Elderly and Disabled Falling Through Cracks
By Dilanthi Jayamanne
Hold my hand and walk with me. We must break the back of social inequity; We must empower every individual with a disability To live with dignity in an inclusive society. – William E. Lightbourne
He lived to a ripe old age of 82, although the disabilities of age had set in. His only companion and caretaker was his granddaughter, who was in her 40s. The protagonist of this tale was admitted to hospital for an ailment, but while he was in hospital, he also contracted COVID19. Being unable to look after himself, and with no willing hands to help owing to his infection, the loving granddaughter was the only one to turn to.
Unfortunately, a woman, in a male COVID ward was unacceptable! Therefore, the hospital discharged the elderly patient and sent him home to be cared for by his granddaughter under the ‘observation’ of the Medical Officer of Health (MoH).
While in homecare, the elderly man developed diarrhoea and a minor breathing difficulty. Well in control of his senses despite all his ailments, he was able to inform the Public Health Inspector (PHI) who visited him at his home about his health issues. An ambulance was summoned from the hospital.
With the COVID vaccination programme in progress, the health workers in the area were busy. Therefore, everyone heaved a sigh of relief when the ambulance arrived about 1 to 1-1/2 hours later. Unfortunately, the granddaughter was unable to ‘load’ her grandfather into the ambulance. It required two stronger people to get him into the ambulance. The PHI and the woman too could not achieve this feat between them. Being a COVID patient, they could not look for help to their neighbours. The only available pair of hands belonged to the ambulance assistant.
At first, he turned down their request for help stating that “it was not in his job description to offer assistance to patients.” Subsequently, however, he agreed, having demanded that he be given personal protective equipment, which was provided to him. Having lost so much time, the ambulance finally left with the patient. Suffering from diarrhoea and experiencing difficulty in breathing, it was not long before the granddaughter was told that her beloved grandfather had succumbed to his illness in the ambulance.
Army mobile vaccination programme
The Army, till now, has responded to nearly 10,000 home vaccination requests, where it has visited the elderly and the disabled in their homes to administer the COVID vaccine in a bid to safeguard their lives. That includes the vaccination of a person who was 102 years on Thursday (16). One vehicle with its team of medics could administer around 30 vaccines a day, as the going was slow.
They have to administer the vaccine and observe the elderly or disabled person for 20 minutes and be satisfied that there were no allergic reactions to the vaccine. The vaccination was implemented and completed in all provinces, except the Western Province, where there are still persons over 60 who need the vaccine, but are unable to come for it.
Health Ministry’s homecare programme
The Health Ministry launched its homecare programme considering hospital congestion during the past month or two. The increasing COVID-19 patients prompted the Ministry to set up home-based isolation for asymptomatic COVID19 patients. Thus, it enabled reducing the unwanted hospital admission – leaving hospitals open to symptomatic patients who need admissions. Therefore, the MOH in the area was given the responsibility for triaging the virus-infected individuals who need home-based care and institutional healthcare.
The patients eligible for homebased care should be aged between 2 to 65 years and should be isolated in a separate room with sanitary facilities and adequate ventilation allocated for them. They should not have uncontrolled comorbidities such as morbid obesity of a Body Mass Index over 30, diabetes, hypertension, chronic heart, lung or renal diseases or other medical conditions. They should not be suffering from immunocompromised conditions or not on long-term immunosuppressive therapy.
Also, they should be able to care for themselves or have adequate selfcare or caregiver support at home and proper communication facilities and the ability to communicate. The patient should also have given informed consent to home-based isolation. According to the guidelines issued by the Health Ministry, area MOH should register low-risk patients in the Patient Home Isolation and Management System (PHIMS) and then hand over the responsibility of the patient to the Call Centre and the Medical Care Team through the PHIMS.
This remote assessment and daily monitoring were carried out through telephone consultations by the Standardised Screening Tool. Also, patients in the PHIMS requiring hospitalisation will be identified early by a medical care team supervised by a Consultant Family Physician and will be handed over to a Specialist Medical Officer/Medical Officer nominated by the Regional Director of Health Services. This Medical Officer will arrange the patient’s transport to the hospital in coordination with the relevant hospitals which have appropriate facilities.
