Bed Rails - Guidelines regarding safe use

Bed rails may seem to be a simple apparatus used in different care settings yet it’s importance cannot be ruled out. Standards / guidelines regarding the use of bed rails specific to India needs to be developed or it could be my lack of knowledge on the subject matter because I could not find any relevant information.

The attached document on bed rails (Source: Health and Safety Executive) should be useful for service providers who are offering residential or domiciliary care.

It will become imperative in the coming years that similar guidelines should be drafted at the national level to ensure standardization of care across the country.

What is the risk?

Bed rails, also known as side rails or cot sides, are widely used to reduce the risk of falls. Although not suitable for everyone, they can be very effective when used with the right bed, in the right way, for the right person.

However, accident data shows that bed rails sometimes don’t prevent falls and can introduce other risks.

Poorly fitting bed rails have caused deaths where a person’s neck, chest or limbs become trapped in gaps between the bed rails or between the bed rail and the bed, headboard, or mattress.

Other risks are:

• Rolling over the top of the rail

• Climbing over the rail

• Climbing over the footboard

• Violently shaking and dislodging rails

• Violent contact with bedrail parts

In UK, bed rails are ‘medical devices’, which fall under the authority of the Medicines and Healthcare Products Regulatory Agency (MHRA). MHRA enforces the Medical Devices Regulations and the General Product Safety Regulations to ensure medical devices are acceptably safe.

What do you need to do?

When bed rails are used during the course of a work activity, such as in a care home or hospital, the employer or self-employed person providing them must ensure that they are safe.

Risks identified during inspection include:

• Trapping between poorly fitting mattresses and bedrails

• Rolling over the top of the bedrails when overlay mattresses reduce their effective height

• Trapping between the bedrail and mattress, headboard or other parts because of poor bedrail positioning.

Bed rails need careful management. Users should ensure:

• They are only provided when they are the right solution to prevent falls

• A risk assessment is carried out by a competent person taking into account the bed occupant, the bed, mattresses, bed rails and all associated equipment

• The rail is suitable for the bed and mattress

• The mattress fits snugly between the rails

• The rail is correctly fitted, secure, regularly inspected and maintained

• Gaps that could cause entrapment of neck, head and chest are eliminated

• Staff are trained in the risks and safe use of bed rails

The document can be accessed on: Safe Use of Bed Rails Download

or the website at: https://www.safetybusiness.co.uk/

Wheelchairs - User Safety Guidelines

One of the basic and most important adaptive equipment for people with mobility problems is a wheelchair. A wheelchair is not just a piece of steel and rubber, it is the engine for individual freedom, dignity and independent living.

According to WHO, the key functions of wheelchair services include assessment, provision, training, support, and referral, unfortunately the ground reality in India is very different.

GOI has a system to make mobility devices available to persons with disabilities through the Assistance to Disabled Persons (ADIP) scheme, for purchasing/ fitting of aids/ appliances, however I could not find any literature regarding safe use and maintenance of wheelchairs.

As per an article (A Narrative Review of the Government Wheelchair Provision System in India), persons with disabilities who earn less than a specified monthly income are entitled to receive a free wheelchair that can be replaced after three years. However, there is no system to repair or replace parts.

Wheelchair design options are limited and there is limited scope for customization and fitting. These wheelchairs are designed based on national standards but the standards have not been regularly updated.

User experience of wheelchair services suggests that most persons with disabilities lacked the knowledge, or found it hard to submit eligibility documents or participate in the wheelchair distribution camps. Even if they did participate at times, they got the equipment after a year, especially in places where the implementing agencies may not have a head or are understaffed.

According to available data, only 20% of persons with disabilities requiring such devices have been advised to acquire one, of which, only 16% have a device. Only one-fifth of them acquired their device through a government scheme while almost two-thirds purchased the device themselves

The users are unhappy with the durability of the wheelchairs and felt these did not last three years after which they could be replaced. Moreover, the wheelchair they received was not always suited to them or their environment. This could not be used indoors and it was difficult to transfer themselves into it. The wheelchairs could not be adjusted to meet individual requirements, as only basic models were available.

Reading the research paper, it is obvious that as a country it is important that all stakeholders facilitate the existing environment through knowledge sharing and plug the gaps in the distribution and service delivery system.

For the benefit of the larger cause a booklet on Wheelchair user safety (website of Cardiff and Vale University Health Board) is being shared.

The document can be accessed on: Wheelchair User Safety Guidelines Download

or the website at:https://cavuhb.nhs.wales/

Moving and Manual Handling of Residents in Care Facilities

India has about 2100 - 2300 assisted living facilities / care homes for senior citizens. The total bed capacity is estimated to be 1,10,000 - 1,20,000 (based on personal research). While most of the new care homes are offering services on pay & stay basis however the older ones were set up by charitable trusts offering free services or are subsidised.

The larger point of debate is, as a country where do we stand w.r.t elderly care delivery guidelines and policies? Unfortunately not many homes have the financial or training bandwidth to up-skill the caregivers in professional service delivery.

In my view, need for national level policies is important and India specific training material should be freely available.

One important area for training is moving and handling of residents in care facilities especially for the oldest of old.

Manual handling of residents means moving or supporting a person's hands or arms or by some other form of bodily effort. In the handling of people, this includes the use of force by a person to lift, lower, push, pull, carry, move, support and hold another person.

A research paper (Patient handling in India—Evidence from a pilot study) highlights the need for proper training, policies and guidelines in moving and handling residents.

Manual handling forms an important part of a health care worker's daily routine. Faulty techniques may result in musculoskeletal injuries in health workers and further injury to patients.

Health care providers are prone to sustain injuries while moving or handling residents. Body parts most frequently injured during this process are the lower back, neck, thumb, upper back, and shoulders.

Studies show that over 88% of health care workers report work-related pain in at least one body part. This could be in part because of faulty technique, and excessive workload.

Improper handling has been shown to injure patients or worsen a patient's injuries, leading to increased morbidity and prolonged hospital stay.

Care facilities must assess manual handling procedures and identify protective measures to avoid any injuries.

Examples of protective measures that could be used:

• Training in the use of a resident hoist or sliding sheet;

• Training of clinical staff in resident handling techniques;

• Widening of door openings to allow hoists to fit through;

• Installation of low gradient ramps and slopes to be used instead of steps;

• Undertaking of preventive maintenance programmes for equipment/facilities.

A guide book by Occupational Safety and Health Branch, Labour Department, Hong Kong is attached for further information.

The document can be accessed on: Manual Handling of People Download

or the website at:https://www.labour.gov.hk/eng/index.htm

Elderly Care - Fall Risk Assessment & Prevention

Falls among the elderly are the most common cause of immobility, mortality, hospitalization, loss of independence, poor quality of life, and early entry to long-term care facilities.

A fall is defined as an event which results in a person coming to rest inadvertently on the ground, floor or other lower level.

Research paper (Review of Epidemiology of Fall among Elderly in India) highlights that the major contributing factors for fall injuries are aging, visual impairment, previous history of fall, depression, and gait problem.

According to WHO estimate, falls are the second leading cause of mortality worldwide and it is estimated that 80% of the falls occur in low and middle-income countries, of which South East Asia accounts for 60% of fall-related mortalities.

In the year 2004, around 95,000 death-related falls have occurred in India. Report generated by the WHO has estimated falls account for 40% of all injury deaths. The prevalence of falls in India, above the age of 60 years, reported to range 14%–53%. From the reported 4,24,000 fall-related deaths in 2004 globally, one-fifth of them took place in India.

Due to fear of falls, elderly tend to compromise on social interaction, reduced quality of life by limiting their mobility and feel diminished sense of well-being.

Demographic transition in India has led to an absolute increase in older adult population, which in turn has increased the demand on the health-care systems to improve quality of life (QOL) in the golden years.

