In other pages, harness the research behind what truly motivates people in this issue’s Improvements, which features Daniel H. Pink’s Drive: The Surprising Truth About What Motivates Us. Do also find out in Newsbytes how to prepare tantalising yesteryear recipes in Nutrition Highlight and get updated on initiatives which have enhanced medication safety, provided savings, improved haze preparedness, and enhanced care through the Nursing Home Information Technology Enablement Programme (NHELP). Service providers also gave us insights about their innovative programmes in this edition’s Sector’s Sharing.Lastly, we congratulate winners from our feedback exercise and quiz. Thank you for sharing your thoughts on how mosAIC can be further improved. Do look out for your suggestions in upcoming issues.Till the next issue, happy working!

Lynda SoongChief, Community Care Development [email protected]

mosAIC is the recipient of three APEX Awards for Publication Excellence – Print Newslettercategory (2015), Most Improved Newsletter category (2014) and Newsletter – Electronic andWeb category (2013).

Lynda Soong

In support of a sustainable planet, this publicationis printed on environmentally friendly paper.

About Agency forIntegrated Care (AIC)Agency for Integrated Care (AIC) seeks to create a vibrant Care Community enabling people to live well and age gracefully. AIC coordinates and facilitates efforts in care integration to achieve the best care outcomes for our clients. We do this by empowering them with health and social care information and arranging for their care when they are discharged from hospitals. We enable stakeholders to raise the quality of care, and also enhance collaboration by working with health and social care providers to increase services to support the ageing population. Our work in the community brings care services and information closer to those in need.For more information, visit aic.sg.

About mosAICmosAIC shares happenings within AIC and in the Community Care sector.For more information, visit aic.sg/mosaic.

PublisherAgency for Integrated CareEditorial TeamLynda Soong, Chief EditorCharmaine Tan, Second EditorThiru Gunasegaran

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MCI (P) 136/04/2015mosAIC is a publication by the Agency for Integrated Care (AIC). The views and opinions expressed or implied in mosAIC do not necessarily reflect those of AIC, its directors or editorial staff. All information is correct at time of printing. Articles may not be reproduced without AIC’s permission.

For editorial queries, feedback and subscription*, please email [email protected]

*Health and Social Care staff subscribe for FREE!

This cover series depict that individuals can make a positive impact when they give their best.

In the third cover of the series, water ripples have formed into a stream as it flows over various terrains. When our efforts are pooled towards a common goal, we can overcome difficulties easily.

Scan mosAIC’s Quick Response (QR) code with your smart devices to easily access online content (flipzine, photo/video gallery and additional journal articles).

2EDITOR’S NOTE January 2016

ENGAGING INDUSTRY-LED WORKGROUPSTO DEVELOP IMPLEMENTATION GUIDES

A Centre staff referring to the Implementation Guide to get resources such as templates and checklists. (Photo Credit:Metta Day Rehabilitation Centre for the Elderly)

1Centre-based services: Community Rehabilitation (improving functional ability through Physiotherapy and Occupational Therapy), Day Care (supportive care viasocial/recreational activities when families are at work), Dementia Day Care (structured programmes for maintaining cognitive/physical function of clients living withdementia) and Centre-based Nursing (procedural nursing services [such as post-surgical wound management, insertion of nasogastric tube]).2Home Care services: Home Medical (doctor’s visits), Home Nursing (wound dressing, stoma care, etc.), Home Therapy (improving/restoring functional status),Home Personal Care (personal hygiene, light housekeeping, etc.) and Palliative Home Care (multidisciplinary approach to providing pain control, counselling, etc.).

In April 2015, the Guidelines for Centre-based1 and Home Care2 services were introduced by the Ministry of Health (MOH) to aid service providers in delivering better quality care. To assist providers in interpreting these, two respective industry-led workgroups (comprising service providers, clinicians and subject matter experts) were formed by AIC and MOH to develop complementary Implementation Guides. In order for the information to be practical and achievable, the workgroups deliberated over eight months to come to a consensus on practices and processes that would be included. For the Centre-based Guide, input was also obtained from providers who were not involved in the workgroup.The Implementation Guides are divided into two sections:• Explaining the intent of the Guidelines and how they can be implemented and;• Offering practical resources.

Maimunah Mahpuz, Medical Care Manager, Metta Day Rehabilitation Centre for the Elderly (Centre-based workgroup), shared, “The Guide covers a wide range of aspects in care delivery and serves as a reference

tool. Some of the explanatory notes and good practices showcased were also obtained from the practices of several Centres.”Some of the key considerations made in the Guide included:• Striking a balance between being detailed and open-ended in the explanatory notes (i.e., for critical areas such as client’s safety, it is more detailed, for those concerning continuous improvement, greater flexibility is offered); and• Inclusion of useful resources such as tools, templates, checklists and references for providers to customise/adapt.Yvonne Khoo, Associate Consultant, Goshen Consultancy Services Pte Ltd (Centre-based workgroup), shared, “With changing expectations, staff must be able to provide personalised and holistic care. For example, in response to caregivers’ feedback, we have included a screening tool that staff can use to better understand the stress caregivers may be facing and to address it, if needed.”Commenting on the Home Care workgroup’s experience, Dr Tham Weng

Yew, Clinical Director, Care for the Elderly Foundation (Singapore) shared, “Home Care clients often have complex needs – both social and health. To achieve the desired outcomes, these must be addressed… the Guide helps by recommending an assessment checklist which covers pertinent health, functional and psychosocial domains, and follow-up actions.”Sharing his thoughts, Associate Professor Philip Yap, Senior Consultant, Department of Geriatric Medicine and Clinical Director, Geriatric Centre, Khoo Teck Puat Hospital, said, “The Guides are timely and much-needed to help bring about a quantum leap in care quality for seniors in Singapore.”

1. The MOH’s Guidelines articulate desired outcomes in four domains for Centre-based services (i.e., Provision of Care Services; Safety; Dignity of Care; and Organisational Excellence) and Home Care services (i.e., Holistic Care; Quality of Care; Informed and Enabling Care; and Sustainable Care).2. These Guidelines can be found at www.moh.gov.sg/content/moh_web/home/Publications/guidelines/intermediate-and-long-term-care-guidelines.html

3. The Implementation Guides can be found on AIC’s Learning Management System (LMS) at https://lms.aic-learn.sg/lms/app/SYS_login.aspx

4. Moving ahead, AIC will be working with MOH and key partners on: Training and Development, Capability Building and Voluntary Baseline Assessments. Quarterly networking sessions will also be held to share information with service providers.

Fast Facts

Contact [email protected] and [email protected] for Centre-based and Home Care Implementation Guides’ matters respectively.

FOR MORE INFORMATION!

3BULLETIN aic.sg/mosaic

More photos at:aic.sg/mosaic/gallery/jan16

A DAY IN THELIFE OF ...

Name: Zalinah RozaliOrganisation: National Kidney FoundationDesignation: Staff NurseYears in Service: 1.5 years(Photo credit:National Kidney Foundation)

In this section, we catch up with Community Care staff – Zalinah Rozali, Staff Nurse, National Kidney Foundation and Joy Cruz, Senior Occupational Therapist, Man Fut Tong Nursing Home – to find out about their work.

