Lotus Eldercare

Lotus Eldercare

KIMES 2017 featured a number of innovative solutions in Aged Care and Healthcare as a whole. Overall, it has been an interesting experience to see what Korea has to offer in the Healthcare field.

 

Nasogastric tube feeding is becoming increasingly common, as chronic sick patient load increases in our aging population. Nasogastric tube feeding traditionally is not recommended for use in long term care, it is usually only used for 4 to 6 weeks.  However, due to certain patient’s, clinical and operational factors, it is routinely use for long term care in the acute hospitals in Singapore.

Singapore’s market has been using Abbott’s Flexiflo nasogastric tubes, both size 12 and 14 in the past 5 to 10 years. However, Abbott has since decided to discontinue some of their enteral products in 2012. The stocks of the tubes in Abbott’s warehouse lasted another 2 years. In early 2014, the market was introduced to 2 other brands of nasogastric tubes for long term usage.

   Shown: Tubes after 3 month's usage

Insertions of nasogastric tube carry potential risks.  In the hospital’s standard protocols, post intubation placements will be confirmed radiologically. Hospitals also have the additional advantage to use endoscopic, fluoroscopic, electromagnetic and even surgical aided insertions. In the community, the insertions of nasogastric tubes are almost always done blind.  Non-visual placement confirmation techniques that are used in the community are air inflation and auscultation, looking out for symptoms with a trial feeding of small amounts of water with pulse oximetry monitoring and aspiration of gastric contents to confirm acidity with pH indicators.

Our patients in nursing homes and home care services using long term nasogastric tube feeding are often those with severe neurological injuries from traumatic brain injuries, stroke diseases and various forms of encephalopathies (hypoglycaemic, hypoxic etc); and the elderly population with dementia or swallowing impairment from functional and physical decline from various medical conditions and end organ failures. This group of patients will have increased risks during the insertion of nasogastric tube, with even higher risks when inserting a nasogastric tube into a demented, agitated elderly. In this group of demented patients, nasogastric tubes are usually poorly tolerated and would be removed by the patient repeatedly, causing much stress and anxiety to the care givers.

  Shown: Tubes after 3 month's usage

The main and most obvious risk of nasogastric insertion is mal-positioning. Mal-positioning of tubes can range from 0.3% intrapleural (Valentine and Turner) up to 2.4% (Sorokin and Gottlieb n= 2000) of the adult cases, with those inserted into the trachea, bronchus or even pleural spaces as the key causes of morbidity and mortality. Pulmonary formulae infusion with choking, pulmonary infections /abscesses and pneumothorax can occur in mal-positioning. Oral malposition is very common and easily detected in uncooperative and agitated patients undergoing tube insertions.

Since each insertion posed a risk of mal-positioning and various associated complications, the less frequent the tube is changed the less chance there is that the tube will be mal-positioned. Corflo tubes are labelled as nasogastric tubes, and since nasogastric feeding are not thought to be a long term solution in traditional way of usage, their official standard recommendations is to be used for only 4 weeks. However, in Singapore, for many long term chronic sick patients, nasogastric feeding can continue for even 10 years or more in some cases. Flexiflo tubes are being used previously for 2 to 3 months usually without any issues for majority of the patients. Now, with around 3 year of experience with Corflo tubes, they have been shown in my practice to be able to last around 2 to 3 months or more (our threshold is still maximum 3 monthly changes so we do not have experience on longer periods). The removed tubes (after 3 months) are observed and noted to still be in functional conditions.

 

If these tubes were to be changed monthly, and blindly inserted in community, the cost, possibility of mal-positioning of the tubes and direct trauma or discomfort to the patient will be raised by 300%. This is in my opinion, is very unfair to the patient (in having the discomfort of getting the tube replaced monthly – 12 times a year vs 4 times a year), the family (raising the cost suddenly by 300% in terms of the services and buying of the tubes) and the operator (with 300% increase in malposition risk and other associated complications which may or may not culminate to law suits against the institution)

Hence, Lotus Eldercare will recommend Corpak’s Corflo feeding tubes to be changed every 3 monthly period with proper care and maintenance.