The US Public Health Service has estimated that two-third of the deaths due to fall are preventable, and the WHO proposed “active aging” which aims at improving QOL for all people as they age.

In view of preventing falls among older adults in India, research has largely focused on identification and management of risk factors for falls, but the circumstances of the fall and its associated factors are sparsely researched.

Sociodemographic characteristics, living environment, lifestyle, chronic disease condition, mental health, assistance with activities of daily living (ADL) needs to be researched to identify potential circumstances for falls.

Developing a National level fall prevention strategy and training at ground level is imperative to mitigate the harm of falls among the elderly.

Though there are many tools for screening of potential falls however practical and validated tools to assess fall risks should be referred to.

Resource document on Preventing Falls and Harm From Falls in Older People: Best Practice Guidelines for Australian Residential Aged Care Facilities, 2009 by Australian Commission on Safety and Quality in Health Care (ACSQHC) is attached for reference.

The Australian Government does not endorse or recommends the website Elderly Care India.

or the website at:https://www.safetyandquality.gov.au/

Restrictive Practice use in Elderly Care Homes

Few years ago a Senior Citizen was hospitalized for 3 weeks. Post her discharge from the hospital she developed "fear of people" and she stopped allowing anyone to care for her.

Her daughter who resides in another continent rushed back to India to be by her side. For a while no one could figure out the reason for the change in her mother's behaviour but eventually the problem was identified.

During her mother's stay in the hospital, her hands used to be tied so that she does not self harm her frail body however no one imagined that this act would leave a scar in her memory.

On closer inspection the daughter saw dark patches on her mother's hands where the restraining straps were tied. This act of restraint had a deep impact about fear of being harmed due to which she started feeling threatened by the care staff.

Though it is a difficult decision for clinicians to restrain a person for their own safety but unfortunately these type of cases still happen.

India is seeing rapid growth in elderly care & it is important that all stakeholders should be aware of national policies on this sensitive subject.

Mental Health Care Act, 2017 talks about restrictive practices but it's interpretation on ground level can be debatable.

As per Department of Health and Aged Care (Australia), a restrictive practice is any action that restricts the rights or freedom of movement of a care recipient. Restrictive practices in aged care should only ever be used as a last resort, for the shortest time possible and in the least restrictive form.

There are strict requirements for the use of restrictive practices in most countries however in India we still have a lot of catching up for standardization of Senior Care.

Resource guide "Restrictive Practice use in residential Aged Care", highlights that there are 5 types of restrictive practices:

1) Chemical restraint
2) Environmental restraint
3) Mechanical restraint
4) Physical restraint
5) Seclusion

A study on "Patients’ and staff members’ experiences of restrictive practices in acute mental health in-patient settings" highlighted that, recent guidance has called for the reduction of restrictive practice use owing to growing concerns over the harmful physical and psychological effects for both patients and staff.

Despite concerns & efforts, these measures continue to be used regularly to manage challenging behaviour in psychiatric in-patient settings.

Restrictive practices fall under the medical domain & consultation with industry experts is important.

'Patient physical & chemical restraint policy" of Safdarjung Hospital, New Delhi is attached for reference.

The document can be accessed on: Restrains Policy Safdarjung Hospital Download

or the website at:https://vmmc-sjh.mohfw.gov.in/

Medication Management in Elderly Care Homes

As the world advances in the field of medical & scientific research it's direct impact is on the amount of medicines one has to consume. In today's world dying has become more difficult than being born, medicines don't let us die & diseases don't let us live.

For a historically rich & advanced country like India, medicines have played a vital role since 2nd Century BC. India has been the epicentre for Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy, unfortunately these sciences are now mostly seen as alternative medicines.

Medicines & medication related issues in elderly care homes will become a focus area in the coming years, the complexities of modern medicine & alternative medicines along with the calibre & training levels of care staff will be at the forefront.

As per the research paper "Aging and Medications" By J. Mark Ruscin, older people tend to take more drugs than younger people because they are more likely to have more than one chronic medical disorder.

Almost 90% of older adults regularly take at least 1 prescription drug, almost 80% regularly take at least 2 prescription drugs, and 36% regularly take at least 5 different prescription drugs. When over-the-counter and dietary supplements are included, these rates are even higher. Older people who are frail, hospitalized, or in a nursing home take the most drugs.

Pharmaceutical Society of Australia (PSA) report "Medicine Safety: Aged Care" 2020 highlights that:

* Over 95% of people living in aged care facilities have at least one problem with their medicines detected at the time of a medicines review; most have three problems.

* One in six medicine-related problems are due to adverse medicine reactions.

* 6% of people living in aged care were administered at least one potentially hazardous medicine combination.

* Over half of all people living in aged care facilities are prescribed medicines that are considered potentially inappropriate in older people.

* One in five unplanned hospital admissions among people living in aged care facilities are a result of taking medicines generally considered potentially inappropriate for older people.

Senior Citizen Care homes in India need support from the Central & State level authorities to educate & train personnel on the rules regarding who can dispense medicines to residents, guidelines on storage & avoiding misuse of medicines by care staff.

India needs to work on national standards & guidelines for medication in care homes on a war footing.

Resource document "Guiding Principles for Medication Management in Residential Aged Care Facilities" by '© Commonwealth of Australia (Department of Health and Aged Care) 2022’ is a good read to begin with.

The Australian Government does not endorse or recommends the website Elderly Care India.

The document can be accessed on: Medication Management in Elderly Care Homes Download

or the website at: https://www.health.gov.au/resources/publications/guiding-principles-for-medication-management-in-residential-aged-care-facilities?language=en

Training Manual on Elderly Care

Elderly Care in India is still at a nascent stage hence it is important that we develop the right policies and standards which could form the foundation for the future.

It is the collective responsibility of all stakeholders to share best practices and training material which are understandable and relatable. For a diverse country like India the training material needs to be documented in vernacular languages which is easy to remember and implementable by the concerned care staff.

Though socially developed countries have well defined care standards however in my opinion some countries have overcomplicated the same. Objective of policies and guidelines should be to create a simple framework which is practical and not become a limiting factor for growth.

Health Care in India is a State subject hence the task at hand is even more challenging. Central Government has many welfare schemes which are independent of the state programmes yet without the support of respective State Governments implementing them can be an uphill task.

Some of the Central Government schemes are gradually witnessing a positive impact at the ground level, one such scheme is Ayushman Bharat.

Ayushman Bharat Yojana or National Health Protection Scheme is a program which aims to provide service to create a healthy, capable and content new India.

For any scheme or programme to make a positive impact the key is to start from the village level, Ayushman Bharat is working on the same lines through Ayushman Bharat-Health and Wellness Centres.

The Operational Guidelines of Elderly Care at Health and Wellness Centers envisage mobility based classification of elderly with three main categories:

1. Mobile elderly

2. Restricted mobile elderly (mobility only with personal assistance/device)

3. Bed-bound (assistance required in some form)/home bound elderly for any reason and those requiring palliative care or end of life care.

Comprehensive Primary Health Care-Comprehensive Geriatric Assessment (CPHC-CGA) is a multi-disciplinary assessment to plan care and treatment including short term and long-term goals, follow up and rehabilitative services.

The systemic evaluation of physical health, functional status, mental and psychological health and social health factors of elderly population are evaluated by a team of health professionals.

Elderly individuals require special care and support. The Primary Health Care Team has the responsibility for providing care for the elderly starting from the community level to the Primary Health Centres.

Training Manual on Elderly Care for Staff Nurse at Ayushman Bharat – Health and Wellness Centres by Ministry of Health & Family Welfare, Government of India is a very good training guide which should be read by all.

