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Homemade TLC - Gulf News

When ill, the comfort of being cared for by loved ones is incomparable. A close second is being looked after at home by professional caregivers. Suchitra Bajpai Chaudhary speaks to a few in the UAE to understand the challenges and rewards of the job.

It was sad for the family when old man S.M. K (not his real name) passed away. The saving grace was the dignity of it all. Khalid, a stroke patient, was nearly 94 when he expired. But he died in his favourite room, watching the lofty peaks of the Jebel Hafeet mountains from his window, feeling the delicate fragrance of jasmines from the creeper in his garden drift into his room, listening to the babble of his six-month-old great grandson and surrounded by his whole clan.
He died with a smile on his face.

His family members were able to lay him in his eternal resting place, content in the knowledge that he had been very well cared for, had not a single bedsore and had died in absolute peace. This was made possible by the services of round- the-clock geriatric care provided by home nurses the family had arranged for. A modest sum in return for which he received full, attentive care at home and which allowed his family priceless satisfaction.

To live with dignity is everyone's right but when health fails, when a person is terminally ill, when an infant requires 24x7 care or a special needs patient needs the support of a care-giver, it is difficult and close to impossible for parents or guardians to be at the hospital at all times.

Many of these patients may have come from remote corners of the UAE, thus making it difficult for the other family members and relatives to travel to the hospital quickly in case of an emergency. After all, the truth remains, life has to go on around the central fear or anxiety of a loved one at the hospital. It is precisely during such times that the idea of home nursing services seems a boon.

Recognising the needs of the country, a few private and government hospitals have begun to provide homecare nursing services.

Friday met some nurses at the Dubai-based homecare provider Emirates Rehab and Homecare Centre, to find out how the system works and the tremendous emotional and physical endurance called for from the caregivers.

Nerves of steel

"What you really need apart from all the training and experience is a big heart that can accommodate a lot of love and compassion for your patient," says Zenaida Estoe. Estoe is a trained nurse who is from the Philippines and has over five years of experience in nursing around the world, including Jeddah, Singapore and now Dubai.

"Since we look after one patient at a time, it is very easy to forge a strong emotional bond with them.

"Sometimes, these patients are terminally ill or are special needs patients [in which case there is very little that we can do to improve their physical condition]. Considering these factors, it is all the more important that we are emotionally strong to handle the pain and the trauma.

"The other most important thing for home caregivers to do is to overcome the language barrier. But sympathy and compassion have no language barriers. So whatever obstruction we face in comprehending the language of the patient is usually compensated by the care we provide."

All in a day's work

Says Tamara Solah, assistant head nurse, "We provide experienced nurses dedicated to the highest quality of customer service to look after the needs of our patients in the comfort of their homes. This service is rendered with warmth, kindness and individual pride."

Among the most important things to be considered while recruiting candidates who are right for this demanding job is experience, followed by efficiency and knowledge, says Osol Dalloul, head nurse. "But more than that I look for signs of emotional maturity in the candidates."

Dalloul describes how the care plan is worked out. When she receives a call for homecare nursing services from anywhere in the UAE, it mostly comes for geriatric care or for terminally-ill patients. The contract could be for daily, weekly or monthly hire and the duty hours could extend from 8 to 16 to even 24.

The homecare nurse is expected to perform a lot of chores. She is expected to administer IV fluids, enemas, medication, injections, provide first-aid in case of emergencies, know CPR procedures, defibrillation, suturing, give the nebuliser, dress wounds, clean the patient etc, among a lot of other duties.

"It depends on the kind of contract we have with the person who hires our services. So considering the gravity and magnitude of the job, a roster is drawn up and a minimum of two nurses working in different shifts are assigned for the job. Sometimes the number goes up to three if night care is required. An elaborate action plan is drawn up for the patient," says Dalloul.

"We tell the nurse that apart from dealing with the medical needs of the patient, sometimes she has to also deal with the patient's family on an everyday basis. This makes it imperative for the caregiver to be emotionally strong, calm and prepared to handle any kind of a situation."

