The fellows of SIIP III who are looking to identify problems under the broader theme of geriatric care visited an elder care home in Someshwarwadi, Pashan, on the 26th of March 2018, along with their manager. This facility is run by Ms. Prajakta Wadhavkar who is an activist and has been working for social causes since many years.
The fellows entered the care home during the ‘prayer time’ for the elderly residing in the facility. Most of the elderly recited these mantras along with mobility exercises with movement of hands and legs. Few seniors who weren’t interested in chanting mantras, were listening to the old songs from ‘60s and ‘70s through ‘Saregama Carvaan’ speaker exclusively designed for the seniors as they belonged to the era of Amin Sayani-Binaca Geet Mala. The atmosphere was neither dull nor energetic, it was peaceful! The seniors were enjoying what they were doing and the caregivers were helping them out as per their need.
Ms. Wadhavkar talked briefly about the journey of Tapas, the problems she faced and how she got overwhelming responses from some of the clients as Tapas has recently completed one year. Basically, Ms. Wadhavkar wanted to work for the elderly, and during the process of needs identification, she observed that there was no support system available for the elderly suffering from various mental disorders, the most prevalent among them being ‘Dementia.’ She decided to set up a care facility which was sanctioned under the Mental Health Act of Govt. of India. ‘Tapas’ is basically a paid care facility for older adults who are need of constant physical support and attention. There were about thirty patients residing in the facility at the time of observation. Infrastructure included a single four storey building with some open spaces and a basement converted into a common meeting place. A spacious elevator is also available for the wheel-chair bound patients to fit in along with their caretaker. Common kitchen is also available within the facility where food is cooked for each patient as per their nutritional demand.
The Team: Medical Practitioners and Care-givers
Primarily being a medical care facility, Tapas has a crew of renowned doctors spread across Pune, who visit the facility and provide consultation on a weekly basis. Physician, psychiatrist, physiotherapist, nutritionist, behavioural therapist and specialized geriatrician visit the facility regularly, said Ms. Wadhavkar. Apart from the visiting doctors, the nurses are available 24X7 and they work in shifts. These nurses are primarily recruited through bureau’s and through references from nearby villages. The criteria for selection is a willingness to serve the elderly and being commited to the cause, and not specifically specific skillsets such as geriatric care, nursing. For every 2 patients, there is one separate trained caregiver who supported the patients in their day to day activities. Most of the caregivers were trained on job. It is mandatory for every caregiver to attend review meetings, gatherings and celebrating various festivals together along with their senior friends. The caregivers were also given specialized training, and underwent counselling on a regular basis for stress management and emotional, physical well being.
Ms. Wadhavkar also described the typical pattern observed in case of dementia patients i.e., the progression of disease from early symptoms to the behavioural changes which are seen during the later stages of the disease.
Major Observations and Comments
- Most of the patients in the facility were bound to wheelchair. Older females were given a task of cutting the vegetables and older males were playing carrom.
- Each older person was carrying his/her own napkin with utmost hygiene being ensured across the entire facility.
- Caregivers were enthusiastic and had good social skills: active listening and speaking, thereby making the elderly patients comfortable and friendly. Ratio of caregivers to patient was almost 2:1.
- Grab bars were present around the staircase and in the washroom to assist the elderly in moving around the facility with utmost care. Security grills were present.
- Availability of doctors was appropriate and tie-up with variety of the hospitals was commendable.
- Counselling of the caregivers was being provided on a regular basis, which ensured they perform their role in the best possible manner,
- Conventional lock and key is used. No digital alarming system was observed. CCTV Camera were located and working!
The facility has been well constructed with proper well thought strategies, and a decent influx of patients. Ms Prajakta was clear in her understanding, that the model was primarily catered to the higher end segment with a clear financial model to earn revenue and break-even at the earliest.
She has set-up collaborations and networks have been set-up in place, with an intention to develop the facility as a research and policy centre for elderly needs in the country. Ms Prajakta did mention her interest of working with the leading players in this space, to learn from them highlighted by her collaboration with International Longevity Centre (ILC) and interactions with people in the MCI ecosystem.
The modus operandi and the vision she has for Tapas Healthcare is indeed commendable, but there is a need for the ecosystem for integrated-affordable models primarily catered to the middle and lower income groups.