The document can be accessed on: Elderly Care Training Manual for Staff Nurse Download

The document can be accessed on: Elderly Care Training Manual for CHO Download

or the website at:https://nhsrcindia.org/

Housekeeping Guidelines for Elderly Care Homes

Housekeeping Management is often undervalued as a service in India especially in Senior Citizen Care Homes. Though housekeeping is an important component in the overall service delivery of Eldercare yet somehow we tend to overlook it's importance.

Cleanliness & hygiene form an integral part of facilities management which requires proper training & documented standards. In order to maintain good health and well-being of residents & staff, it is necessary that each staff member is sensitised in good housekeeping practices.

Basic boarding & lodging which were once the norm in traditional Aged Care Homes are no longer the differentiating factors. In today's time, Senior Living projects are well planned, professionally managed and offer holistic care.

Since there is very limited training material on housekeeping for Senior Citizen Care Homes in India hence it is important that National level standards & guidelines needs to be drafted for the development of the sector.

National Guidelines can serve as reference guide so that Care Homes can develop their own cleanliness and safety standards w.r.t Housekeeping Management.

Ministry of Health and Family Welfare (MoHFW), Government of India published the "National Guidelines for Clean Hospitals" in 2015. Though the guidelines are focused on hospital settings yet some parts of it can be relevant for Elderly Care Homes.

Cleaning a floor or community areas of a Care Home are equally important as cooking food or giving medicines. A slippery floor can lead to falls amongst senior residents whereas undercooked vegetables or expired medicines could lead to infections.

It is of outmost importance that Elderly Care facilities should implement best practices from across the globe. If Senior Living in India is to be seen at par with International Standards then National and State level authorities need to take a proactive approach.

Resource document, Scottish Health Facilities Note about "Safe Management of the Care Environment, Cleaning Specification for Older People and Adult Care Homes" (May 2021) by National Services Scotland is a well drafted guide which should be helpful for Care Home operators.

The document can be accessed on: Housekeeping Management in Elderly Care Homes Download

or the website at:https://www.nss.nhs.scot/

Infection Prevention and Control in Elderly Care Homes

For residential care homes to be prepared for any unwanted emergency it is important for the staff to be trained in multiple areas of safety i.e. fire, water, earthquake, infection control etc.

Infection prevention and control is an important area of safety whose relevance was evident during COVID-19.

Infection prevention and control is not a one off activity which should be conducted once a year, it needs to be monitored on a daily basis with equal focus on prevention as well as control.

Senior Citizen Care Homes in India may have handled the recent pandemic in a professional manner however that does not mean that there is no need for policies and guidelines.

Resource document "National Guidelines for Infection Prevention and Control in Healthcare Facilities", Ministry of Health and Family Welfare, Government of India, January 2020, covers the important areas for healthcare facilities however there is still a need for specific training and information for the benefit of care homes.

Attached document "Infection Prevention and Control for Long-Term Care Homes
Summary of Key Principles and Best Practices", Ontario Agency for Health Protection and Promotion (Public Health Ontario) 2020, is meant to be a quick reference for those delegated with infection prevention and control (IPAC) responsibilities.

Routine Practices is the term used to describe the standards one must use in the care of all residents all of the time regardless of their clinical or infectious status. Adherence to Routine Practices protects not only the health care provider but also staff and residents who may subsequently be in contact with the health care provider.

The importance of strict adherence to Routine Practices is higher in LTCH than in many other health care settings due to the infection risks associated with congregate living, rapid staff turnover, substantial involvement of caregivers beyond regulated health professionals, immunocompromised status amongst many residents, and frequent use of invasive devices.

It is important and critical that India should develop country specific standards, policies and guidelines for elderly care homes.

The document can be accessed on: Infection Prevention and Control in Elderly Care Homes Download

or the website at:https://www.publichealthontario.ca/

Oral Health for Elderly People

Ageing process is not only about boarding and lodging, it is about Person-centered care and holistic well-being.

One important aspect of elderly care is Oral Health. Unfortunately most Elderly Care Homes in India are unaware of it's importance and/or are not equipped to handle oral care in residential care homes.

Normally one tends to think that brushing one's teeth once or twice a day will keep the doctor away however the reality is much different.

As we age there are multiple health issues and one critical aspect is Oral Health. Unfortunately most developing countries do not take oral hygiene and care on a serious note which eventually becomes a big problem in the later stages of life.

Resource document, "Better Oral Health in Residential Care" developed by the Better Oral Health in Residential Care Project, funded by the Australian Government Department of Social Services, states;

Oral diseases and conditions can have social impacts on quality of life, including comfort, eating, pain and appearance, and are related to dentate status.

Older adults need to eat and talk comfortably, to feel happy with their appearance, to stay pain free, to maintain self-esteem, and to maintain habits / standards of hygiene and care that they have had throughout their lives.

The attached document is a very good training guide for nurses and care workers who are in the field of caring for older people.

The training book is divided into 3 main modules and can be referred by senior citizen care homes operators.

Module 1: Good Oral Health is Essential for Healthy Ageing.

Module 2: Protect your Residents’ Oral Health.

Module 3: It Takes a Team Approach to Maintain a Healthy Mouth.

We need to appreciate the efforts put in by the team who have compiled this information and also applaud the aspects of sharing it for the larger cause.

The document is a well-researched and comprehensive guide which should be a handy reference guide for people who are into the Elderly Care sector.

The Australian Government does not endorse or recommends the website Elderly Care India.

In the Indian context, as a Nation we need to develop country specific standards, policies and guidelines for facilitating the growth of Senior Care sector.

The Australian Government does not endorse or recommends the website Elderly Care India.

or the website at: https://www.sahealth.sa.gov.au/

Foot Care (Podiatry) for Elderly People

One of the most neglected care intervention area in the service delivery of Eldercare is Foot Care, known as Podiatry or earlier known as Chiropody.

Podiatry is the specific field of medicine that specializes in the diagnosis and treatment of foot problems and conditions related to the lower legs.

While most of us tend to take care of our general health however when it comes to feet and nails we assume that cutting our nails are good enough to remain healthy.

Chances of developing podiatry related medical issues may be lower in comparison to heart, blood pressure, diabetes etc however foot care can equally be a problem area especially for people suffering from diabetes.

In a country like India, elderly care is still making inroads, hence it becomes imperative and important that care staff are well trained and aware of the issues related to ageing and associated medical problems.

Attached document, "Basic Foot Care - A resource reference for Personal Care Workers" by Australian Government, Department of Veterans’ Affairs (DVA) is a short and concise guide.

As per the resource document:

Foot health is not just about the feet – it’s a good indicator of overall health. For example, foot ulcers can be an indication of poorly managed diabetes. Swelling, numbness, coldness and discolouration can be signs of numerous diseases, which is why a daily check of a person’s feet for changes or problems is so important.

Poor foot health can have emotional and psychological impacts. People may feel frustrated about being unable to move easily or embarrassed about foot odour. Their levels of pain or discomfort may be limiting their ability to participate in activities, reducing their enjoyment of life and self esteem.

Foot problems are a common issue for people with diabetes. Poor blood supply is a complication of diabetes and can result in slower healing. This means that cuts and sores may not heal, causing pain and ulcers which can become infected.

The above paragraphs is just a gist of the document with the objective to highlight the need. After reading the guide, I felt it is important for every individual to be aware of Podiatry related issues especially the personal care workers.

Hope this effort of compilation by the Department of Veterans’ Affairs helps the larger cause.

It is suggested to check with the podiatrist for any foot related issues rather than doing self-medication.

The document can be accessed on: Foot Care for Elderly People Download

or the website at: https://www.dva.gov.au/

Training Manual on Eye Care for Elderly People

Eye Care is an important intervention area in the service delivery of Aged Care. Though Opthalmology is a specialized medical area however it is important that Care Home Staff & Home Care Workers are trained on the basics of Eye Care.

