On 27^th of June 2018, SIIP 3 fellows and their manager visited Virar, Mumbai for a half day visit to A1 Snehanjali, A project by Silver Innings. Silver Innings is a social enterprise founded in 2008 and working for the elderly with the mission of ‘Transforming lives to mitigate loneliness, helplessness and boredom’. The President of Silver Innings Mr. Sailesh Mishra was also present at the care facility and we all had a fruitful discussion with him followed by the visit.

The setup

A1 Snehanjali is a dementia care assisted living facility catering to around twenty senior citize

ns who are in need of constant attention due to dementia and related health conditions. Original setup of Snehanjali which is like a Portuguese bungalow converted into a very soothing care home with a set of trained caregivers and housekeeping staff. Mr. Mishra has been working on his project and is keen on improving the facility. There are two buildings, a new setup is ten minutes away from the original Snehanjali, with the same set of facilities which was actually a resort, now converted into a care home. Around eight senior citizens are residing in the new facility and it is managed by Ms. Jenifer under the guidance of Mr. Mishra.

Observations

Both the facilities are well-equipped with individual rooms, kitchen, an activity area, walk away and the garden. Food cooked is same for the residents as well as the managers and visitors. Regular, vegetarian food is cooked every day, only on special occasions, the sweet is made and served. Outside food either by families of the residents or the donors is not allowed in both the facilities. Regular medical check-up of all the residents is carried out by the assigned doctor every week and in case of emergency, the patient is referred to the nearby hospital.  All festivals in the year are celebrated at Snehanjali. Tours are arranged at different places where seniors can go and have a peaceful outing in nature.

The residents during our visit were awake and were playing the memory stimulating games with the help of the caregiver in the activity area.  A puzzle, soft foam balls to increase hand grip, drawing books, making a smiley out of a card-sheet and similar activities are performed by the residents on a regular basis and the residents were enjoying as we observed during the visit.

Few grab bars, slopes for easy use of wheelchair, age-friendly bars were observed in the facility. However, light seemed insufficient due to gloomy and rainy weather. Though the generator is available, frequent power cut is common in that area. Elevator was not available in both the facilities and hence, in case of emergency, it is difficult for the caregiver to move the patients from ground to the first floor.

Interactions with Mr. Mishra:

1. Mr. Mishra is very enthusiastic and devoted towards his work. His friendly attitude towards the residents and his staff is one of the major reasons behind success of Snehanjali care home.
2. Mr. Mishra shared his experience of being with people with Dementia. One of the residents had developed dementia due to wrong medications subscribed by his family doctor. Other residents had developed dementia gradually and most of them were retired from senior posts and have been active throughout their lives. Hence, it is very unpredictable disease and its progress is different for different individuals. According to Mr. Mishra, tools to detect early signs and symptoms of dementia among older individuals would be useful and it is the need of an hour.
3. In Snehanjali, The residents take regular medicines to control diabetes and blood pressure if suitable in their case. The patients do not take any medication for dementia as mostly all the medicines are sedatives or sleep inducing drugs which later on create complications if taken over a long period of time.
4. Use of therapies like music and spa therapy were recommended by Mr. Mishra as the elderly enjoyed those sessions, were relaxed and these therapies have been found useful even in the scientific literature. Use of dolls (doll therapy) in case of dementia patients which brings back happier memories of parenthood in them is also practiced at the care home. Therefore, use of such small interventions could be incorporated in different settings such as for the elderly in the community as well as in the nursing homes.

   

5. Mr. Mishra mentioned few techniques like use of neon lights in the room, innovative brain games to target specific abilities like memory, concentration, motor skills and spacial judgement, user-friendly wheel chairs, spoons with grip band and so on which are widely used in foreign countries and they should be made affordable and available for the elderly in India.
6. Regarding the problems faced by the elderly, Mr. Mishra said that uncomfortable wheel-chairs, fear and anxiety among people with dementia of going to the hospital or any other place than their own room, risk of fall in the bathroom due to balance dysfunction, use of diaper and the cost involved in it, dealing with the interference or total negligence of the family members towards senior citizens are serious issues which must be considered and addressed immediately.
7. ‘Quality of life’ is an umbrella term which includes living life with dignity and though dependent physically, the decision of an individual is still respected so he is treated as an independent person. This aspect has been practised in Snehanjali and such attitude must be taught to the caregivers while dealing with any of the elderly patients, especially in case of people living with dementia. Old Age Homes generally lack this angle and it is miserable for an elderly person to dwell rest of the years of life in such anti-friendly environment.

   

After receiving very beautifully done hand-made greeting card from one of the caregivers in Snehanjali, we headed for next immersion site. Thanks to Mr. Mishra and his team for their warm welcome and tour to the facility.