Two NUS medical students came up with home care where secondary and university students work together with community allied health professionals to care for vulnerable elderly in the community.

BY: Eleanor Yap

Tri-Generational HomeCare @ North West matches secondary and university students with medical professionals to provide holistic care to seniors during home visits. Launched in 2014, the initiative was thought up by two fourth-year NUS medical students at the time, Kennedy Ng and Angeline Tey, who felt there were opportunities on the ground that needed to be addressed. They approached the North West Community Development Council (NWCDC) with their idea and was linked to Alexandra Health System and schools.

Since their launch, 269 NUS students and 300 secondary school students have helped 149 seniors. Ageless Online chats with Kennedy, 26, and Angeline, 24, now house officers in the public sector, to find out more about their initiative:

 

What made you come up with such an initiative and why add in the intergenerational element?

The ageing population in Singapore presents several unique challenges. The elderly are more prone to diseases, particularly chronic ones, that require multi-disciplinary management and long-term medications. Moreover, they are also besieged with many other problems such as insufficient finances from lack of income and savings, and poor social support. We were privileged to have first-hand encounters with patients in the hospitals where we saw that many issues they face can potentially be arrested in the community.

Recognising these potential issues of an ageing population and a growing public sentiment that the elderly must be given more support and help, the Government and society have implemented many initiatives to cope with these challenges. While there is definitely room for improvement, there is a great deal of resources that the elderly and their families can tap on to age-in-place.

Elderly living in homes with good social support usually have loved ones who act as their advocates to bring different resources together for the elderly’s well-being. However, there are many vulnerable elderly who are living alone and are illiterate – two formidable barriers – that may prevent their access to such resources. This project envisions students acting as advocates of these elderly in our population. We see the students playing some of the roles of loved ones in:

• Assessing the needs of the elderly,
• Meeting these needs, and
• Coordinating the care of the elderly.

Care teams comprising of both university and secondary school (SS) students will be in charge of caring for these elderly over an extended period of time to facilitate relationship-building and better provision of care.

We also recognised that many youths are already playing the roles of caregivers (to their grandparents or parents) or will do so in the future. We hope to provide opportunities for secondary school students to be equipped with theoretical knowledge and practical skills in ageing and caring for the elderly through the workshops planned. More importantly, we hope to inculcate important values such as compassion and respect for the elderly into these students who are at an impressionable age.

This project is based on the service-learning concept where community service is used as an opportunity to enrich classroom learning. Hence, the secondary school students will be incorporated into the care teams led by university students to serve the elderly together. The university students will serve as team leaders and mentors to guide the secondary school students. We want to tap on the youthful energy and creativity of the secondary school students by giving them opportunities to shape the management plan for the households they are caring for.

Lastly, we hope that that the project can serve as another platform where the intergenerational communication can be nurtured and cultivated.

 

Can you explain more about the process?

Tri-Generational HomeCare @ North West is made up of NUS students from the schools of medicine, nursing, pharmacy and social work who are passionate about serving the elderly in the community and nurturing the next generation. Our partners include Khoo Teck Puat Hospital (KTPH) (part of Alexandra Health System) – Aging-in-Place (AIP) Program led by Dr Wong Sweet Fun and NWCDC led by Yang Mei Ling, its general manager.

Through the support of our partners and the mentorship of Dr Wong, we aim to provide long-term (meaning six to 12 months) of holistic care to the vulnerable elderly in terms of medical and psychosocial support. We have also engaged secondary school students in this endeavour via the service-learning approach where these students can learn valuable skills by serving the elderly.

The students are also organised into small teams of six to seven individuals comprising both university students and secondary school students. Each team will be in charge of caring for two to three elderly/households fortnightly over a period of six months before they hand over their duties to another team.

To ensure a high standard of care for the patients, the teams will present their assessment and management plans to a multi-disciplinary team consisting of healthcare professionals from KTPH (geriatricians, nurses, medical social workers and occupational therapists) and staff from NWCDC at the start and end of each cycle. Adequate trainings are provided for all volunteers to equip them with the knowledge and skills required. In our efforts to continuously improve the programme, we are supported by KTPH to perform a systematic evaluation of the programme through research.

 

Were there any initial teething problems?

Yes, we did have some initial issues. For volunteers, the students (both university and secondary school) had differing schedules and could not find a common time to visit the patients together. The secondary students also sometimes had difficulty engaging the patients (e.g. they did not know what to say). On our part, it was important to prepare the students sufficiently so they can provide the care we hope they can provide.