Zalinah is able to build rapport with my mother and me. She guides us in the PD procedures and gives us valuable advice.– Nurshafiqin, daughter of PD patient, Ronimah Anangchik

Supporting Peritoneal Dialysis* (PD) patients at home is both hard work and ‘heart’ work. Zalinah has never complained about the work, the frequent travelling or the need to step intoan unknown and sometimes uncomfortable home environment. I am glad to have her in the team, supporting patients and their families, assuring them that they are not alone.– Tang Woon Hoe, Senior Nurse Clinician, Peritoneal Dialysis Community Support, National Kidney Foundation

*Peritoneal Dialysis (PD) is an alternative treatment to Haemodialysis. A special sterile fluid is introduced into the abdomen through a permanent tube that is placed in the peritoneal cavity. The fluid circulates through the abdomen to draw impurities from surrounding blood vessels in the peritoneum, which is then drained from the body. (Source: NKFS.org)

9.00amI provide community support services to patients on Peritoneal Dialysis (PD). Some patients choose PD over Haemodialysis as PD is a painless procedure with lesser side effects. It also does not require needling and works more like a natural kidney.As PD patients perform their own dialysis outside of medical settings like a Dialysis Centre, they need to learn how to do this in a safe and accurate manner. Our PD team guides them as they make dialysis a part of their lifestyle and take charge of their own treatment plan. As my patients are primarily at home, my day begins by scheduling

Zalinah guiding a PD patient on how to use an Automated Peritoneal Dialysis (APD) machine at home. Patients are given guidance until they can eventually manage the PD treatment themselves.(Photo Credit: National Kidney Foundation)

visits and addressing issues from their hospital follow-ups.

12.00PmI typically visit two to three patients a day and sometimes make ad-hoc visits. I brief patients about what to expect when they begin PD and support them until they feel confident and competent enough to manage the procedure themselves. Subsequent visits are made regularly to ensure they are coping well. I also provide feedback and work with hospitals to address issues patients face.As we work flexi-hours, I may even visit

patients at night to help them. For this work, knowledge on its own is often not enough; patients need to know that you genuinely care.

2.00pmNew patients sometimes see me as a PD “inspector”, watching out for their mistakes. With time, they realise that I

want to help them look after themselves better. Working in a home setting helps as most patients feel more at ease to share their inner thoughts. Doing my best to address some of their worries enables me to gain their trust.Working in Home Care also includes occasional adventures with patients. Once, I had to drive in the heavy rain to rush a patient to the hospital. My car broke down along the way but thankfully, the patient got there safely. Other times, we receive urgent home visit requests and encounter patients who refuse to seek immediate medical attention despite our advice. Understanding that fear is usually what keeps them from seeking further treatment, I reassure them how going to the hospital can lead to a better outcome.

6.00pmCompared to my previous administrative role, this job is definitely more fulfilling. In addition, the flexi-hours have enabled me to fulfil my role as a mother too as I can spend quality time with my lovely children.

January 2016 4SPOTLIGHT

After my total hip replacement early last year, Joy and her team helped to coordinate my care – from initial assessment and identifying my needs to implementing a plan. After teaching me exercises and daily tasks like commuting and preparing for work, I could go back to my job within five months.– Song Lye Lin, Client

Joy is highly motivated and contributes greatly to achieving holistic care for her clients. Her role in care coordination is crucial in addressing the clinical aspects of care. She works cohesively with our multidisciplinary team to reach better outcomes and quality care for our clients.– Panneerselvam Manchu, Manager, Rehabilitation Services, Man Fut Tong Nursing Home

Name: Joy CruzOrganisation: Man Fut Tong Nursing HomeDesignation: Senior Occupational TherapistYears in Service: 7 years(Photo Credit:Man Fut Tong Nursing Home)

9.00AMMy workday starts with our Centre Manager, Administrative Officer, Programme Coordinator and I planning areas such as clients’ screening, referral management, programme and transport scheduling. I then conduct individual occupational therapy and supervise therapeutic groups. Our team of 23 staff members (comprising therapists, therapy assistants, physiotherapy aides, health assistants and nursing aides) provide a full suite of inpatient therapy, day care and day rehabilitation services.Other than helping clients maximise their functional status to be as independent as possible, I am actively involved in care coordination with our multidisciplinary team, pooling our areas of expertise to better help clients. Our care coordination work includes assessment; individualised care planning and implementation; patient and caregiver education in self-management; care plan and goal monitoring; care plan meetings with a multidisciplinary team and family members; and care transition management.For areas beyond our scope, I oversee linking and following up with entities such as Ministry of Social and Family Development’s Social Service Office for financial assistance, Housing & Development Board for home modifications,

and Bizlink Centre for employment opportunities. Care has to be multi-pronged in order to help clients effectively reintegrate back into the community.

12.00PMWe discuss care issues and make recommendations to clients and caregivers during education and feedback sessions. To help clients overcome barriers to reintegration, we also share self-management skills, how to improve exercise compliance, and make other follow-ups.

2.00PMI supervise occupational therapy groups of day care clients and advise therapy assistants on how to encourage participation and modify activities to suit clients’ needs. To assist clients with reintegration, they practise instrumental activities of daily living (IADL), such as buying food and managing money. I also do home assessments to recommend modifications such as grab bars so clients can live in a safe and independent manner. To encourage mobility and social skills, we sometimes also visit coffee shops together.

4.00PMAs initial screening and care needs assessments are crucial to the referral process, we collaborate with the Referral Management Team, Care Transition Division, AIC, to plan holistic care for referred clients. We also speak to our Rehabilitation Manager and multidisciplinary team to better understand clients’ holistic needs and

discuss recommended programmes.Often, family members express concerns about care, recovery period and expected functional outcomes of their loved ones. To alleviate their worries, I discuss with them about various care options (e.g., recommended day care, therapy programmes); time frame; and setting of realistic goals and expectations, taking into account their preferences.

5.00PMI complete my day after documenting sessions and updating clients’ clinical statuses and my schedule. Helping clients reintegrate back into the community always gives me a tremendous sense of satisfaction.

Joy working with a Programme Coordinator and Administrative Officer, who both manage clients’ social and financial needs, to ensure they receive holistic care.(Photo Credit: Man Fut Tong Nursing Home)

5aic.sg/mosaic


The ILTC Quality Festival is an annual event which aims to inspire, develop and promote a culture of patient safety and quality improvement (QI) in the Community Care sector. Its fifth instalment was held on 14 October 2015 at Furama RiverFront and attended by over 500 health and social care staff.Focusing on the theme “Quality: Translating Vision to Action”, the Festival featured leading speakers – Professor Gary Day1, Helena Li2 and Dr Ng Li-Ling3, among others, and breakout sessions about driving change and case studies of QI in action and implementation.

Kicking off the plenary sessions, Professor Gary Day shared that good managers need to use their “left brain”, which manages logic and reasoning, and their “right brain” as well. He elaborated on the various approaches in developing “right brain” leadership (e.g., using metaphor, analogy, narrative) to stimulate more creative solution making.Helena Li then discussed clinical governance and a shared framework for it. Quoting Lord Ara Darzi, one of the world’s leading surgeons, she stated that quality healthcare is the responsibility of every staff member and should be safe, effective and result in positive patient experiences. She also elaborated on how management can ensure opportunities for staff to participate, deliberate and develop strategies. Board members too can familiarise themselves with standard operations to assist the organisation in reaching good quality outcomes.Dr Ng Li-Ling closed the plenary sessions with a sharing on person-centred dementia care, summarised in the acronym “VIPS” – Valuing persons with dementia (PWDs) and their caregivers; treating people as Individuals; looking at the world from PWDs’ Perspective; and

Participants enjoying a light-hearted moment during one of the plenary sessions.

Participants reviewing submissions for the ILTC Quality Festival Poster Competition and learning about good practices from fellow Community Care organisations.

ILTC Quality Festival's plenary speakers included (L-R): Professor Gary Day, Helena Li and Dr Ng Li-Ling.

The NKF team giving a “thumbs up!” to celebrate coming out on top in the Non-Community Hospital Category.