While researching about Eye Care for Older People, the attached resource document "Training Manual on Eye Care for Staff Nurse" at Ayushman Bharat – Health and Wellness Centres, Government of India (2021) showed up on Google.

Besides the great work being done in India regarding eye care, it was encouraging to find such well drafted and educative guide book.

Since relevance of the attached training manual can be of help to the entire country hence the same is being shared for better reach.

As per WHO, below are the leading causes for blindness.

1) Age-related macular degeneration
2) Cataract
3) Diabetic retinopathy
4) Glaucoma
5) Uncorrected refractive errors

It is no surprise to see that age related eye problems is one of the major causes of blindness hence it is even more critical to be trained in basic eye care for older people.

Resource document "Eye Care for the Aging Eye" by American Academy of Ophthalmology, states that, visual loss as people age is a major problem.

One out of three individuals have some form of eye disease that potentially could reduce vision by the age of 65.

A loss of vision can be both emotionally and financially devastating for anyone but especially for an older person on a fixed or limited income.

Difficulty recognizing people and inability to drive can lead to social isolation, depression, and poorer quality of life.

Reduced vision is a risk factor for falls and fractures as people age. Finally, visual loss may render people, as they age, unable to care for themselves, and force them to move from a family care situation to a more costly nursing facility.

In addition, with age, certain systemic diseases increase in prevalence. Some of these diseases are also associated with eye disease, such as the following:

• Hypertension, which is associated with retinal vein occlusion
• Arthritis, which is associated with dry eye
• Diabetes, which is associated with glaucoma, cataracts, and diabetic retinopathy

While the training manual of Ayushman Bharat covers the important & critical areas of eye care however I feel that the same document can be customised for Aged Care.

Basic training modules which are customised for grassroot level workers and Eldercare Caregivers and developed in vernacular languages will definitely improve the service delivery at Senior Citizen Care Homes and at the community level.

The document can be accessed on: Eye Care Training Manual for Staff Nurse at AB-HWC Download

or the website at: https://nhsrcindia.org/

Ear Care for Elderly People

As we grow older our 5 senses tends to start getting impaired. Impairment of any kind not only affects our physical & mental well-being but also impacts our quality of life.

On one hand growing old is seen as an achievement but then ageing process has its own limitations also.

Ability to see, hear, smell, touch and taste are not mere philosophical aspects, these are critical biological mechanisms which needs to be monitored & serviced regularly.

Age-related hearing loss (presbycusis) is the loss of hearing that gradually occurs in most of us as we grow older. It is one of the most common conditions affecting older people.

Resource guide, "Supporting older people with hearing loss in care settings", by Action on Hearing Loss, UK, is a well drafted short guide for managers & care home staff.

As per their report "A World of Silence" highlights that, if the hearing loss of care home residents is identified & managed effectively, then there is a real chance of improving their quality of life, by reducing loneliness and social isolation, and by improving their overall health and well-being.

If people are not supported to manage their hearing loss effectively, it can lead to:

1) Communication difficulties
2) Social isolation and loneliness
3) Anger and frustration
4) Low confidence, especially in social settings.

Hearing loss also increases the risk or impact of various other long-term conditions, and many health conditions are associated with ageing and so are likely to occur alongside hearing loss.

Their report "Hearing Matters" highlights that hearing loss:

1) Doubles the risk of developing depression
2) Increases the risk of anxiety and other mental health issues
3) Increases the risk of developing dementia
4) Is linked to cardiovascular disease, stroke and obesity
5) May be linked to sight loss and more frequent falls.

World Health Organisation (WHO) has a training guide "Primary Ear and Hearing Care Training Manual" which can be read in conjunction with the attached document. The information in these documents is not medical advice & is meant only for educational purposes.

As India is moving towards becoming a socially developed economy, hence it is important that national level standards, guidelines & training material needs be developed for Aged Care.

The document can be accessed on: Hear To Care Guide Download

or the website at: https://rnid.org.uk/

Hip Fractures in Elderly People

Ageing process has its own nuances, one of them is hip fractures in older people. Since it is an important area of eldercare hence a bit of layman's desk research is being shared.

Worldwide hip fractures are projected to increase from 1.7 million in 1990 to 6.3 million in 2050. The projected increases are primarily the result of an ageing population and increased life expectancy, particularly in India and China.

According to studies from India, the crude incidence of hip fracture was 105 and 159 per 100,000 among men and women, respectively and 1-year mortality was 42%. A report estimated an annual incidence of 600,000 osteoporotic hip fractures in India.

As per research, most hip fractures sustained by older people result from falls. Hip fractures are difficult to recover from, and many patients cannot live independently once they do. A hip fracture is a major injury with a very high fatality risk.

75% of all hip fractures happen to women. More women than males experience falls. Osteoporosis, a condition that weakens bones and increases the risk of fracture, affects women more frequently than males.

According to statistics, falling is the main cause of more than 95% hip fractures. So the menace of hip fractures will be very significant in the future.

Caring for an elderly parent who is suffering due to a hip fracture can be a demanding task. It is not only painful to see our loved ones being bedridden and in pain but also makes us feel helpless.

To ensure that as caregivers we don't further aggravate their existing pain, hence it is critical that the care staff and/or family caregivers are aware about the basic management of geriatric hip fractures.

Resource document, "Hip Fracture Handbook" published by Hackensack University Medical Center, is a short and simple read.

The material/information in the handbook is provided for informational use only and is not intended to be medical advice.

The document can be accessed on: Hip Fracture Handbook Download

Assisted Bathing (Bed Bath) for Older People

As India is progressing towards an elder friendly society hence it is critical that care policies and guidelines needs to be drafted for the benefit of the larger cause.

One important area of concern is standards and procedures for Assisted Bathing and Assisted Showers.

Though bed bath in the form of sponge rub and other formats has been in practice, however when it comes to assisted bathtubs and assisted bathrooms, unfortunately there are no policy guidelines which promotes standardization of bathing procedure.

A Safe Bathing and Showering national policy in India w.r.t older people, people with Dementia/Alzheimer's or bedridden elderly, will not only help care home staff and operators to deliver best practices but also improve the well-being and dignity of older people.

Socially developed countries have their own set of standards on aged care, of which personal care services is an extremely important area of intervention.

Though it is not advisable to blindly follow all standards and guidelines on senior care of developed nations, however it is always advisable to be educated on the best practices being followed across the globe.

It is high time that Indian policy makers define relevant policies, guidelines, processes, rules, regulations and laws to rein in the unregistered, unregulated and unsupervised senior citizen care homes.

Attached is a brief guide by Clinical Skills Ltd on "Giving a bed bath". The larger point of debate is, are assisted bathtubs or bath lift chairs/ hoists safe to use in Indian care homes?

The document can be accessed on: Bed Bath for Older People Download

Blood Pressure Monitoring

How important is it for staff of elderly care homes and home care staff to be educated on the importance of measuring correct Blood Pressure?

As technology is progressing, new devices for capturing vital signs are being developed. Most analog machines are being replaced with digital recorders and cloud-based applications.

The larger point of debate is, how many people are actually aware on the right procedures to use over the counter medical/health monitoring devices?

Be it a family carer, paid care staff or any individual, we all have started using easy to use health monitoring devices. Simple devices like Blood Pressure Monitor, Pulse Oximeter, Blood Glucose Monitor have become household necessities.

The trend of using self-monitoring devices gained traction during the COVID 19 and in my opinion this trend will only grow.

While it is always advisable to regularly monitor health parameters, however it is critical that the user is aware of the correct way to use these devices.

Unfortunately in a country like India, a lot of caregivers are not properly trained or professionally qualified.

Since many care staff come from the hinterlands who cannot read or understand English or Hindi, hence it crucial that easy to read and understand guidelines on basic medical and health monitoring devices should be developed.

The attached pictorial guide on Blood Pressure monitoring by Clinical Skills Ltd is a well-designed document.