We also have recommendations from Corflo attached here.

Here are the corflo tubes after more than 3 months, they are actually totally still usable apart from some expected discoloration from gastric contents!

     staining seen after 3 month's usage, tube is still fully patent.

Lotus Eldercare attended 2016 Elder Care Asia in Kaohsiung, Taiwan. The fair showcases some services on eldercare in Asia together with eldercare conferences.

I was honoured to be interviewed by Max over the topic on future care possibilities.

Lotus Eldercare team visited this year's H.C.R. 2016 expo in Tokyo Big Sight, Japan this October 2016.

The next set of disruptive technology for healthcare is coming. It is community based and it is smart!

A while ago, I was roped into advising and suggesting how Internet of Things can support the flow of healthcare data to achieve a more global access. Here is an attempt to create an open source platform for the technologist to reference on: https://github.com/OpenIoMeT/Iomet-wiki/wiki

 

Lotus Eldercare Technologies, as a wannabe Tech set up as well, has been involved in or planning to be involve in some of the currently technology competitions and funding exercises available.  We have participated in a few the the past and current grant calls. Here is a list to share with you!

Ageing Master Plan, about livelong learning and employability
 

In the recently published MOH’s action plan for successful ageing, the first 2 topics are: Employability and Livelong Learning.

Here is a not-so-new but perhaps missed out possibility on supporting both these action plans: 

SeniorPreneurs.

 

Here is a possible action plan and reasoning for such a movement and entity call SeniorPreneurs Sg to happen here in Singapore –

SeniorPreneurs Sg seeks to create awareness in entrepreneurship in seniors, creating an ecosystem for senior entrepreneurs in order to create more employment opportunities and life-long learning opportunities.  It is modelled after SeniorPreneurs Australia, whereby entrepreneurship is encouraged and supported with networking, training and business coaching sessions. As such, we strive to be involved in a growing number global network of SeniorPreneurs for networking opportunities and exchange of ideas or even expansion of businesses.

SeniorPreneurs Sg key population includes:

1.     Seniors who are retired from their lifelong work and wishes to start a new initiate related to their hobbies or calling to either retain economically active or serve a greater good.

2.     Seniors who are retrenched from their work and wishes to start something on their own for continual employment and revenue stream.

3.     Seniors who have not been gainfully employed due to family commitments and now wanting to have a new start after their children have all grown up and financially independent.

4.     Seniors who wishes to take advantage of a business opportunity they identified from their professional background, or from the feedback from other seniors and friends in relation to eldercare and the silver industry.

With an ageing population, forms of employability for seniors need to be relooked and entrepreneurship in seniors can be a new form of employment for the seniors.  They can even be more successful then younger entrepreneurs with more experience, skills and endurance honed from years of employment. On a whole, successful SeniorPreneurs can also give a new dimension to the overall national economy.

Key benefits in running SeniorPreneurs Sg 

·      More seniors are employed and still actively contributing economically in Singapore through us

·      More seniors are more engaged socially due their startup commitment and be more willing to participate in lifelong learning activities though Seniorpreneurs

·      KPI of at least 2 startup yearly by seniors supported by Seniorpreneurs Sg

·      Usage, feedback and survey on Seniorpreneurs Sg activities and services for the entity to be financially sustainable on its own

·       Facilitate Seniors to be involved in competitions and conferences with their products or services

Services include:

1.     Networking sessions other seniorpreneurs with Industry experts.

2.     Co-working space rental as needed basis

3.     Linking up in governmental start-up fundings like CDG grants/competitions/venture capitalist/chartable organizations support

4.     Setting up website and creating e marketing solutions or traditional marketing workflow

5.     Coordinating with governmental organization in the ageing master plans on employability and life long learning segments.

6.     As a research facilities for government organizations for topics regarding to elder worker and entrepreneurs.

7.     As consultants for large governmental or non government cooperation in terms of prolonging working lives for their ageing employees and promoting retention among those post retirement age via company policies or twitches to job scope and profile.

 

We aim to set up an Asian Institute for Experienced Entrepreneurship following the lead in America: GIEE

 

How do we intend to be sustainable then?