This year’s “Gold” award for the Community Hospital category of the Competition went to Ren Ci Hospital (RCH) for their project which improves the comfort and quality of life of patients on tracheostomy. Dr Kala Kanagasabai, Director, Clinical Quality Management Unit (CQMU) and Senior Consultant, shared, “We came up with this QI project to provide intensive nursing care and improve the quality of life for patients who face several complications and had difficulty with vocalisation and feeding due to tracheostomy. The award is in recognition of the quality care we strive to provide our patients.”For the Non-Community Hospital category, National Kidney Foundation (NKF) received the “Gold” award for their project which has enhanced care for new end-stage renal disease patients. Team

TRANSLATING VISION TO ACTION:ILTC QUALITY FESTIVAL 2015

Dr Kala Kanagasabai receiving the “Gold” award in the ILTC Quality Festival Poster Competition (Community Hospital category) on behalf of the RCH team.

creating a positive Social environment for the relative wellbeing of PWDs. She explained that this would require a “many hands”, multi-pronged and multi-agency approach, and a commitment to help PWDs live well.Aside from the sessions, participants also benefited from submissions for the ILTC Quality Festival Poster Competition.

January 2016 6SHOWCASE

1 Professor Gary Day is the Director, Centre For Health Innovation and Professor, Health Service Management, Griffith University, Australia. 2 Helena Li is the President, Hong Kong College Of Medical Nursing and Nursing Director, University Hospital, Macao.3 Dr Ng Li-Ling is a Senior Consultant Psychiatrist, Department Of Psychological Medicine, Changi General Hospital and Vice President, Alzheimer’s Disease Association, Singapore.

*The PDSA cycle guides providers in testing innovative ideas by piloting and assessing their impact.**Lean principles help eliminate resource wastage and maximise value to clients, thus achieving better quality, productivity, cost savings and timeliness.

• The first ILTC Quality Festival was organised in 2011.• In 2015, the Festival was organised by AIC and supported by Ren Ci Hospital, Man Fut Tong Nursing Home, St. Luke’s ElderCare Ltd, St. Joseph’s Home, The Lentor Residence, St Andrew’s Community Hospital and Home Nursing Foundation.• The ILTC Quality Festival Poster Competition in 2015 had a significant increase in submissions – 132 abstracts from 29 organisations. It received 93 abstracts from 17 organisations in 2014.• AIC Learning Institute’s QI Toolkit workshops have trained about 150 participants since 2012.

Fast Facts

The next day, to enable participants to effectively put into practice what they had learnt at the Festival, interactive workshops were conducted at St Andrew’s Community Hospital and Grace Lodge. Professor Gary Day introduced participants to organisational, professional and personal factors which can impact their clinical staff’s ability to provide quality care. He also discussed practical approaches to increasing their engagement and commitment.

Visit aic.sg/qfprogramme to download the speakers’ presentations or contact AIC Learning Institute at [email protected] for training details.


During the Festival, Guest of Honour, Dr Amy Khor, Senior Minister of State, Ministry of the Environment and Water Resources and MOH, launched the Quality Improvement Toolkit. Developed in collaboration with Community Care partners by AIC, the Toolkit complements training workshops at the AIC Learning Institute and also offers useful resources for implementing QI projects such as:• Basic QI methodology and quality tools (e.g., the Plan, Do, Study, Act (PDSA) cycle* and Lean principles**); and• Tips on organising a team to start improvement projects, identifying and applying areas of improvement, optimising resources and evaluating outcomes.The toolkit is available for download at AIC’s LMS at https://lms.aic-learn.sg/lms/app/SYS_login.aspx

Quality Improvement Toolkit Launched

leader Bindumol Joseph, Clinical Nurse Manager, said, “Our nurses realised that new Haemodialysis patients sometimes faced difficulties adapting to the Dialysis Centre’s environment, resulting in missed sessions which negatively impacted their health. To enhance their wellbeing, we initiated a nurses’ support group to identify patients’ clinical and social issues and recommend early interventions by the Medical Social Worker. Moving ahead, we will be focusing on enhancing nurses’ roles to improve continuity of care.”

Dr Amy Khor learning about Ang Mo Kio – Thye Hua Kwan Hospital’s cross training and integration of therapy services project for its therapy assistants.

Helena Li, on the other hand, shared about quality indicators, goals and ways to identify and interpret them as part of client-focused care.Sharing her thoughts on the Festival, Geraldine Lim, Director of Nursing, Tai Pei Social Service, said, “This is my fourth year attending the Festival. I have gained some ideas on how to improve nurses’ documentation processes. Quality is everyone’s affair.”

7aic.sg/mosaic


What was the hospice care landscape like when you first began your work in the 1990s?If you are looking at a graph, it was below zero. I don’t think we got past zero until 1995. For 10 years, we were really struggling because we did not get much support.There was the impression that Singapore had enough hospital beds and too many hospice beds. We were not allowed to expand and had trouble getting a land lease to build a hospice. We were told then that we had enough hospitals until 2020… but now, new hospitals are being built all over Singapore to meet the needs of our ageing population and the government is pushing for more nursing homes and hospice beds!

The hospice care movement has come very far. What would you say are some major factors behind its achievements?The growth of hospice has been indigenous. It has grown because there have always been kind people in Singapore who will volunteer time and effort and give generously.When we first started, I was strongly supported by volunteers. Our staff were mostly foreigners. Singaporeans did not want to work in this sector as salaries were low; there were no opportunities for career advancement; and superstitions associated with death and dying were prevalent.

To win this battle, we knew we had to win the minds of people. For the first decade, we ran many community and public education projects. I still remember one of our most interesting community relations projects where a negative situation turned out to give us the best publicity!Sunflowers have internationally been associated with the hospice care movement and we decided to sell silk sunflowers at Raffles Place to raise funds and awareness. We obtained permission for donors to “plant” their purchased sunflowers on the green patch in Raffles Place to show their support. By evening, there was a “sea” of gold on the green.What we didn’t expect to happen that evening was for MRT commuters – thinking that the flowers were free for their taking – to jump onto the grass patch and take the sunflowers away. We made headline news the next day and for the next two weeks, people were coming to DPH to apologise, return the flowers and give donations. It was not the donations that mattered – it was the fact that hundreds of people now knew about hospice and we had touched the hearts of many Singaporeans.

What efforts have been made to recruit locals?It is important to attract good people, give them recognition and also to pay salaries

Dr Seet Ai Mee has been helming the work of the hospice care movement since the 1990s. In 2013 and 2014, she retired from active leadership in hospice and holds Trustee and Honorary positions in DPH.(Photo credit:HCA Hospice Care)

In this new section, we catch up with pioneers and leaders in Singapore’s Community Care sector. For our inaugural interview, we spoke to Dr Seet Ai Mee, Founder Chairman, Dover Park Hospice (DPH); First Chairman, Singapore Hospice Council (SHC); and President, HCA Hospice Care (2003-2014). At times fiery, other times, pensive, Dr Seet shared candidly about the obstacles and triumphs she and fellow volunteers experienced as they tenaciously pursued their mission of providing care and support for palliative care clients. Throughout the sharing, her tremendous passion and enduring love for hospice care were apparent.

commensurate with other health institutions. To do so, we had to have training for those interested and to raise sufficient funds through greater awareness events.The SHC members – who are volunteers themselves – worked very hard to professionalise the work, raise awareness and attract good people. Let’s face it – the people working in hospice are very special. They know they will never rise to high-level positions; we are but a small health service provider. Coming to work in hospice is like a missionary call, to come and do something needful, something special with people who are dying.Fortunately, things have changed. Now, we hope it will continue to improve as more and more Singaporeans choose to work in hospice care.

Speaking of the SHC, what other contributions has it made to the hospice care movement?The SHC was formed when the hospice care movement banded together to raise awareness and public education. The SHC does not compete with hospices for fundraising but all local hospice organisations co-operate once every two years to present the “Voices for Hospices” concert. It’s the only fundraising event that is run by the whole hospice movement.Currently, we are the only country in the world where the hospice care movement is under one united umbrella body. My hope is that we will always remain united and never split. Singapore is too small to have more than one hospice care movement.