The document can be accessed on: Measuring Blood Pressure Download

Speech Therapy for Older People

As India is progressing towards becoming a socially developed country w.r.t Elderly Care, hence it is imperative to define and develop national standards and guidelines on the various service delivery components of Aged Care.

One important area for developing guidelines and training is Speech Therapy.

Though most seniors may not require services of a speech therapist, however it is important for the care staff and family caregivers to be aware on the basic guidelines on speech therapy and management.

Common causes of speech impairment in older people can include:

1) Stroke
2) Traumatic head injury
3) Brain tumor
4) Neurodegenerative diseases

The attached resource document, Guideline for Speech Therapy Service in Residential Care Homes for the Elderly (RCHEs) by Hong Kong Institute of Speech Therapists Limited, states that;

Speech Therapists are uniquely qualified and should be considered as core members in management of feeding, swallowing, speech and language disorders of residents in RCHEs.

The roles of Speech Therapists are as follows:

1) Management of Feeding and Swallowing disorders:

Speech Therapists play an essential role in the screening, assessment, diagnosis and management of feeding and swallowing disorders in RCHEs residents.

2) Management of Communication disorders:

Speech Therapists play an essential role in the screening, assessment, diagnosis and intervention of RCHEs residents with developmental or acquired speech and/or language disorders.

3) Management in End-of-life residents:

Speech Therapists have roles in different aspects for the end-of-life residents.

4) Management in Comfort feeding:

Comfort Feeding is a palliative approach of nutritional intake. It can be considered when residents are suffering from irreversible end-stage disease, and the swallowing disorders and / or feeding problems are significant.

Some common Speech Therapy intervention areas are:

1) Aphasia: A disorder that affects how we communicate. It can impact one's speech, as well as the way we write and understand both spoken and written language.

Aphasia usually happens suddenly after a stroke or a head injury. But it can also come on gradually from a slow-growing brain tumor or a disease that causes progressive, permanent damage (degenerative).

2) Dysarthria: Weakness in the muscles used for speech, which often causes slowed or slurred speech.

3) Apraxia: Difficulty with skilled movements even when a person has the ability and desire to do them.

Apraxia is more common in older adults due to the higher incidence of neurological diseases, such as stroke and dementia.

The document can be accessed on: Guidelines for Speech Therapy in Elderly Care Homes Download

Administration of Medication for Older People

Medication management for older people can be a tricky affair. A few wrong medicines or a wrong way of administering can have adverse effects.

Though medicine administration in care homes should ideally be done by qualified staff but unfortunately not all senior citizen care homes have the bandwidth to address individual medication needs.

Since many seniors tend to forget their medication, hence it is important for non-nursing staff to be vigilant and aware on the procedures of medication administration.

While socially developed countries have dedicated departments who design and develop national standards and guidelines, but unfortunately in India eldercare guidelines are limited.

Attached resource document "Routes of administration" by Clinical Skills Limited is an easy to understand guide for caregivers and other persons involved with elderly care.

The details in the guide are in pictorial form which are easy to understand and remember. It is important that in India we should develop freely available training material in vernacular languages which are relatable and practical.

As per the resource guide, Pharmaceutical companies manufacture medicines in a range of different formulations, which they design to ensure that each medicine delivers an effective therapeutic response.

Many factors influence the prescriber’s choice of formulation and route of administration, including the response required, the accessibility of the target site and patient factors.

The procedures in the document describes the various enteral and parenteral routes of administration, as well as special considerations for administering different formulations via these routes, such as oral liquids and tablets.

The attached document should be read in conjunction with the clinical skills procedure, “Administration of medicines: key principles”.

The document can be accessed on: Routes of Administration Download

Mouth Care for Older People

Oral care is an important part of Activities of Daily Living which should not be taken lightly.

Assisted living facilities and care homes offer a range of services, one of them is personal care.

While Activities of Daily Living (ADL) includes many services however some of the important personal care elements which offers support with, are: bathing, grooming, brushing, feeding and toilet assistance.

Mouth Care plays a crucial role in the overall well-being of older people. Since many seniors are dependent upon caregivers to maintain their personal wellness, hence it is important that they are aware of the care standards and guidelines.

As per the attached resource document, Mouth Care by Clinical Skills Ltd, Oral care is one of the most fundamental aspects of nursing care. Poor oral hygiene impacts upon the health, comfort and well-being of senior citizens in health and medical care settings and in the community.

Poor oral care can lead to inflammation of the mucous membranes of the mouth, dry mouth, dental caries etc. Elders with these problems may find it painful to chew, swallow or taste their food.

They may also be unable to communicate effectively, which may contribute to low self-confidence and self-esteem.
Advances in oral health care in the last decade have resulted in people retaining their teeth into older age but not necessarily caring for them.

Oral care may be one part of the care service delivery yet it is one of the most important part of the care process.

Very few private sector care homes and senior living facilities have some sort of training procedures on caregiving and unfortunately most care homes and home care agencies do not have the bandwidth or qualified staff who can deliver standardized care.

The document can be accessed on: Mouth Care for Older People Download

Commode Audit Tool for Elderly Care Homes

Commode hygiene it is an important area of infection prevention and control.

While there are detailed national standards and guidelines on infection control and prevention but unfortunately there is very limited information on commode cleaning procedures and audit tools in the Indian context.

Commodes hygiene is a critical area for infection prevention especially in senior citizen care homes.

Since older people tend to consume higher medication hence the smell of urine and feces tends to smell foul, which makes it imperative to ensure proper hygiene of commode and bathrooms.

As India is witnessing a positive growth of Aged Care sector, hence it is even more important that caregiving staff should be aware of the health and safety procedures.

It is critical that home management should develop easy to understand care home policies and guidelines which are used for staff training and advocacy.

Lancashire County Council in their "Commode Audit Tool" defines a brief checklist on commode cleaning and audit.

As per NHS, UK, in order to comply with the Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance, equipment that comes into contact with the resident, e.g. commodes, must be decontaminated appropriately between use and use by another resident.

Since a large population of India uses Indian style commode along with the western style, hence there is need for two different sets of cleaning procedures.

It is important that concerned stakeholders and policy makers need to focus on Elderly Care and facilitate the design and development of national standards, policies and guidelines.

The document can be accessed on: Commode Audit Tool for Elderly Care Homes Download

Rapid Assessment of Physical Activity for Older People

As doctors say, most health problems can disappear if a person is physically active, I guess this holds true for the elderly also.

As we grow older, the wear and tear of body parts starts to affect our Quality of Life (QoL). While a simple knee pain or low physical stamina can impact our emotional, physical and mental well-being, however this gradual health decline can be avoided or rather delayed.

The larger point of debate is, what is it that the elders can do to avoid becoming physically rusted and/or getting decommissioned.

Though it is easy to give advice on the benefits of walking, jogging or other physical exercises, the question is how many people actually follow them?

Even if our inner determination to become physically active awakens one day, the problem is, we tend to lose steam and go back living a sedentary lifestyle after a few days of efforts.

Typically most people require external support and motivation to keep a track on their physical activity, the elders are no different.

For the overall well-being of older people, it is important for care staff and family members to undertake regular assessment of physical activity levels for their elderly parents or residents in a care home.

A simple checklist not only helps in keeping track on the level of physical activities, it also serves as a timeline/trendline in understanding any future health problems.

Since India is on the right trajectory w.r.t eldercare, hence it is important that at the ground level the care staff should be trained to monitor and record simple to use guidelines.

Though there are many Physical Assessment modules available on the internet, somehow I found the attachment guide on "Rapid Assessment of Physical Activity" (RAPA) developed by University of Washington Health Promotion Research Center to be short and crisp.

The document can be accessed on: Rapid Assessment of Physical Activity Download

Laundry Audit Tool for Senior Citizen Care Homes

How many Senior Care Homes in India actually feel that Laundry Management is an important area for Infection Prevention and Control (IPC)?

