Taking A Tri-Generational Tack In Healthcare

The teens, evergreens and in-betweens

The five youngsters in the “family”, all in Secondary 2 or 3, are waiting, together with student nurse Ya Qi—Li Ning’s senior—and medical student Jia Shen. Along with Li Ning, they form one of NUS’s 25 volunteer healthcare teams under its TriGenerational HomeCare (TriGen) project.

Led by undergraduates across diverse healthcare disciplines from Nursing and Medicine to Pharmacy and Social Work, TriGen teams conduct home visits to vulnerable, socially isolated seniors who are frequently readmitted patients.

“TriGen intrigued me,” Li Ning shares why she joined. “What goes on beyond the hospitals, when an elderly patient is discharged and back at home?”

Mr Tan, one of two elders they visit, suffers from multiple chronic conditions including chronic kidney disease, for which he undergoes dialysis thrice a week. However, he tends to skip his medication and indulge in oily foods and sweet drinks.

At his flat, the secondary students help take his blood pressure and glucose levels, tasks they have been trained for. This in itself is an achievement, for Mr Tan was initially resistant to any form of health monitoring. “When we first visited, Mr Tan was not convinced his insulin jabs were important and refused our efforts,” Li Ning recalls. “So we spent our time building rapport with him instead. Gradually, we managed to persuade him to comply with his treatment. His glucose levels have since improved significantly.”

Practically family

With scant support from family and friends, the visits by the TriGen youths have become occasions the wheelchair-bound senior welcomes. The youngsters bring an enthusiasm that is contagious, whether they are wheeling him out for fresh air or helping with the housework. Mostly, though, the group enjoys Mr Tan’s sharing of stories from years past. Jennie, one of the teens, says, “It helps me stand in his shoes, and motivates me to help however I can.”

Despite the language barrier, over time all three generations have learnt to communicate comfortably.

Indeed, Mr Tan and his TriGen team have become like family. Li Ning relates, “Once, in December, he asked us to pass him a small red paper bag from the kitchen. He gently took two new mugs from it, cleaned off the few specks of dust and told us (in Mandarin), ‘I’m keeping this for you to use in the New Year.’ He then carefully placed the bag on the shelf next to him.

“We were so touched. He may not be well off, but he still thought of us and wanted to give us what he could.”

The effect when we connect

Such bonds are pivotal to the project’s success. TriGen’s student directors explain that “Our multi-generational approach to elder care capitalises on the strength of the large, tri-generational families of yesteryear, as opposed to the nuclear family structures of today. It encourages an exchange of perspectives between young and old which can lead to positive psychosocial and health behaviour outcomes.”

Li Ning’s favourite experience was having the other senior they visit, Mdm Soo, show off her dance moves from her youth. The moment was memorable for Li Ning as Mdm Soo had been noticeably affected by dementia in the previous weeks, and wasn’t being her usual self.

“When she was teaching us the steps, she was so energetic,” Li Ning laughs. “It proved to me that engaging our elders makes them lively; it showed me the importance of discovering their strengths and interests.”

Touching hearts

TriGen’s engagement with each senior lasts a year. While it is enough time to fulfil its mission for the elder to experience the protection, care and love of a family, the ending of each project is always bittersweet. Li Ning admits that when the team let Mr Tan know the programme was coming to an end, “Mr Tan did not take the news very well—he was reluctant and rather affected by it,” she says. The healthcare professionals who evaluate TriGen’s projects then stepped in to help Mr Tan find closure.

Professor Lau Tang Ching, the Vice-Dean for Education at the NUS Yong Loo Lin School of Medicine, is one of the mentors of the TriGen programme. He is proud not just of the impact the project has had—decreased readmission rates for the elderly and increased empathy from the youths—but also that the students are learning from and improving on the programme incessantly. TriGen recently took a big step to extend its model from the Northern to the South-Western region of Singapore, while its alumni have started a pilot cycle serving the Central population together with polytechnic students.

The TriGen volunteers conclude, “Some of us are afraid of reaching out to the elderly because of the language barrier. However, a heart to care for them is more important than the ability to communicate. Even a small gesture can bring much hope and joy to their lives.”