Fatalities at home
Looking back at the COVID waves the island experienced, the Nation witnessed a large number of home deaths, where the elderly and sometimes even the young had died at their homes. Only PCR tests conducted on the mortal remains disclosed that those patients had died of COVID-19. A majority of patients were those who suffered from comorbidities, age and disability. The Ministry called for people to take their medication regularly and found solutions to the religious issues that contributed to such unhappy deaths due to COVID. Unfortunately, the Health Ministry is yet to find a solution to the issue of catering to the needs the elderly and disabled population who contract the virus.
National Secretariat for Elders (NSE)
NSE Director, K.G. Lanerolle said it was an issue which had been discussed between the Health Ministry and all respective stakeholders, but had not been resolved. The fact that all persons fear the viral infection and that one cannot expect even one’s own kith and kin to step in if diagnosed with it is a major obstacle which none of the parties were able to overlook during discussions. But the two elders’ homes under the NSE and the four being run by Provincial Councils have formed an, if not ideal, feasible plan to tide through the problem.
They have been issued instructions to isolate those elders at homes and attend to them. He noted that this had been practiced during the latter part of the first COVID-19 wave which had hit their elders’ home in Saliyapura, Anuradhapura. In most cases it is one of the employees of the home who bring the infection to the home. Therefore, when several elders resident in the Saliyapura home contracted the virus, they were isolated, while employees who contracted the disease were instructed to care for them in an isolated area inside the home.
During discussions, the idea came up that health staff or family members who had contracted the disease and had recovered should be employed to attend to the needs of the elderly and the disabled unable to care for themselves while in hospital. However, that idea too was shelved, as it was later revealed that a person who had the disease and been cured of it could get infected again, he said.
Therefore, the issue still remains unresolved. He said in the case of family members – especially those living in the same house, stepping in to assist the patient during their hospital stay was different. But one cannot ask even hospital staff to step in, as they too fear the infection, the NSE Director observed.
Public Health Inspectors’ Union of Sri Lanka (PHIUSL)
President of the PHIUSL, Upul Rohana lamented that it was the ground-level workers who felt the impact of this social issue. Even hospitals and Interim COVID Care Centres are heavily reluctant to admit elderly and disabled patients unless there is a caregiver. It is the field worker who witnesses the difficulties that these patients face.
With no one to attend to them and sometimes even their children or relatives unwilling, they are helpless. He said, however, that this did not apply to the 1990 ambulance service, as besides the ‘pilot,’ the paramedics who arrive in those ambulances are equipped and ready to take care of the patient in whichever condition.
Although the home-based service boasts of continuous monitoring of patients, the MOH merely registers the patient and then leaves him or her at the mercy of the Call Centre which is manned by Medical Officers who have no idea about the ground situation, unless they themselves have served in such areas.
As the Health Ministry has its COVID meetings minus the ground level staff who actually witness the conditions of COVID patients, it has no inkling, or prefers to turn a blind eye to a section of society who either have to have a pair of willing hands to tag along with them to the hospital or die in their homes.
He urged the Ministry to start by reviewing the job descriptions of ambulance assistants and provide them with the necessary training to load and unload the elderly and disabled COVID patients who are unable to fend for themselves. They should be briefed as to the condition of the patient they are coming for, without being clueless, he observed. Also, the Ministry should train a section of its attendants to provide the necessary care for these patients when in hospital or an ICC functioning under it.
With the large amounts of donations being given, the Health Ministry can afford to request well-wishers to provide PPE and other facilities to provide for these patients as well, he added. The Health Ministry boasts of the superiority of its health service to the Nation. But, in addition to the knowledge, the skills and the training which the health staff in Sri Lanka are given, perhaps its best that they also be taught the milk of human kindness.
A deadly disease and the need for social distancing should not get in the way of the Health Ministry finding a solution to this social issue, where the elderly and the disabled COVID patients are not given their due respect in their time of ill health.