To be honest, I have my doubts if Care Homes in India have any documented guidelines and training material on how to handle laundry of residents, staff and community areas.

Though, National Guidelines for Infection Prevention and Control in Healthcare facilities (NGIPC) have been developed by National Center for Disease Control (NCDC), Ministry of Health and Family Welfare (MoHFW), but then the larger point of debate is, how serious is the Aged Care sector in India on reading and adopting such guidelines.

While on one hand, we should be thankful to the Charitable Senior Citizen Care Homes for taking care of the poor and underprivileged older people, however the question on quality standards is still a debatable issue.

Since it is not practical nor advisable to simply adopt International Standards on Elderly Care, however it will be naive to ignore the need for standardized care for Senior Citizens.

As a starting point, it is critical that Care Home staff are trained in basic standards of IPC including Laundry Management. I am sure we do not need another COVID-19 to remind us on the importance of Infection Prevention and Control.

Not every standard or guideline is complicated or difficult to implement, there are many simple standards which can be learnt by staff which are easy to understand and incorporate in the daily functioning of a Senior Citizen Care Home.

The attached "Laundry Audit Tool" which is available on the Lancashire County Council website is a simple checklist which can be used by the Care Home Management.

The document can be accessed on: Laundry Audit Tool for Senior Citizen Care Homes Download

Safe Use of Ladders in Senior Citizen Care Homes

It may sound absurd to have guidelines on safe use of Ladders in a Care Home, but then it is an important part of Health and Safety of Residents and Staff.

Normally in India we take the mundane tasks as simple activities which do not need supervision or training, however when an untoward incident happens due to oversight then the blame game starts.

A Senior Citizen Care Home is a place where we want and expect our parents, grandparents or ourselves to live in a safe and secure environment, but if a Home does not have basic standards or procedures in place then the chances of risks and threats increases.

Guidelines on safe use of Ladders is probably the last thing which a care home may think of, but if a person who has dementia climbs up an unattended ladder then it could be a major safety concern.

If a single person/staff who is using a ladder falls on a resident then again it is a safety concern.

If the nuts and bolts are loose, or the surface is slippery then it could be a safety concern for the staff.

These are a some of the concerns, issues and possibilities which could compromise the safety of residents and staff, hence it is critical that the Home Management should have guidelines and standard operating procedures in place.

Though there are enough National Guidelines on Health and Safety however the bigger question is, how many people actually take them seriously?

The attached resource document, "Safe use of Ladders and Stepladders" by Health and Safety Executive (HSE), UK is a crisp note on the basics of Ladder use and guidelines

The document can be accessed on: Safe Use of Ladders in Senior Citizen Care Homes Download

Mattress Audit tool for Senior Citizen Care Homes

Infection Prevention and Control (IPC) is an extremely important area of concern especially in Elderly Care Homes.

Mattresses and/or pillows are not only a potential source of infection they could also be a source of discomfort and sleep problems.

Unsupervised or bad maintenance could spread cross-infection if contaminated mattresses remain in use.

A damaged mattress or a pillow could affect a resident's sleeping posture which could result in sleep issues.

Regular audits allows the care Home staff to proactively identify mattresses and pillows which are no longer fit for use and can be discarded in a timely manner.

Though in India we are still a long way to walk in the field of Senior Living and Care, yet I feel that this is the right time to start creating Standards, Guidelines and Policies.

The attached audit tool by NHS, Wirral Community Health and Care, UK is a short and clear reference document. It shares a brief checklist to identify mattress covers and mattresses that are in poor condition.

The document can be accessed on: Audit Tool on Mattresses in Senior Citizen Care Homes Download

Living Will & Advance Directives in India

The worst situation in life is, being old, poor and in End-of-life phase.

No one wants to die a painful death and continue suffering from a terminal illness without any hope of recovery but unfortunately this is the ugly fact of life.

For giving relief to such people, the judiciary legalized Passive Euthanasia in 2007 and "Right to Death with Dignity" came into existence.

Living Will / Advance Medical Directive is a legal document explaining one's wishes about medical treatment if one becomes incompetent or unable to communicate.

The larger point of debate is not about the procedures, merits and demerits of the legislation, the main point of concern is, what are the legal implications if a Care Home does not follow the directives given by a resident in his/her Living Will / Advance Directive?

Since there was and still there is little clarity about the law applicable to terminally ill patients who wish to die a natural death by refusing life-sustaining treatment, what happens to the Care Homes who are unable to facilitate execution of the Living Will of a resident?

Can the family of the resident take the Care Home management to court for non-adherence to the written wishes of the senior citizen or can the Care Home simply put the blame on the medical staff or the treating physician?

If dying was easy then in my opinion half the world would have been dead by now, but then this is a sensitive subject which no one wants to discuss.

Since Senior Care sector in India is getting more structured and professional by the day, hence somewhere down the line the industry veterans will have to define and recommend the standard operating procedures on issues like Right to Death, Cardiopulmonary Resuscitation (CPR), Do-not-Resuscitate (DNR).

Most staff members in Senior Citizen Care Homes are not aware about the Right to Death, hence it is critical that necessary training on how to handle such delicate matters should become an integral part of their induction program.

The attached document "Advance Medical Directive (Living Will) and Health Care Power-of-Attorney Authorization" taken from the website of Pallium India is a self-explanatory guide.

The document can be accessed on: Right to Death with Dignity Download

Hand Hygiene in Senior Citizen Care Homes

How much importance do we give to hand hygiene in India? To be honest not may people.

Though most of us do not think twice about hand hygiene yet we forget that it's an important area in relation to Infection Prevention and Control (IPC).

Senior citizens are prone to catching infections easily hence it is extremely important for the care staff to be trained on personal hygiene especially hand hygiene.

Since hands are the first point of contact with elderly residents in senior citizen care homes, hence it is critical that the Home Management should have the necessary Standards, Policies and Guidelines on hand hygiene.

The attached audit tool of 3 pages by GetSmart, Lancashire is a crisp read.

The purpose of the audit tool is to ensure staff are observed undertaking the correct hand hygiene technique.

In the event of non-compliance, action plans should be produced and reviewed regularly.

Completed audit tools should be kept for good practice assurance and as evidence for any inspections or audits.

The document can be accessed on: Hand Hygiene for Senior Citizen Care Homes Download

Bed Bugs & Senior Citizens Care Homes

How seriously do we take the Housekeeping department in a Care Home?

Across all industries, there are certain departments who are in the limelight simply because of being in a customer facing role, but then there are departments who work the graveyard shifts and are normally not given their due importance.

Housekeeping department is one such department in a Senior Citizen Care Home which is often not given its due respect, yet they are an integral part for the upkeep and smooth functioning of the facility.

The larger point of debate is, how many Care Homes actually take the problem of Bed Bugs seriously?

Bed Bugs are a common problem in community residential facilities, since the upkeep in such facilities are often not of the same level as that of 5 Star Hotels, hence it's critical that staff needs to be vigilant in such residential care settings.

Bed Bugs may not spread diseases yet they can affect a resident from a mild itching to a serious allergic reaction.

Most people will have a small, itchy, red welt that may last from one day to several days. At times infections may occur from scratching the bite and may need medical attention.

Anxiety and Insomnia are additional health concerns associated with bed bug bites. Anxiety has led people to take extreme treatment measures to get rid of the bed bugs.

The attached document, "Bed Bugs in Wisconsin - Questions and Answers" by Wisconsin Department of Agriculture, Trade and Consumer Protection is a good read.

The document can be accessed on: Bed Bugs in Wisconsin Q&A Download

Complaints Handling in Elderly Care Homes

Care Home operations is demanding work, it is not like a regular Facilities Management of a housing society, the service delivery in a Care Home directly impacts the safety, security and well-being of Elderly Residents.

