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Elderly Care Dilemma (II): Making a case for 'zero restraints'

2016/10/30 15:47:26

By Elizabeth Hsu CNA staff writer
Yeh Tzu-kang CNA staff reporter

Chien Chin-yu (簡金玉), a Yunlin County native, felt powerless watching her 85-year-old mother try repeatedly to pull a nasogastric tube from her nose because of discomfort.

Though she knew the tube made her mother uncomfortable, she felt she had no choice but to authorize caregivers at the nursing home to tie her mother's hands down.

She felt even worse when her mother began to suffer from a pressure ulcer on her skin because of being confined to a bed for an extended period of time.

At wit's end, Chien and her family later decided to transfer their mother to the Tongren Ren-ai nursing home in Yunlin County, where patients' movements are not restrained by props, Chien recalls.

At the new home, caregivers said they would help her mother change her position on the bed every two hours, which Chien remembers thinking "to be a comforting promise."

Less than two years later, her mother's condition has improved to the point where she can sit on the bed for a short period of time and smile when someone mentions her name, Chien says.

Struggling to care take of an aging parent is a common experience in Taiwan.

In Chien's case, her mother started showing symptoms of dementia at age 74, and she later had trouble eating and swallowing and lost her ability to walk, forcing Chien and her sisters to put her in a nursing home.

What is less common are positive outcomes. Now being able to talk to their mother and get her to respond with nods and smiles has thrilled Chien and her sisters after seeing their mother tied to a bed in the previous nursing home.

For a new breed of people who specialize in elderly care, the experience of Chien's mother at the new care center, which stresses "zero restraints," should become the norm in Taiwan.

Lin Chin-li (林金立), chief executive of the Yunlin County Senior Citizen Welfare and Protection Association, has been an enthusiastic advocate of helping seniors needing long-term care become more independent, calling for "no restraints," "no diapers" and "not staying bedbound" in elderly care.

He said he first heard of "restraint reduction" in 2006, and four years later he began helping the elderly at his association's Tongren Ren'ai nursing home and day-care center try to improve their quality of life through rehabilitation on an experimental basis.

The results, however, were disappointing, Lin recalled, so he went to Japan in 2011 and visited Japanese dementia expert Takahito Takeuchi to learn about "independent living" -- a popular theory in super-aged Japan -- and its practices.

In April 2014, the association joined with Takasaki City-based Shimachi Genkimura Social Welfare Corp., a civil organization devoted to promoting self-support care for Japanese seniors, to introduce the concept and techniques to its nursing facilities, Lin said.

"The initial results are promising," proving the concept can be applied successfully in Taiwan, Lin said.

In the second half of 2014, Lin's association launched self-support training workshops in Yunlin and promoted the theory and technique to other cities and counties.

There are now around 60 nursing homes in Taiwan -- mostly in central and southern Taiwan in areas like Pingtung, Chiayi, Taichung and Changhua -- that have adopted the care service model emphasizing "no restraints, no diapers and not staying bedbound," according to Lin.

The self-support model was also included as one of the policy's goals when the Tsai Ing-wen (蔡英文) government presented its updated long-term care policy in August after a previous false start, Lin noted.

"Self-support is not just a kind of spirit, a theory or a technique, but also a holistic concept" in daily care for seniors that Taiwan has to promote actively to protect their dignity and quality of life, he said.

So-called "self-support" care emphasizes solving most of the problems hampering patients' activities of daily living (ADL) so that the patients can keep their quality of life as intact as possible and live independently with only limited help from caregivers, according to Lin.

That philosophy is playing out with patients like Chien's mother or another elderly man surnamed Hsu, who was paralyzed by a severe stroke and had also been tied to his bed before being moved to the Tongren Ren'ai Home under Lin's association.

One of many seniors being helped there to deal with stroke complications, dementia or Parkinson's disease, Hsu is learning to hold a walker with his stiff and curled hands in a walkway with the help of a caregiver.

Asked what he was doing, Hsu says clearly though with a stutter: "do-ing - exercise." With signs of joy on his face, he told reporters he enjoys be able to move around.

Tongren Director Lai Wan-shu (賴婉淑) said the seniors seem much happier and more at ease without restraints, and the use of rehabilitation equipment helps them be mobile again.

"Even in wheelchairs, they can move around," she says. "It's like they see hope."


Related news include
Elderly Care Dilemma (I): Aging Taiwan facing test on 'restraints'

Elderly Care Dilemma (III) : Many obstacles to 'zero restraints'