What is your vision for the future of hospice care?Home hospice: Hospice care will go into more and more homes. We are working with patients in their homes but there is still a long way to go.I believe we can train many more home caregivers – by empowering stay-at-home parents, retirees and people with a lower level of education who are presently unable to get a job – so that there is a group of people who are paid to go into homes to provide care and assistance for the terminally-ill for at least a part of the day.Home Care has to grow beyond what it is now – we need to expand our pool – to meet the needs of our ageing society.

NEW! January 2016 8REFLECTIONS

DRIVE:THE SURPRISING TRUTHABOUT WHAT MOTIVATES US

Go Beyond Extrinsic Rewards

For creative and non-routine tasks, extrinsic rewards such as money and the “carrot-and-stick” (reward and punishment) method may dampen motivation as it transforms play into work. Extrinsic rewards may however be used if they are:• Unexpected and offered only after the task is completed (e.g., a lunch treat); and• Non-tangible (e.g., positive feedback).

Enable Self-Direction

Autonomy has a powerful effect on an individual’s performance and attitude. To enhance satisfaction, enable the person to make their own choices such as activities or tasks that they would like to do.

Remember the Four “T’s”

Provide individuals with autonomy over:• Task: e.g., Encouraging them to do a project of their choice stimulates creativity;

It’s often said that money is the best motivator – but is that really the case and does it apply in all situations? In Drive: The Surprising Truth About What Motivates Us, bestselling author Daniel H. Pink shares that true motivation comes from people’s intrinsic need to direct their own lives, learn and improve on new skills, and be part of something larger (autonomy, mastery and purpose). He shares five tips on how to better motivate ourselves and others.

• Time: e.g., Letting them choose when to do a task fosters more focus and energy;• Technique: e.g., Enabling tasks to be done in their own way results in greater satisfaction; and• Team: e.g., Offering choices over whom to team up with produces better team players.

Use “Flow” to Achieve Mastery

The most gratifying experiences occur when in “flow” (i.e., the goal is self-fulfilling and the reward is the activity). Employ the following approaches to enable “flow” in:Staff:

• Assign “Goldilocks” tasks (i.e., neither too difficult nor simple); and• Turn work into play: When staff enjoy work, they perform better and are less likely to face stress and anxiety.Yourself:

• Set learning as your goal;• Persevere over the long run;• Enjoy the process, not the outcome; and• Periodically record what you are doing, feeling and if you’re in “flow”.

Cultivate Purpose Maximisation

It is in our nature to seek purpose. As we age, we may wonder if we will get to live our best life and make a difference in the world. Thus, enable individuals to engage in activities that are meaningful to them (e.g., patient care, research and community service) so that as part of the process, they also achieve what they personally seek.

Watch Daniel H. Pink explain about what motivates us at goo.gl/rHeIQp.

Are you motivated extrinsically or intrinsically? Find out at goo.gl/QqgBCd.

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9aic.sg/mosaicIMPROVEMENTS

Yin Zhan Xin, Kitchen Helper, United Medicare Centre (Elizabeth Drive), preparing ingredients before cooking “Stewed Winter Melon with Black Fungus”.

QUICK BYTES

Tote Board Community Healthcare Fund (TBCHF)

ApplicationClosing Dates

ProjectCommencement

• 31 Mar 2016, 5pm• 31 Jul 2016, 5pm• 30 Nov 2016, 5pm

• From 1 Aug 2016• From 1 Dec 2016• From 1 Apr 2017

APPLY TODAY!

NUTRITIONHIGHLIGHT

CREATING MOUTHWATERINGMAKAN MEMORIESThe “Culinary Boot Camp”, part of the ILTC Nutrition Movement1, is an eagerly anticipated event for Community Care cooks. In September and October 2015, 27 cooks from 16 organisations took part in “Nostalgia: Makan Memories” where they learnt nutritious yesteryear recipes, some coupled with an innovative twist!Under the tutelage of chef trainer, Devagi Sanmugam, author of 22 cookbooks, the cooks prepared dishes such as:• Lotus Root with Chicken Soup;• Chicken and Spinach Rice;• White Fungus with Sweet Potatoes;• Mulligatawny Soup;• Chicken Briyani;• Wrapped Lettuce with Curry Potato and Chicken; and• Banana Sago Gula Melaka.

Recipes were selected from a new cookbook, “Eat Well. Age Well. Live Well”, featuring recipes from celebrity chefs and also the sector, which was produced by AIC.

1The ILTC Nutrition Movement is an annual campaign which aims to raise awareness about the importance of good nutrition, food service and provide capability building opportunities in the sector.

“Eat Well. Age Well. Live Well” comprises 50 recipes for clients in the Community Care sector and was produced to commemorate SG50.

Participants from one of the boot camps share their evaluation of the sessions.

More Tasty Happenings!

• AIC signed a Memorandum of Understanding (MOU) with Singapore Chefs Association (SCA) on 12 November 2015 to provide more opportunities for Community Care cooks to enhance their culinary skills. Annually, SCA will conduct four training courses for about 40 cooks in areas such as cooking skills, techniques and improving productivity through bulk cooking.• Get your copy of the “Eat Well. Age Well. Live Well” Cookbook at the link below.

The sessions provided the cooks with valuable learning opportunities. Sai Saw Win Tun, Senior Assistant, Kitchen, Bethany Methodist Nursing Home shared, “I learnt how to identify nutritious food to cook for the elderly and will share these points with my colleagues.” Nancy Soon, Day Hospice Supervisor, HCA Hospice Care – who joined the boot camp because of the chance to learn nostalgic recipes – shared,

“I can now prepare nutritious meals for my clients when our volunteers (who usually cook for us) are not around.”Chef Devagi added, “I was inspired to be part of this project because it benefits the elderly and cooks in nursing homes. I hope the cooks have benefited from the event, learning new recipes, mingling with other cooks and learning from each other.”

Visit aic-learn.sg/nutrition-facts or contactSim Tan Rui at [email protected].


Visit aic.sg/tbchf or contact the TBCHF Secretariat [email protected].


10NEWSBYTES January 2016

Joyce Tan, Senior Pharmacist, KTPH (right) sharing her observations with Lathiga, Staff Nurse, SNMH during medication administration.(Photo credit:Sree Narayana Mission Home for the Aged Sick)

CAREINMIND

1Reference:Wang HX, Karp A, Winblad B, Fratiglioni L. Late-Life Engagement in Social and Leisure Activities Is Associated with a Decreased Risk of Dementia: A Longitudinal Study from the Kungsholmen Project. American Journal of Epidemiology. 2002;155(12):1081-1087.

MAKING SENIORS’WELLNESS A FOCUS

As the adage goes, “An ounce of prevention is worth a pound of cure". Since 2012, TRANS Family Service Centre (FSC) in Bukit Timah has been running the “FOCUS” programme for residents aged 50 years and above to develop their talents, skills and

TRANS FOCUS Centre participants taking part in morning yoga sessions.(Photo credit: TRANS FOCUS Centre)

bond with each other through activities. In November 2014, the Programme expanded and became a full-fledged centre, known as the TRANS FOCUS Centre. Activities, such as yoga, cooking, calligraphy, etc., are organised every weekday and conducted by staff or volunteers. Aside from enjoying activities together, participants have also fostered a “kampong spirit”, gaining a safe haven to share problems and benefit from being part of a social group.TRANS FOCUS Centre believes that effective preventive healthcare can be provided to seniors by enhancing and maintaining their physical, mental and social function. Similarly, research published in the American Journal of Epidemiology1, found that a rich social network creates a protective

Contact Ng Ying Ting at [email protected] for ENHS-related partnerships and programmes.