Wherever there is any exchange of goods and services, it is natural to have complaints, I guess that's a part of the feedback and improvement process for the Care Home.

The larger point of debate is, what are the Complaints Mechanism and redressal processes for Care Homes in India?

Since most private Senior Citizen Care Homes in India are charging anything between ₹75,000/- to ₹1,50,000/-, what is the safety net for residents who are not happy with the services?

Should the residents politely accept whatever is thrown at them or raise their voice and complain to the competent authorities?

Unfortunately in India there is no such National Level agency who can pull-up the Care Home operators who are not delivering the services promised to the residents (maybe Ministry of Social Justice and Empowerment can shed some light).

Unfortunately due to lack of detailed National Standards and much needed relevant Legislative Acts, the Care Home operators are not sure which licences to apply, what are the Minimum National Standards and what are the legal implications in case of a complaint by a resident.

Internationally, Complaints Handling is a serious component, in many countries it is part of the Legislative requirement with serious implications in case of not respecting the rights and not addressing the complaints of residents.

The attached document, "Better practice guide to complaints handling in Aged Care Services", by The Aged Care Quality and Safety Commission, Australia is a good reference guide to begin with.

The Australian Government does not endorse or recommends the website Elderly Care India.

or the website at: https://www.agedcarequality.gov.au/

Comprehensive Geriatric Assessment Tool

On one hand many of us feel that there is no work happening by the Govt in the Eldercare sector, but then, the reality is that there is a lot of good work happening at the National and State level.

Most of the work is happening behind the scenes, but unfortunately most people are either not aware or try to be oblivious to the great efforts.

One such area is Ayushman Bharat. The Govt had published an impressive Training Manual on Elderly Care, but then the Senior Citizens Care Homes are probably not equipped or concerned to read it.

The larger point of debate is not about the entire Training Manual, it is about a sub-chapter called "Comprehensive Geriatric Assessment Tool"

Geriatric assessment is not only about going to the doctor to get a health checkup, it is something which impacts all of us including our parents.

Though there are numerous tools and formats available online but in short, Geriatric Assessment Tool is a checklist which doctors use to evaluate a person's health and well-being.

Comprehensive Geriatric Assessment Tool is an interdisciplinary assessment for evaluating the medical, psychological, physical functions and socio-economic problems to detect unidentified and potentially reversible problems and develop a co-ordinated and integrated management plan for treatment and long-term care plan (Source: Physiopedia).

The sad part is, Ayushman Bharat which has developed such detailed guidelines and checklist but then the Care Staff or the medical fraternity are so stretched out for time that they are unable to do justice in most cases.

The document can be accessed on: Geriatric Assessment Tool Download

Restraints of Elderly in Care Homes

OHow many Care Homes in India have Restraints Policy?

Not every person is blessed to be mentally sound & have stable mental health, there are many people who have mental health problems, impairments & are mentally disturbed.

Not every Elderly Care Home in India is for Active Ageing, there are many homes who take care of mentally disturbed elders who live on the roads, have been eaten by rats, maggots & suffering from Scabies.

When these Seniors are rescued many of them get aggressive & tend to throw stones, spit & physically & verbally abuse the staff who try to take them to a more humane environment.

The larger point of debate is, when there is a challenging and threatening behaviour shown by the rescued individual, what is the policy on restraints in India?

Restraints is not only applicable for the homeless and destitute elderly, it can be seen across many Dementia Care Homes (Memory Care Homes) also.

Aggressive behaviour can be displayed by our parents or ourselves in the future, the question is how would we like to be treated by the care staff in such situations?

The order for restraints can only be given by a Doctor & necessary supervision & guidelines have to be followed to ensure safety & security of the individual.

Since not many Care Homes in India would be having Restraints Policy and Restraints Assessment Checklist, hence I am sharing the same for the larger cause.

Mental Healthcare Act (MHCA 2017), Section 97 defines the guidelines on Restraints but then a simple checklist is always advisable as most care staff are not equipped to read & understand the legal implications of the Mental Healthcare Act.

The document can be accessed on: Restraints Assessment Checklist for Elderly Care Homes Download

Resident Care Plan in Elderly Care Homes

The importance of a Resident Care Plan should not be taken lightly, it can have serious implications for both the parties especially in cases of health and medical emergencies.

Typically a Resident Care Plan is completed within a few days of a resident joining the Care Home. Individual Care Plan is the logical step after the Residency Application Form and Residency Agreement.

The Care Plan is like a guiding checklist on the personal care needs and health monitoring requirements for residents which is updated based upon feedback from the interdisciplinary team consisting of doctors, care staff, social workers etc.

The initial Care Plan precedes the Comprehensive Geriatric Assessment (CGA) so that the immediate care needs of the residents are not affected.

Once the Comprehensive Geriatric Assessment is done in a month or two then further fine-tuning to the Care Plan is updated.

The document can be accessed on: Resident Care Plan in Care Homes Download

Cleaning and Housekeeping Guidelines for Elderly Care Homes

The importance of Housekeeping, Environmental Audit, Infection Prevention and Control in Healthcare facilities should never be diluted, overlooked or taken in a non-serious manner.

Cleanliness and upkeep should be the utmost priority especially in Senior Living facilities because a well-kept environment is the foundation for a healthy and safe living.

It is important for the Care Home Management and staff to follow a regimented routine on Housekeeping and Environmental Sanitation, all concerned personnel should be properly trained so that they can take informed decisions at all times.

This sub-chapter on "Procedures For Cleaning and Sanitation of Environment" which has been taken and adapted from "National Guidelines for Infection Prevention and Control in Healthcare Facilities", National Centre for Disease Control, Ministry of Health and Family Welfare, GoI, January 2020.

This Annexure is part the International Operational Guidelines for Senior Citizen Care Homes which is being developed by a few of us.

This Annexure is not to be mistaken as the "Environmental Audit Tool" or the "Infection Prevention and Control Tool", this is just a simple annexure which can be used by Care Homes which are being run on Charitable basis or Government supported.

The document can be accessed on: Cleaning and Sanitation in Elderly Care Homes Download

Serious Incidents in Elderly Care Homes

Imagine our parents living in a Memory Care Home, having Dementia, goes missing from the Care Home and there is no record of it.

Imagine our parents living in a Senior Living facility, have a serious fall which is neither recorded nor informed about it to the family.

Imagine there is a serious health and medical emergency of our parents in an Assisted Living centre but not informed or recorded.

These are some of the real life examples which typically happen but are generally brushed under the carpet by many Senior Citizens Care Homes.

Serious Incidents are not only limited to residents living in a Care Home, it can happen to any of us in the future.

Serious Incident, Significant Incident, Special Incident are a serious issue and a major concern which can have physical, mental, emotional, psychological and legal implications.
The larger point of debate is, as the Indian Senior Care sector is reaching International levels w.r.t infrastructure and facilities, but who is developing and training the staff on the International Standards on Quality of Care, Guidelines, Monitoring and Control?

While it may be easier for the private sector Care Homes to have well defined guidelines (hopefully) but then what happens to the Charitable and Government supported facilities?

Though there is no single format for Serious Incident Reporting form and typically the Care Homes should develop it internally, however for the benefit of the larger cause, we have compiled a short document.

The document can be accessed on: Serious Incident Reporting Form Download

Quality Assurance in Elderly Care Homes

How important is Quality, Quality Assurance and Quality Improvement in Senior Citizens Care Homes?

I am not sure how many people ask the Care Home Management to share the Home Policies and Procedures on Quality Assurance and Continuous Improvement at the time of paying the deposit or the hefty monthly rent, but then most of us do not read the fine print ever.

The success of any Senior Citizen Care Home depends upon the quality of services being offered to the older residents.