Revenue will come from a few sources:

  1. Sponsorship for events from MNCs/government agencies/Business associations/ Foundations in view of possible project collaborations.
  2. Services provision for members and membership subscriptions
  3. Training (WDA courses/Skills future courses etc)
  4. Consultancy services for large organisations for retaining and retraining retired staff
  5. Research services for governmental organisations for topics on senior workforce
  6. Shares from some of the Seniopreneurs startups (Case by case basis)

 

 

Here is the Australian version: http://seniorpreneurs.org.au/

Here is some feedbacks and ideas on SMEF funding for equipment.

 

I have lots of ideas in the past and many are still hidden in my mailboxes unused and unknown.This idea was first started and suggested by my good self on the 18th November 2014 to the .gov and some business partners. Since it is still just an idea till today, I am putting up in my Ideas page to share.

On the ground I have always been receiving calls when my patient pass on and family wants to donate all the equipment to my service. I have no space, no time and no workflow to manage these bulky items. A kind Medical Social Worker from one of the restructured hospital of the community care department sometimes might arrange these hospital furniture to another needy family. This is however sporadic and not very efficient. 

I am now suggesting to have a policy to “buy back” these used hospital furniture and maintain them until the next family might want them. Some equipment providers have been in this business for more than 15 years and have experience servicing and selling 2nd hand hospital furniture and equipment. 

Let’s suggest a fictitious company RECycMEd Pte Ltd. (I hope nobody has such a name at present!)

Relatives “sell” back the hospital furniture to RECycMEd. RECycMEd cleans, services and maintains them, and when needy patient wants even cheaper hospital furniture, they can use SMEF as well to buy these second hand furniture at an even lower pricing.

For example:

3 Crank Electric Low Hospital Bed $1680 from a vendor,  brought by patient at $168 from SMEF funds living in a 3 room flat.

Unfortunately, patient pass on 2nd day getting the bed before he was even discharged from hospital and before the bed was actually used. Now, family wants to dispose the nearly new hospital bed, calls RECycMEd.  RECycMEd comes in and “buys” the bed from them at perhaps $50or even free , helps the relative the remove the bed from the house to his warehousing area. Perhaps a new patient referred to  any MSW needs the bed, but family is unable or refuses to pay $168 for the bed although it is needed after PT/OT assessment. RECycMEd offers the bed at perhaps half or less of the selling price, like $840, and patient is willing to pay $84 for the bed now after the 90% SMEF subsidy. Bed is recycled successfully and it makes commercial sense for RECycMEd to do this business. RECycMEd may even offer the patient for free if he is able to claim the $840 - $84 = $756 from AIC SMEF for the bed.

It will be a win-win-win-win situation, family can dispose of use furniture for Free or even get something in return, new needy patient gets cheaper hospital furniture and equipment are recycled and not wasted. MSW can have easier access to cheap hospital furniture and the government saves from the discounted furniture.

Kindly help me forward to anyone interested in working out such processes. At least I will know what to do next time patient calls me for all these used hospital furniture.

How We Operate

Our doctor is available from 9.00 am to 5.00 pm. Mondays to Fridays, excluding public holidays, strictly by appointment only.  Please call to arrange for an appointment.

Our charges range from about $250 to $300 per doctor visit per patient for a routine visit for patients under our long term home care service, including procedures and reviews. Medications and expendables will be charged separately if required. All visits are strictly appointment based only. We are not a medical clinic service and will not support services such as immunizations or review urgent hyper-acute conditions. We also only sign CCODs for patients under our long term care.

For referrals, kindly call us at 9800 4828 or E mail the request to us at info@lotuseldercare.com.sg and we will get back to you as soon as possible.

Technology companies please e mail us at technology@lotuseldercare.com.sg  or use this LINK to set up appointments with Dr Tan Jit Seng

Get in touch with us!

Our care coordinator will advise you on the possible options available to cater to your unique needs.

1 Raffles Place #19-61, Tower 2, Singapore 048616

Handphone: +65 9800 4828 WhatsAPP, Direct Call or SMS available. 

Office line : +65 6808 5664  Fax line: +65 6808 5801