Contact Mohamed Khalid Qarni Bin Yahya at [email protected] for mental health-related programmes.


effect from dementia as social interactions and intellectual stimulation preserve mental functioning. The need for initiatives which meaningfully engage seniors is hence crucial in enabling them to maintain their wellbeing and to age gracefully.

ENHANCING MEDICATION SAFETY IN NURSING HOMESGood pharmaceutical practices are crucial in all healthcare facilities. As at December 2015, 60 nursing homes have ongoing regular partnerships with registered Pharmacists to review and strengthen their medication management processes.Two nursing homes1, Sree Narayana Mission Home for the Aged Sick (SNMH) (Partner: Khoo Teck Puat Hospital [KTPH]) and Jamiyah Nursing Home (JNH) (Partner: Watson’s Personal Care Stores Pte Ltd [Watsons]) share some of the enhancements made as a result of their collaborations since 2014:• Standardised Practices: Work processes (i.e., preparation and administration of medication etc.) are more standardised and aligned with requirements of the Enhanced Nursing Home Standards (ENHS);• Improved Inventory Management System: Medication storage and packing procedures are now improved to ensure drug integrity and prevent wastage (i.e., organising medication on a First-Expiry, First-Out [FeFo] system);• Medication Optimisation: With regular medication reconciliation conducted, polypharmacy – a common cause of poor medication compliance – is minimised, and potential drug-related problems reduced; and

• Regular Audits: Checks to identify gaps in medication work processes are now regularly conducted to ensure continuous improvement.“Our partnership with the Pharmacists has enhanced our medication management and prepared us to meet the ENHS requirements. In fact, we have expanded our KTPH partnership to other medication-related projects,” said Ambalavanan, Assistant Director of Nursing, SNMH.For JNH, shared Baltazar Marviolet Pagador (Marvie), Nurse Educator, “We now have a more comprehensive medication management system in place which benefits residents. In nine months, we also had a direct cost saving of $1084.92 through medication optimisation and inventory control.”Pharmacists have also benefited from this collaboration. Grace Kng, Pharmacist, Watsons, shared, “This has provided us the opportunity to play a role in caring for the ageing population and hone our skills in geriatric care. It also gives us a chance to show trainee Pharmacists this aspect of our job and spark their interest in Community Care.”Joyce Tan Zhenyin, Senior Pharmacist, KTPH, added, “Pharmacists can aid by having a second look at all the medication a resident is

1In June 2014, AIC and the Pharmaceutical Society of Singapore (PSS) signed a MOU to enhance pharmaceutical practices in nursing homes through the Pharmaceutical Care Programme. SNMH and JNH are part of this Programme.

taking, ensuring it is safe and enabling them to get the best out of their therapy. A Pharmacist can be an ally to help achieve safety and higher care standards.”

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Share your initiatives and stories with mosAIC readers! For more information, contact Thiru Gunasegaranat [email protected].

WE WANT YOUR SUBMISSIONS!

SECTOR’SSHARING

GOING HOME:A HOME LEAVEPROGRAMME FORPALLIATIVE CAREPATIENTS AT BRIGHTVISION HOSPITALContributed by Sandy Koh, Tan Yoke Hoon andCeline Yong, Bright Vision Hospital

THE ROLE OF FAMILYCAREGIVERS IN THECOMMUNITY CARE SECTORContributed by Yong-En Care Centre

Lim Choon Qwee (extreme left) celebrating his mother’s birthday with family members atYong-En Care Centre.(Photo credit:Yong-En Care Centre)

Many end-of-life patients prefer passing away at home but often end up spending their last days in an unfamiliar environment, such as a hospital, due to increasing and complex care needs. This sometimes leads to family members feeling troubled by their inability to fulfil loved ones’ last wishes.To address this, Bright Vision Hospital piloted a home leave programme which enables patients to return home for one to two hours with essential medical equipment (oxygen concentrator, etc.). They are also accompanied by an Occupational Therapist, who assists with their care needs, and a Social Worker, who helps with activities that address their concerns.The team tracked patients’ moods and participation before and after home leave. In one case, Madam M was very unsettled and restless in the hospital and repeatedly asked to return home. After the home visit, which enabled her to pray to ancestors, chat with neighbours and take a short nap in her bed, she expressed great joy and even declined future home leave as she said she had “done what she had to”.Such situations provided family members a sense of relief as they were able to fulfil their loved ones’ last wishes without the stress of caregiving in the home.To date, an estimated one out of five patients and their families have benefited from the Programme. Some of the positive outcomes include:• Lower anxiety and restlessness in patients;• Increased involvement in rehabilitation; and• Closure for caregivers.

“Caregivers are the most forgotten people. They take on the role out of love and responsibility, but in the process, risk their life, health, career and retirement planning,” shared Lim Choon Qwee, a family caregiver.Recognising the stresses that caregivers often undergo, in addition to offering a range of information and resources at Yong-En Care Centre, we have also been creating avenues for caregivers to contribute their diverse capabilities and skill sets to benefit clients and other caregivers. This not only affirms their individual uniqueness but also showcases other facets of their identity beyond their role as caregivers.Choon Qwee, for instance, who is passionate about eco-friendly sustainable living environments, helped us improve the Centre by setting up an aquarium. He also shared his knowledge about financial protection with other caregivers. He said, “I hope to inspire more parties to step forward and help caregivers gain knowledge, skills, experiences and moral support.”Another caregiver, Jane Wallace, has been raising funds for the Centre by upcycling and recycling, sewing and crafting, and turning old greetings cards into bookmarks and gift tags. She said, “The Centre removes the burden of caring for my mum so I wanted to show my appreciation and support.”Bix Yap Kwan Choon, who has also been been helping fellow caregiversby sharing his knowledge in Traditional Chinese Medicine, commented, “Ibelieve alternative treatments can help loved ones and also prepares them for a better old age in the future.”Serving and learning together has created a support system for caregivers. Jane said, “I learnt more about dementia and bonded with everyone in the Centre. We are like one big family.”


A JOURNEY TO HEALingContributed by Club HEAL

Contributed by Montfort Care

CREATING A LIFEBOOKOF MEMORIES

One of the Lifebooks created showcases the life story of a Woodlands Secondary School student’s grandfather.(Photo credit: Montfort Care)

(L-R) Mdm Halimah Yacob, Speaker of Parliament, looks on as authors, Dr Radiah Salim and Yohanna Abdullah autograph books.(Photo credit: Club HEAL)

Every person has a life story.Lifebook is a person-centred approach which aims to capture significant moments in a person’s life. It encourages the elderly, especially those living with dementia, to reminisce about their successes, interesting incidents and meaningful relationships. These recollections in turn positively impact their psychological and existential wellbeing.As part of AIC and Alexandra Health System’s initiative to develop a dementia-friendly community in Chong Pang, Montfort Care’s Project Angels conducted a ‘Lifebook for Elderly’ training session for 500 Secondary One and Two students from Woodlands Secondary School. During the sessions, students learnt about dementia, its symptoms and how to render assistance. In addition to learning the

rationale and how to create a Lifebook, they also learnt communications tips on improving interactions with the elderly.Students shared that as a result of this activity, they had enriched intergenerational bonds with their grandparents. Most stated they got to know their grandparents’ lives better, enabling them to acquire a deeper understanding of their family roots. A student commented, “Either good or bad, we should cherish our memories and never forget them. It makes us who we are today.” Another shared, “My mom had many good stories and memories of the past. I learnt that bonding with her is very important.”This activity has not only strengthened family ties but also given students a better awareness about issues that the elderly face, such as illness, loss and loneliness. It was also especially beneficial for students who have an elderly loved one living with dementia as it provided an avenue for communication, encouraging closer interactions.