In case of the inevitable

Sometimes the inevitable happens. The patient passes away. It is hard on the family. But what about the nurse who has to remember that she is on duty and has no business to grieve? Not in the case of Maria Anna May Diaz, a young recruit who joined Emirates Rehab and Homecare Centre a few months ago. Her first patient, a retired army personnel from Ras Al Khaimah, was suffering from cancer of the larynx. He died in her care.

"I noticed that he had not eaten that day and had very shallow breathing. I gave him CPR and called his family. He was 94 years old and despite all my efforts, he passed away. I was so distraught, as he was like a grandfather to me. I couldn't cope emotionally with his death and broke down."

Diaz was unable to move on to her next assignment and suffered Post Traumatic Stress Disorder. So much so that the Emirates office bearers decided to set up a stress support group for nurses, says Daffodil Guevarra, a specialist in rehabilitation medicine, who works closely with the nurses on the care of diabetic and geriatric patients.

"We thought a lot over this issue and came to the conclusion that we weren't equipped to handle emotional issues such as these. Diaz didn't want to work anymore after the death of her patient. She was crying inconsolably. I think this is the hardest part about homecare nursing as the nurse gets assimilated in the household.

"Our stress support group, which was set up after this incident, provides a forum for nurses to share their experiences and understand from the experiences of others that they are not alone. There is a yoga therapist and stress management experts on hand to teach them coping mechanisms," she adds.

Despite the emotional demands of their job and the nature of homecare, both Diaz and Estoe are deeply satisfied with their jobs. "I derive a lot of happiness from the recovery of my patient. Things look depressing and difficult (at first) but when a nurse disciplines herself to look beyond it and simply concentrate on the care her patient needs, it always bears results," says Estoe.

"For instance, I had a patient with a challenging necrotic ulcer. He was highly diabetic but I took care of it and dressed his wounds and kept him clean. I monitored his blood sugar and ensured that it was under control. After a long period of time, his ulcer responded to the treatment and I was the happiest person to see him free of pain and smiling. I thought it a big achievement."

After a moment, she adds: "Sometimes in weak moments, I do question my choice of career. I wonder why I chose this profession. But then when I put in my best and see my patient's pain disappear and he or she relieved of discomfort, I realise there is nothing in the world that can compensate for the deep satisfaction one derives from caring for the sick and dependent.

"It is ennobling. And that's when I realise why I chose to be a nurse and not something else. Not everyone has the compassion and patience to attend to the sick. I am grateful for being given this opportunity."

After working for the entire week in somebody's home, sometimes in long shifts, the caregivers return to their own homes to attend to chores, unwind, catch up on some much-needed sleep and recharge themselves. It's just that they need a little more recharge than others. The kind of job they do calls for it. And most of them are always eager to be reunited with their patients and their extended families.

At Emirates, the charges for homecare nursing range from Dh4,000 to Dh17,000 per month depending on the kind of care, the nature of illness and the number of nurses required for the job. The Centre keeps in regular touch with nurses on assignment and the head nurse and assistant head nurse make it a point to drive down to the homes these nurses have been assigned to know first-hand of their progress.

Among other hospitals offering homecare nursing are the Belhoul Apollo, ProCare Nursing, Jebel Ali Medical Centre and some hospitals in Abu Dhabi as well.

Benefits of Senior / Elder Home Care Services

There is nothing like the comfort and security of home when you're ill or recovering from an illness. Research shows that even for those living with chronic illness or disability, living at home is often the best option for physical and mental well-being. Some of the benefits of in-home care include:

  • Homecare is a cost-effective alternative to hospitals and nursing homes.
  • May help prevent or postpone hospital or nursing home care.
  • Allows maximum freedom and comfort for the individual.
  • Offers individualised care tailored to the needs of the individual and family.
  • Provides professionally supervised services.
  • Provides individuals needing care with dignity and independence.
  • Supports families while keeping them together.