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Homes for the Aged  - Ema Souza-Colaco,    continued from page 1

C. The quagmire of intrafamily politics.

The crucial questions here are :

1. Is the request for the elderly person to be placed into a "Home" a genuine one or One with another agenda ? i.e. To "get a particular person OUT " of the house and into a "Home". This is a serious problem and needs to be studied in every single case of third party referral for placement into a Home.

2. Is the family of the elderly person justified in trying to place the individual into the "Home" ?

3. Does the elderly person really wish to move to this "Home" ? Is there a viable alternative?.

4. Does this elderly person refusing to move to the "Home" have all the mental faculties intact and is it medically and physically safe for that person to remain in the present habitat ?

5. Who will impartially evaluate this referral to a "Home" vis a vis the refusal by an elderly individual to move out of  house ? In other words, Who decides?

6. Who will run the day to day affairs of the "Home".

The Home for the Aged in Nachinola is particularly fortunate to have been able to secure the services of Catholic nuns. These nuns play a significant role in the smooth and efficient operation of this Home.
 
 Once a decision is made that a particular community would benefit from a "Home", and the appropriate house for the "Home" identified, the criteria for admission to the "Home" worked out, the next step is the setting up of the " Home". The following are some of the facets which need attention: 

1. Access : All Homes for the Aged should have appropriate access for individuals with disabilities. Provisions should be in place for the individual with disability to be admitted to such a facility and for the care of those admitted who might develop a disability during the stay in this "Home". * All entry and exit points should have graded wheel chair access i.e. a 1:20 gradient ramp. * The door should be wide enough to allow persons in wheel chairs to move unhindered. * The entire floor should be on one level with flooring of the non-slip type. * Walls should have support handles and railings to assist older residents as they walk along. * Modern, clean toilets appropriately modified in order to be user friendly . * A snake-free garden area would be a bonus. Some of the residents may benefit rom activities such as gardening or even relaxing in the garden. * A common supper room can double up as an entertainment room for music, TV, reading, board games and where concerts or even dances can be held. * A chapel for quiet prayer and religious services. * A private meeting room for conferences with visiting members of the family. 

2. Provision for normal day to day care of the residents. * Many residents might be quite ambulatory and wish to do their own chores. * There however will be good days and bad days for all residents. Sometimes, a flu infection or two might weaken an otherwise independent resident. * Nutritious food and vitamin supplements are essential. * Appropriate care should be taken to prevent the development of bedsores and the development of cross-infections. * Adequate preventive steps must be in place to prevent infections like malaria and food-borne illnesses. * If and when serious infections or conditions develop among the residents, enough trained staff must be on hand to detect and organize transport to a tertiary level health care facility. 

3. Medical Care : * Medical Care offered to elderly individuals is notoriously poor. * Prior arrangements should be made with a good and readily accessible physician to visit the "Home" if needed. Elderly patients have great difficulty to travel great distances to see a doctor. Additionally, many physician offices are not on the ground floor. Climbing up those precarious stairs to see a doctor is not what these seniors need to face. * appropriate arrangements should be made for the rapid transfer of residents from a "Home" to the hospital in case the need arises. * Each "Home" must have access to a good and comfortable transport vehicle which can be used to transport the seniors to the hospital. The traffic, roads and driving in Goa, are bad enough; no need to add to the inconvenience by having rickety taxis to transport the elderly. The drivers of these vehicles, too, must be sensitized to the level of discomfort that rash driving causes these seniors. 

4. Activities and Social contact for the elderly: * Picnics at the beach * Visits to historic and nature sites * Socials also involving the elderly who are not residents of the "Home". 4. Funding for the "Home" . * Funding for initial setup of a home is usually available from a number of sources. * Funding for the on going maintenance may present a problem. 

5. There three other questions which need attention in the setup of a "Home" * How to handle grief when a member of the family or one of the residents passes on. * What happens to a resident whose guarantor does not meet the financial obligations to the "Home" * What if a resident of a "Home" wishes to return to his own house. In this case the house may need to be modified for increased safety of this individual. 

In this article, I have tried to delineate the various facets which need to be addressed in order to set up an appropriate "Home". Much of this information may have to be tailored to suit the needs of a particular community and set of individuals. Having said that, I 'd like to add that the visions of the community are likely to be manifold, but the needs of the elderly remain the same all over the world. All they ask for is a little peace, a little quiet and a lot of dignity in which to spend their twilight years. They have struggled all their lives and paid their dues with their struggle and sweat. It is time for us to afford them, their due. 

 Ema Souza-Colaço © 1999

Ema Souza-Colaço is the former Head of Department of Occupational Therapy at the Goa Medical College Hospitals ( Panjim-Ribandar ), staff therapist at the University Hospital of the West Indies, Kingston, Jamaica, Head of the 'Stroke Unit' at the Greenwich District Hospital, London (UK), and presently Head of Occupational Therapy for The Bahamas.