Founded in 2012, Club HEAL (Hope, Empowerment, Acceptance & Love) provides community-based rehabilitative psychiatric services and support to persons with mental illness (PMIs) and their caregivers. We also promote mental health literacy through talks, training sessions and publications. Through these, we seek to help PMIs regain confidence as they journey towards community integration and also educate the public to reduce mental illness stigma and break down barriers to a PMI’s recovery process.In 2014, we launched our first book – Shattered, We HEAL (English), Berkecai, Kami Pulih (Malay), written by Yohanna Abdullah, a recovering PMI, and Dr Radiah Salim, President,Club HEAL – which features information on Club HEAL as wellas PMIs’ recovery stories. On World Mental Health Day in 2015(10 October), we launched part two of the book, which presentsour organisation’s milestones; more stories of PMIs and their caregivers; and information from mental health professionals. Features include: The Peer Recovery Movement in Singapore by Dr Joseph Leong Jern-Yi; The Past, Present and Future of Psychiatry by Adjunct Assistant Professor Habeebul Rahman and Mental Health First Aid by Dr Angelina Chan.Through resilience, determination and community support, recovery for PMIs is possible. For instance, “Nora”, a single mum who has schizoaffective disorder, has progressed from being a client to a volunteer assisting our Programme Executive, to now, our trainee Programme Executive. She is one of many success stories of PMIs living amongst us.We are thankful to organisations like the Institute of Mental Health, Singapore Anglican Community Services and Singapore Association for Mental Health for offering eligible clients places in their programmes and services. When many hands within the community band together, we are able to better support PMIs and their caregivers in their journey to full recovery.To buy a copy of Club HEAL’s books, please contact them at 6899 3463 or [email protected].

13aic.sg/mosaic


TRIVIATIME!

Email your answers with the subject header “mosAIC #24 Quiz”, together with your name, designation, organisation and mobile number to [email protected]. Winners will be notified by email!

1) What are the key benefits of NHELP?

a. Better time management b. Consistent documentation c. All of the above2) Who did AIC sign a Memorandum of Understanding with to enhance Community Care cooks’ skills?

a. Singapore Cooks Association b. Singapore Chefs Association c. Singapore Cooking Association3) How much is the annual subsidy for approved training courses under the Caregivers Training Grant?

a. $50 b. $100 c. $200

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KEY APPOINTMENTSIN THE SECTOR

(Photo credit:Society for the Aged Sick)

Joe Ong, Chief Operating Officer,Society for the Aged Sick (August 2015)“The opportunities to volunteer, work in a management position and then in the private rehabilitation service of the Community Care sector have broadened my horizons and deepened my passion in the area. I am excited to share this experience and knowledge in my new role at Society for the Aged Sick. My initial focus will be improving the psychosocial and mental health of residents and the strengthening of their rehabilitation capability. I also hope to build a stronger support network involving residents’ families and the community.”

(Photo credit:Bright Vision Hospital)

Magheshwari Sabapathy, Director of Nursing,Bright Vision Hospital (September 2015)“My nursing career started in 1982 at the now defunct Toa Payoh Hospital. In 2003, I moved to the Community Care sector and this allowed me to engage more with long-term patients and foster close working relationships with the multidisciplinary team. As a nurse leader, it is important for me to encourage nurses to balance organisational results and patient care. Nurses must be empowered to make sound decisions while on the ground. This can be achieved by building trust, encouraging commitment and embracing accountability.”

(Photo credit: NTUC Health)

Karen Bek, Deputy Director,Home Care & Service Partnership, NTUC Health (September 2015)“I look forward to being a part of NTUC Health’s Home Care team. I believe in providing good care support to the elderly so that they can continue living in familiar environments with loved ones and peace of mind. I hope that my experience in the tertiary and primary healthcare sectors, as well as the eldercare social sector, will bring value to the team, as we strive to provide quality Home Care services for ourselves and our loved ones.”

Contact [email protected] to announce new appointments to key leadership positions in your organisation.WE WANT YOUR SUBMISSIONS!

Find out how leaders holding new positions hope to contribute to theCommunity Care sector.


REDUCING COSTS THROUGHSHARED PROCUREMENTIn 2010, AIC started the Shared Procurement Programme with SingHealth Group Procurement Office (GPO) as its partner and agent. Five years on, it now boasts 32 organisations actively participating and sustaining the effort. Since implementation, the initiative has saved a total of $3.45 million and was recognised in August 2015 with a Merit Award in the poster competition under the Supply Chain Category at the Singapore Healthcare Management Congress.In a nutshell, the Programme:• Achieves cost savings through competitive pricing from vendors by aggregating demand and consolidating purchases;• Increases productivity by reducing effort and time on procurement matters; and• Promotes the sharing of procurement knowledge and good practices.

Items which may be procured:• Consumables (e.g., diapers, milk feed, alcohol handrub, wet wipes, dressing and catheterisation sets);• Bed and accessories; • Uniforms and shoes;• Wheelchairs and rehabilitation equipment;• Minor medical equipment (e.g., examination couches, specialised trolleys, hoists, diagnostic medical equipment; pharmaceutical refrigerators);• Ward curtains and linen;• Bedpan sanitisers and sterilisers;• Electrical housekeeping items (e.g., auto scrubbers, power jet, blower); and• Office furniture and equipment (e.g., printers, copiers and projectors).Benefits of the Programme:• Reduced operational spending;• Streamlined processes and improved productivity;• Governance of procurement policy;• Consistency in quality standards; and• Better care for clients.

Low Mui Lang, Executive Director, The Salvation Army Peacehaven Nursing Home and Co-chair of the Shared Procurement Committee, shared, “I am happy and proud to be part of this Programme. It has ensured governance in procurement, reduced administrativeworkload in a tight labour market and sustained our business.”

A staff member from Ren Ci Hospital using some of the items purchased as part of the Shared Procurement Programme, including gloves, wet wipes, alcohol handrub and diapers.

Chew Chee Weng, using transfer techniques learnt during his training sessions, to safely assist his mother to her wheelchair.

To assist caregivers in providing better care for loved ones at home, the Caregivers Training Grant (CTG) provides them with an annual $200 subsidy for approved training courses.After his mother suffered a bad fall, Chew Chee Weng, 61, became her full-time caregiver. To ensure that he could care for her well, he enrolled in CTG-approved courses run by the Metta Day Rehabilitation Centre for the Elderly and the Primary Care Academy. During sessions, he picked up useful skills (e.g., transferring, diaper changing, proper use of the wheelchair, checking vital signs) and was inspired by the sharing of fellow caregivers.Since then, Chee Weng has become more confident in caring for his mother. He said, “I’m glad I am able to take care of her in her old age, and at home too, where she is comfortable and happy.”Eligibility criteria for the CTG: The care recipient must be:• A Singapore Citizen or Permanent Resident; and• Aged 65 and above OR has a disability (as certified by a Singapore-registered doctor).The caregiver must:• Be the main caregiver (family member or foreign domestic worker) looking after the care recipient; and• Complete the CTG-training course and receive a certificate of attendance (if applicable).Applying for the CTG:• Find suitable approved courses on the Singapore Silver Pages’ Caregiver Training Calendar at the link below;• Find out about the selected course by contacting the training provider directly (click on the course title for details); and• Register for the course by submitting the CTG application form directly to the training provider at least two weeks before the course begins.

CARERS CORNER

FOSTERINGCAREGIVERSUPPORT

Visit aic.sg/sharedprocurementservices or contactWilliam Loh at [email protected].


Visit silverpages.sg/training-calendar for a range of CTG-approved courses.


15aic.sg/mosaic


NHELP GOES LIVE ATNTUC HEALTH’S FIRSTNURSING HOME!