It is the moral and professional responsibility of the Home Management to ensure that there is accountability and ownership by all staff towards delivering highest levels of care and well-being services.

The Home Management should ensure that the residents needs should be the topmost priority which are met at all times by qualified and trained personnel.

The Home Management should have systems in place for continuous improvement.

The Home Management should ensure effective quality assurance and quality monitoring systems, based on feedback from residents, their guardians and family members.

The document can be accessed on: Quality Assurance in Elderly Care Homes Download

Environmental Audit Tool for Elderly Care Homes

Environmental Audit is one of the most critical aspect in running a Senior Citizens Care Home, without this audit / checklist the functioning of the Care Home will be like a driverless car.

If the management and staff are not aware on the areas of maintenance, monitoring and improvement then it can have disastrous implications for the Care Home and the residents.

The attached document on Environmental Audit Tool is a checklist of areas and activities which needs supervision, monitoring and improvements.

The following areas have been covered in this document;

1) External Environment

2) Entrance & Lobby, Reception, Lounge

3) Dining Area

4) Kitchen Area

5) General Stores

6) Laundry Area

7) Medical & Health Care Areas

8) Other Communal Items & Areas

9) Resident Unit

10) Resident Toilet & Bathroom
For the benefit of the larger cause, I am sharing the annexure of "Environmental Audit Tool".

Most critical areas and elements required for the smooth and safe functioning of the Care Home have been listed for audit, though a few may have got left out.

This Annexure is not to be mistaken as the "Infection Prevention and Control Tool"

This checklist can be used by most Senior Living formats like Assisted Living, Retirement Communities, Memory Care, Transitional Care, Long Term Care etc.

The document can be accessed on: Environmental Audit Tool Download

Gifts Policy for Elderly Care Homes

There will be instances where residents or their family members would like to give donations, gifts or tips to the Care Home or the staff as a token of appreciation, hence it is important to have a clear policy and guidelines of accepting gifts and tips.

The larger point of debate is, how many Care Homes have documented guidelines and policy on Gifts and Tipping?

For the benefit of the larger cause, I am sharing two annexures, "Gifts and Donations Policy" and "Gifts & Donations Form".

Sharing a few points from the policy:

1) Any cash gifts or gifts in kind by the residents to the staff members should be informed and documented in the resident’s file.

2) Gifts in kind like food items should be avoided at all times and should be shared amongst other staff members only after 2 staff members who have eaten a sample and shared only after 2 hours of testing the food.

3) At no point and under no circumstance will a staff accept gifts directly from a resident who has dementia, impaired memory or unstable decision-making capabilities.

4) The staff member will not be favourable and biased towards residents who give gifts or tips whether know to the Home Management or not.

5) No staff member will solicit or pressurise residents or their family for giving gifts to them either within the Care Home premises or outside the premises.

The document can be accessed on: Gifts & Donations Policy Download

Missing Resident in a Senior Citizen Care Home

How well prepared and trained are Senior Citizen Care Homes in India in handling situations like Missing Residents or Wandering Residents?

India has about 1700 Senior Citizen Care Homes, majority of them are charitable homes.

Though it is not fair to expect them to have international level Care Standards but then, there are certain standards in managing Care Homes which do not require special skills or financial outflow, only proper training and an eye for detail is needed.

Missing Persons Policy in Care Homes / Aged Care Homes / Long Term Care Homes is a well-established protocol internationally, however in India we are yet to have National Guidelines for such an important area.

Imagine if our parents living in a care home leaves the Care Home premises due to Dementia or Delirium and the Care Home has no structured procedures and policies on how to prevent and/or handle such incidents.

Older people with Dementia quietly slipping out of their homes or care homes is not uncommon, but then it is the responsibility of the caregivers to ensure their safety.

The larger point of debate is, are these policies and standard operating procedures really needed and do they actually make sense?

I guess we will never realise the importance of such standards till the time our parents or ourselves in the future do not get lost and probably never to be found, simply because we or them will not have the Mental Capacity to even tell our address.

The attached "Missing Aged Care Resident Procedure" of Government of Western Australia, WA Country Health Service is a short and crisp read which can be read by agencies and operators involved with Senior Citizens Care.

The Australian Government does not endorse or recommends the website Elderly Care India.

or the website at: https://www.wacountry.health.wa.gov.au/

Instrumental Activities of Daily Living

How important is it for staff of Elderly Care Homes to be aware and trained on person-centered care including respecting resident's privacy and dignity at the same time be able to assist them with Activities of Daily Living?

I guess India has a long way to get professionally trained cadre of frontline workers who are trained to improve the Quality of Life (QoL) of elders in Senior Citizens Care Homes.

Activities of Daily Living are functional activities which all of us do on a daily basis, the capacity to undertake these activities defines our level of independence or our dependence.

Individual independence to conduct activities such as brushing, bathing, eating etc are essential for maintaining an Independent Living and this is where assessment of Activities of Daily Living comes into picture.

Typically the activities which we call Activities of Daily Living (ADL) are classified under two broad categories:

1) Basic Activities of Daily Living

Basic Activities of Daily Living are related to a person's ability to walk independently or with assistance, eating by themselves or being fed, being able to dress independently or with someone's help, bathing, ability to use the toilet, grooming, brushing (oral care), shaving, wearing shoes, basic communication etc.

2) Instrumental Activities of Daily Living (IADL)

IADL activities are more complex than ADLs and are activities which requires mental and physical capabilities to conduct the same independently. Activities like ability to use the telephone, do the laundry, being able to go shopping, travelling, ability to cook, home management and maintenance, handle own finances, self-medication etc.

The larger point of debate is, almost 70%-80% Care Homes in India are run by charitable organisations and do not have full resources and/or qualified manpower, in these cases do the training modules remain simple paperwork or have real impact on the ground level? I guess we will only know if we have National Standards on Aged Care.

Another important point is, should evaluation of a person's ability to conduct Activities of Daily Living be the sole responsibility of Care Homes or should the family members be aware of such activities?

There are numerous assessment tools and measurement scales like Barthel Index (BI), Katz Index of Independence in Activities of Daily Living, Functional Independence Measures (FIM), Lawton Instrumental Activities of Daily Living Scale etc which are measurement scales to evaluate the ability of a person's capacity level to conduct ADLs / IADLs.

4) The attached assessment tool on Instrumental Activities of Daily Living (IADL) by M.P. Lawton & E.M. Brody is a simple assessment tool for Instrumental Activities of Daily Living which can be used by Care Homes and family members.

The document can be accessed on: Instrumental Activities of Daily Living Download

Infection Prevention & Control in Elderly Care Homes

At present India may not be the Shining Star in the field of Elderly Care however it is definitely a Rising Star and soon it will become the brightest star in the landscape of Global Social Welfare.

While the Aged Care sector in India is gradually spreading its wings and learning to fly, however the larger point of debate is, do we have a trained and qualified workforce to care for Older People?

Infection Prevention and Control is an important aspect in the overall person-centered care and Quality of Life of the Elders.

The attached resource document "Procedures and Practices for Infection Prevention and Control Training Session – IV, published by National Center for Disease Control under the ageis of the Ministry of Health & Family Welfare is a good training module.

The entire topic is structured under 8 modules titled "Infection Prevention and Control in Healthcare Facilities Training Sessions". I am sharing Module 4 for the benefit of the larger cause.

Module 4 covers the following topics:

1) Hand hygiene

2) Personal protective equipment(PPE)

3) Respiratory hygiene and cough etiquette

4) Prevention of injuries from sharps

5) Safe handling of patient-care equipment-injection safety

6) Principles of asepsis

7) Environmental infection control

8) Airborne precautions

9) Droplet precautions

10) Contact precautions

11) Placement of patient with transmissible disease

The document can be accessed on: Training for Infection Prevention and Control Download

or the website at: https://ncdc.mohfw.gov.in/