The other issue we had was the patients and care. We found that the patients were uncomfortable with the students coming to visit them. That took some time for them to see the value and/or warm-up to the team.

 

Of the 269 NUS students and 300 secondary school students from six secondary schools, how many have stayed on for a longer period of time? (The six secondary schools include Westspring Secondary School, Woodlands Secondary School, Yishun Secondary School, Orchid Park Secondary School, Yishun Town Secondary School and Chung Cheng (Yishun).)

Secondary school students usually do not stay on due to the structure of the programme (they embark on a six-month programme and a new batch of students come in after that). This is to allow more secondary school students to be a part of this programme.

However, in terms of the university students, approximately 10 to 15 percent have come back as volunteers either as a committee member or team leader.

 

Without your initiative, how do the AIP community nurses deal with the care of the elderly?

The AIP community nurses do a fantastic job without us. Their roles include: Befriending, coordinating of care, patient and family education, and evaluation and pickup issues that may require medical/nursing/allied health intervention. They do this through regular visits and phone calls, and attending of multi-disciplinary meetings. Our volunteer programme is not meant to supplant what the nurses are already doing, but to enhance and value-add.

 

Do you hope to work with other hospitals and CDCs to bring your initiative to more seniors and students?

Yes, we hope to do so in the next two to three years.

 

COMMENTS FROM THE STUDENTS: SECONDARY STUDENTS: “Even small acts of kindness can brighten up a person’s day, whether they’re young or old. I will never forget Ah Gong’s expressions during our visits. Chatting and spending time with them can really make them happy. [Even though] there are times when they can’t hear you or misunderstand you, you should be patient and speak louder for them. They are people with interesting stories to tell, and they don’t mind sharing them with you if you’re nice 😀 There are a lot of things we can ask them (e.g. their occupations, family, etc), and we really can. Language doesn’t have to be a huge barrier … we can do practical stuff like origami together or going through exercises as a way to spend time. :)” – Salmah Sng, Yishun Secondary School (Secondary 3), 15 “We should not shun the elderly as even though they are not of the same age as us, they can still share similarities with us. Furthermore, they are still human beings and deserve the same amount of respect that any other person regardless of age.” – Amanda Lim, West Spring Secondary School (Secondary 3), 15 “I learnt to appreciate the elderly more and I grew to understand them more. I don’t live with my grandparents nor do I spend a lot of time with them but this programme is making me wish that I could spend more time with my grandparents.” – Marianne Ashley Medenill, Yishun Secondary School (Secondary 3), 15   UNIVERSITY STUDENTS: “TriGen has helped me keep grounded and see that a consultation in the hospital and discharging the patient does not mean that I have truly empowered the patient to take charge of his own health. [I initially entered Medicine] wanting to save the whole world and change somebody’s life. But sometimes when the patients leave and go back into the community, do we really impact them when we just tell them to take the medicine, and go home and rest? I learnt that we as healthcare professionals must also empower the family to help these patients.” – Jerer Lim, NUS Medicine (Year 4), 23 “TriGen has given me the privilege to visit elderly patients in their homes and to catch a glimpse of their everyday lives. It reminded me that there’s so much more to our patients than their conditions – their families, hobbies, life stories, and even their fears. I felt privileged that I was able to be a part of a healthcare team that could spend time outside the hospital talking to these patients, not to take a history, diagnose or even treat, but just to find out more about them and their lives. I don’t think I’d have had the opportunity to do so any other way and I’m glad that I had the opportunity to have done so.” – Janice Tan, NUS Medicine (Year 3), 22 “I got to understand how a patient feels, especially spending more time with them out of the clinical context. It better allowed me to feel their struggles. I saw the other side of the patients, having visited them at their homes and in the community. I realised that it is actually not easy at all to be a patient. Having that first-hand experience of checking on the patients in their homes really helped me to better understand some of the reasons behind their behaviours. Overall, I enjoyed TriGen and am keen to continue next year!” – Tan Xin Yang, NUS Medicine (Year 3), 22 “It is a very meaningful project where one has the opportunity to go into the community as a healthcare professional and friend to impact the lives of the patients positively and it brings with it a lot of satisfaction when patients’ conditions improve. It provides a wonderful platform to build up one’s leadership and communication skills to work alongside with fellow healthcare students, and create a deeper understanding of the importance of multi-disciplinary teamwork.” – Oh Hui Yen, NUS Nursing (Year 3), 22

 

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