FILE YOUR PROJECT GRANT CLAIMS BETTER!Here is a list of “do’s” and “don’ts” to assist CommunityCare service providers in making more effective project grant claims. DO’S Use AIC’s Grant Claim Form only; Fill in your project details as stated in the Letter of Award (LOA) (Refer to the AIC Grant Claim Guide at the link below);• Ensure your claim form is signed and dated by the approving/delegated authorities; and• Declare if you have received funding from alternative sources. DON’TS• Submit supporting invoices/receipts as these will be reviewed during subsequent audits;• Combine claims from different financial quarters;• Claim beyond the awarded amount as stated in the LOA;• Claim for ‘un-approved’ expenses or expenses that are incurred beyond the approved funding duration; and• Submit overdue or duplicate claims.

In FY2014, AIC conducted an audit for some project-related grants. Here are some findings which may assist you in your submissions:

Duplicate claims made:• Same claims were submitted for different periods; and• Salary adjustment amounts were claimed from AIC despite the service provider receiving funding from alternative sources.Incorrect claims made:• Expenses claimed did not tally with the supporting documents provided (e.g., invoices and payroll records);• Headcount reported and claimed for differed from the actual time spent on the project;• Manpower claims were based on an arbitrary loading factor and differed from the actual amount paid;• Items given by a supplier for free were claimed for in full;• Manpower costs claimed did not tally with the attendance sheet; • Goods and Services Tax (GST) was claimed by GST-registered service providers; and• Cost of items claimed based on projected expenses were different from actual cost.

Discussing residents’ cases is now made easier through the centralised platform offered by NHELP.(Photo credit: NTUC Health)

Contact Ivy Lim at [email protected] or James Kuan at [email protected].

FOR MORE INFORMATION! Visit the AIC Grant Claim Guide at aic.sg/Financial_guide/financial_claim.aspx or speak to your AIC project partners.


Opened on 1 October 2015, NTUC Health Nursing Home is a 290-bed nursing home and Senior Care Centre located at 50 Jurong West Street 93.Recognising the benefits of Information Technology (IT) on care delivery, the Home’s management decided to integrate the Nursing Home IT Enablement Programme (NHELP) into their operations from day one. Ensuring staff members were familiar with NHELP was therefore crucial.Months prior to adoption, staff members underwent NHELP training through workshops, group learning sessions and one-to-one coaching. New staff were also trained as part of their on-boarding, enabling them to use NHELP immediately. “NHELP is user-friendly, so we could easily input medical data of our residents,” said Karen Loh, Executive, Nursing.Major benefits of NHELP include better time management and consistent documentation. Through its integrated assessment system, relevant information is automatically downloaded into a resident’s care plan, saving staff time on manual replication and ensuring consistent updates. “There is also greater convenience now because we can use smartphones or tablets to retrieve information,” said Dominguez Meagan Mendoza, Health Care Assistant.With the support of NHELP and staffs’ efforts and dedication, NTUC Health admitted over 25 residents within their first week of operations!In addition to NTUC Health, NHELP has also been implemented in Singapore Christian Home (pilot home), Grace Lodge, Ren Ci Nursing Home (Moulmein) and Ren Ci @ Bukit Batok, Bright Hill Evergreen Home and Jamiyah Nursing Home.

Comprising a complete medication management system (i.e., medication charts, prescriptions, alert system), some of the features include:• Resident’s information linked to medication administration (i.e., resident’s photo is shown with their primary diagnosis to minimise errors); and• Colour coding on the medication chart so staff have visual reminders about tasks (i.e., medication coded in “red” have not been administered).

New Medication Module to Be Launched Soon!

NEWSBYTES 16January 2016

Contact Loo Shu Ning at [email protected] for emergency preparedness matters and training.


BETTER HAZE PREPAREDNESS IN 2015

A resident having a drink to keep herself hydrated while seated next to an air purifier which had been set up to keep residents safe during hazy days.(Photo credit: Apex Harmony Lodge)

In the past few years, Community Care providers have needed to brace themselves periodically for hazy conditions. In September 2015, the Pollutant Standards Index (PSI) climbed, with some days consecutively recording a 24-hour PSI exceeding 101 (in the “Unhealthy” range).Residential and Centre-Based Care For providers like Singapore Christian Home (SCH) and SASCO Hong Kah North Day Care Centre for the Elderly (SASCO), some key measures taken included:• Deploying haze-related equipment (e.g., air purifiers, air coolers/conditioners, etc.);• Moving activities indoors;• Reminding clients to keep hydrated;• Relocating frailer clients to rooms with haze-related equipment; and• Minimising clients’ haze exposure by rescheduling non-key appointments.Jothi, SASCO’s Centre Manager said, “Our haze monitoring chart was displayed prominently and updated twice daily; we also monitored clients with prior respiratory conditions more closely.”SCH resident, Ms Ang, 49, shared, “It’s smelly but I feel a lot better with the windows closed and the fans have helped cool the place.” For others, it was about being cautious with their diet; Mdm Choo, 71, another resident, said, “I am not affected by the haze as I eat carefully so that I won’t be unwell.”Home-Based CareFor providers like Bethesda Care & Counselling Services Centre, who run meal delivery services for homebound elderly clients, some key measures taken included:• Ensuring clients’ wellbeing by instructing meal delivery staff to listen out for a clear verbal response from clients who were unable to come to the door;

AIC and MOH have been assisting Community Care providers to be prepared for the haze by:

• Organising Emergency Preparedness training sessions where providers develop and evaluate their pandemic preparedness and haze response plans;• Reviewing the sector’s preparedness level so they are equipped with relevant processes and haze-related equipment; and• Facilitating the supply and distribution of haze-related equipment, which were funded by MOH.

A Home Care staff ensuring that clients are well when delivering food to them.(Photo credit: Bethesda Care & Counselling Services Centre)

• Setting aside an air- conditioned room with boiled herbal drinks for staff and volunteers so that they could rest between deliveries; and• Having additional volunteers on standby so that, should the need arise, they could be deployed and the workload shared with those on duty.Lim Sio Seng, Senior Social Worker, added, “We also distributed dried food stuff, biscuits and beverages to our clients. In addition, we extended meal delivery services to our clients’ caregivers (whose health was affected by the haze) as they are an important link to our clients’ welfare and wellbeing.”

17aic.sg/mosaic


SEEDING A CULTURE OFCONTINUOUS IMPROVEMENT

Implementation Guides enable Nursing Homes, Centre-based and Home Care providers to provide better quality of care.

The flurry of Quality-related activities taking place in the Community Care sector today did not happen by coincidence but instead, through years of concerted effort by key stakeholders and service providers. It has been a long journey but one that everyone can be proud of!In 2010, the 1st Strategic Advisory Committee for Quality Improvement (SAC-QI)1 was formed, advocating and guiding quality-related efforts in the sector.

Some key initiatives since then include the:• Development of Implementation Guides: Jointly developed by industry representatives, MOH and AIC, guides relating to the Enhanced Nursing Home Standards, Centre-based and Home Care services, provide service providers realistic perspectives about good practices in various care settings;

• Creation of QI Toolkit Workshops and Handbook: These offer structured learning of QI methods to implement and evaluate projects; and• Organising of the annual ILTC Quality Festival: International and local QI leaders come together annually to share and learn from each other’s best practices and experiences. Service providers also submit their best QI projects for consideration in the ILTC Quality Festival Poster Competition.Today, a growing number of organisations are participating in QI workshops, projects and conferences. More nursing homes(and shortly, Centre-based and HomeCare providers) are also taking part in the Nursing Home Residents’ Satisfaction Survey to better understand and improve their service levels.The sector’s quest for continuous improvement has also been evident in the increasing number of abstracts submitted for the annual ILTC Quality Festival Poster Competition. Since the Festival’s inauguration in 2012, submissions have doubled to an all-time high of 132 abstracts in 2015. 232 Individual and Team awards were also recognised for their exemplaryQI efforts at 2014’s first ILTC Excellence Awards.

