SINGAPORE: Angie Hui reaches out for her mother’s wrinkly hands, rubbing them gently while looking out for sores. Her mother, Madam Seet Soon Lwee, had been complaining about them during a previous visit.
“How are your hands now?” Angie asks in Mandarin.
“No more (there)” Madam Seet replies in dialect, and soon begins another conversation.
The 90-year-old arrived at the NTUC Health Nursing Home in Chai Chee in February this year, two months after sustaining a fall. “She did not want to talk, she was almost at the verge of giving up, and having thoughts like she was old and useless and she was just waiting for the day to come,” Angie said.
But now, the relief in the 61-year-old retiree’s voice is obvious.
“When she was first brought here, her cognitive skills were actually deteriorating,” Angie said.
“But I can see that now she is so good, you tell her to remember things she will make an effort to remember things for you. You tell her to do certain things, she will make an effort to do it for you. She is talking to people, she is bonding, she is friendlier and chattier and livelier as well.”
Angie said the surrounding environment had a big part to play in her mother’s improvement.
IT HELPS THEM GET OUT OF BED AND INTO COMMON SPACES
According to the Agency for Integrated Care (AIC), reminiscence is a psychosocial intervention used with older people and in dementia treatment.
In many nursing home settings, items like old photographs and records of yesteryear are used to introduce a sense of familiarity to the elderly and often as a means to kick-start conversations.
“Its therapeutic value is in its promotion of self-esteem and a positive self-image. This helps seniors better manage the impact of ageing,” AIC said.
It said reminiscence spaces help those with dementia to trigger memories from the past, and has a grounding and calming effect.
Using this as an inspiration, the Nursing Home went a step further, incorporating 3-dimensional spaces from history to evoke a sense of nostalgia among its residents.
For example, the entrance of the home leads to a corner that has been transformed into a street hawker stall of the 1960s. Pushcarts are placed against the backdrop of an old shophouse, complete with wooden chairs and tables for residents to mingle.
Each floor also carries a theme; a wall facing the lift on the third floor has a 3D mural to make it look like an HDB void-deck, complete with a bicycle rack and the quintessential post-boxes. On the same floor, a homely common space has been created for the elderly to engage in art and craft, or just to get out of their wards nearby and start a conversation.
It is this space that Angie believes got her mother, and many other residents, out of their shell. She spoke of a resident who was constantly crying at having been moved to the home.
“I think she was brought here by a social welfare organisation. She had no family or visitors. One day, she came and told us, ‘I think I am going to stop crying’,” Angie said.
“You can only meet people in a common area, and because of this common area, people got to know her, spread their love to her.”
INCORPORATING THERAPIES IN 3D SPACES TO AID LEARNING
On the seventh floor, a group of residents have been given laminated fake notes and are taking turns to ‘purchase’ items with the correct amount of cash.
The activity is part of the home’s cognitive therapy session for some residents.
It’s a seemingly easy exercise, but for those who have had some form of cognitive impairment, such as a stroke or dementia, managing money or doing simple mathematical functions becomes too difficult.
“If we were to challenge them too hard, the response you would get is ‘This is too hard for me’,” said Senior Occupational Therapist Goh Seok Teng.
“Once they are more motivated and once rapport is built, we can push them a little bit more to get them to think harder…’what am I going to buy? If I buy this, how much do I have to pay?’ And once it gets harder when there are more things, they think a bit slower, they pause for a while, they need more prompting from staff to get through.”
That day's session was being conducted along a row of traditional shops that lined housing estates in the 1980s. A barber shop, a fruit stall and a provision shop are all painted on the wall. Authentic wooden furniture, and traditional games like Snakes and Ladders and marbles are stacked against the wall mural, creating an immersive experience.
Ms Goh said conducting the therapy in this space has motivated residents to get involved.
“If I do a cognitive stimulation therapy at their bedside, it can cause some confusion because it’s the place they sleep in. They have the bed as their visual cues. When we tried it before, we would get residents telling us halfway through ‘I want to sleep. I am tired’,” Ms Goh said.
“At this space, the constant visual cues are items they are familiar with, items related to the activities. So they don’t not have visual cues telling them ‘I want to stop’. It’s more like ‘I am more engaged, I am more motivated, what else do you have’.”
Raymond Lim, who is the Nursing Home’s Centre Director said the spaces were conceptualised with three objectives in mind. “We wanted to uplift residents’ mood, and encourage them to get out of bed, socialise with their peers, caregivers, staff and volunteers,” he said.
“We also wanted to encourage caregivers to spend more time with residents in these spaces, and to also create a conducive environment for cognitive therapy. Some residents are more reserved, so if they are in a familiar environment, they will be more engaged in therapy.”
Indeed, it is the airy and relaxed feel of the nursing home that appeals to caregivers like Angie, who say it is a stark contrast from the “doom and gloom” associated with some other nursing homes in Singapore.
"This is the only nursing home I have seen that has come up with the idea of building themes into the home," Angie said.
"Bringing the elderly here, they have this feeling that I'm going to a nursing home, I'm going to fade away and die. But when you put these elements, it does prolong the happiness and life of the elderly."