Formation of the AIC Quality OfficeTo provide dedicated support to the Community Care sector’s QI efforts and growth, AIC has set up a Quality Office (QO) effective from 1 October 2015. The QO’s three key thrusts are:• Quality Improvement;• Service Quality and Culture; and• Standards and Benchmarking.

It will complement the sector’s good work by increasing efforts to bridge quality initiatives in the different care settings (Residential, Centre-based and Home Care services) and foster closer working ties to co-create a more holistic quality movement and culture in the Community Care sector.

1The Strategic Advisory Committee for Quality Improvement (SAC-QI) was formed in 2010 and comprises representatives from Community Care organisations, AIC, MOH and the acute care sector to foster a quality culture in the Community Care sector. The present Committee (3rd SAC-QI) was appointed in April 2015 and is helmed by Chua Song Khim, CEO, NTUC Health.

Contact the Quality Office at [email protected].


Visit goo.gl/8t4waW to download a copy of the Act.


Are you about to begin a research project and needing to know how to do it correctly?

Are you in the midst of a research project and wanting to understand regulatory issues better?

The Human Biomedical Research Act 2015 was introduced in Parliament and published for general information on 13 July 2015. It regulates conducting of any research related to the human body or human individuals.

R&ECOLUMN

HUMAN BIOMEDICAL RESEARCH ACT 2015

This includes interventions to individuals, use of individually-identifiable health information or human biological material. Some issues addressed by the Act include:• What is considered appropriate consent for a minor or an adult who lacks mental capacity?• What information should be provided before taking appropriate consent?

• What are the penalties if any person or organisation contravenes subsections of the Act?• How can an individual or organisation that is not a research institute conduct such research?

18January 2016NEWSBYTES

by The Gerontologist. (2014) (Accessed: 1 December 2015)Read the full article at: gerontologist.oxfordjournals.org

COGNITIVE, EMOTIONAL, AND SOCIAL BENEFITS OF REGULAR MUSICAL ACTIVITIES IN EARLY DEMENTIA: RANDOMIZED CONTROLLED STUDY

The Study

• 89 PWD-caregiver dyads comprising family members and nurses from day activity centres and inpatient centres in Helsinki and Espoo, Finland.• Participants were randomised into three groups: Singing Group (SG), Music Listening Group (MLG), and a usual care Control Group (CG).• Caregivers in the SG and MLG were encouraged and taught to either sing or listen to music regularly with their PWDs to “enhance mood, increase reciprocal communication as well as support the cognitive abilities of the PWD”.• Participants were followed for nine months.• Cognitive abilities, moods and quality of life (QOL) of PWDs, and psychological wellbeing of their family members were assessed at three points: Before the intervention (baseline), Immediately after the intervention (Follow-up 1: Three months from baseline), and Six months after the end of the intervention (Follow-up 2: Nine months from baseline).

Singing Group (SG)

• Led by a trained music teacher/music therapist weekly. • Comprised group singing accompanied by the music teacher on the piano, guitar, or kantele (Finnish zither).• Sessions occasionally involved vocal exercises and rhythmic movements during singing such as clapping and playing maracas.• Sessions emphasised a supportive, engaging, and fun singing atmosphere.

Music Listening Group (MLG)

• Led by a trained music teacher/music therapist weekly.• Comprised listening to compact discs (CDs).• Emotions, thoughts, and memories these songs evoked were then discussed.• Visual cues such as album covers were used to “stimulate reminiscence and discussion”.• Sessions focused on building a soothing and relaxing atmosphere that would encourage emotional expression, free reminiscence, and open reciprocal communication.For both the SG and MLG, songs comprised mainly traditional folk and popular songs from the 1920s to 1960s, and were chosen based on PWDs’ individual musical preferences. Participants in the CG continued with their normal everyday activities.

Globally, care for persons with dementia (PWDs) is provided primarily by family caregivers. These caregivers are often under substantial burden and psychological distress. This study seeks to investigate the efficacy of music intervention as part of daily care.

Findings

• PWDs can cognitively, emotionally, and socially benefit from everyday musical leisure activities such as singing and listening to familiar songs.• Activities helped improve moods of PWDs and maintained/enhanced their general cognition; orientation, attention and executive function; and remote personal episodic memory.• Singing also had a positive impact in terms of enhancing the short-term and working memory of PWDs as well as on the emotional wellbeing of their family members.• Listening to music improved the QOL of PWDs in the long run. Caregivers also rated musical activities as being highly beneficial for themselves and their interaction with their PWDs.Similar to previous studies, these findings indicate that:• Emotional reactions to music are usually preserved in advanced dementia;• Music therapy and caregiver-implemented music interventions can reduce agitation, depression, and anxiety; and• Music-based interventions can temporarily improve verbal and episodic memory and overall cognitive functioning.This study suggests that everyday musical activities can have long-term emotional and cognitive benefits in early dementia and stroke patients. It also highlights the therapeutic effects of singing or music listening. These are particularly informative in shedding light about the potential rehabilitative facets of music that are specific to more active production (singing) and more passive reception (listening) of music while controlling for the general effect of receiving therapeutic attention.The study also concludes that coaching caregivers and nurses to conduct simple musical activities with PWDs is a cost-efficient way of bringing emotionally and cognitively stimulating, and enriching musical experiences to the lives of elderly PWDs.

• What are the penalties if any person or organisation contravenes subsections of the Act?• How can an individual or organisation that is not a research institute conduct such research?

*mosAIC’s Regular Reads aims to bring to Community Care providers’ attention knowledge that may be relevant and useful to their operations. This section features journals that highlight latest research findings as well as good, evidence-based and innovative practices. While the articles aim to keep Community Care providers informed of current developments in the sector, the views and opinions expressed or implied do not necessarily reflect those of AIC, its directors or editorial staff.

19aic.sg/mosaic

More Regular Reads at:aic-learn.sg/resources/regular-reads

REGULAR READS* January 2016

Tel: +65 6603 6800Fax: +65 6820 0735Email: [email protected]: aic.sg

Agency for Integrated Care5 Maxwell Road, #10-00Tower Block, MND ComplexSingapore 069110

ILTC Skills Training Course for Care AssociatesDates : 10-12, 15-16 February 2016Time : 9am-6pmDuration : 5 days

Introduction to Project Management Dates : 22-23 February 2016 (Day 1 and 2) and 11 March 2016 (Day 3)Time : Day 1 and 2: 9am-5pm Day 3: 9am-1pmDuration : 2.5 days

Certificate in Basic Palliative Care NursingDates : Classroom: 12, 19, 26 February 2016; 4, 11, 18, 25 March 2016 Clinical Attachment: 21-24, 30-31 March 2016 Time : 8.30am-5pm Duration : 13 days

Conversational Hokkien for Healthcare StaffDates : 2 March to 11 April 2016Time : 4.30-7.30pmDuration : 12 sessions

Visit aic-learn.sg/TrainingCalendar or contact Melissa Soh/Claire Ong/Jasmine Kam/ Agnes Sobha at 6593 3915/6603 6886/6603 6877/6603 6845 for more information.

AIC Learning Institute is now located at:

City Square Mall, 180 Kitchener Road#06-05/06, Singapore 208539.

Introducing New Features

• Refreshed Design.• Self-Assessment Tool for Financial Assistance.

Improved Popular Features

• E-care Locator in 3 Easy Steps: Use our new simpler search to find nearby care services by answering a few questions about your needs.• Advanced Search: If you are used to our original E-care Locator, don’t worry! It’s still there, and is now called Advanced Search.• Bouquets: Clients may leave reviews of positive experiences with service providers.

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ISSUE - Agency for Integrated Care · a Peritoneal Dialysis Nurse ... In Showcase, find out how leading organisations have ... The fluid circulates through the abdomen to draw impurities