The first in Malaysia and specially built for long-term care
Columbia Asia Extended Care Hospital – Shah Alam is a 66-bedded long-term healthcare facility designed to provide comprehensive nursing and rehabilitative care for severely disabled patients. Established in 1998, it was previously known as Columbia Asia Nursing and Rehabilitation Centre.
As an Extended Care Hospital, State Registered Nurses and Patient Care Assistants provide individualized care in a caring and friendly manner. Licensed as a Private Hospital, the centre is adequately staffed and equipped to handle a variety of non-acute medical conditions on a long-term basis.
The hospital’s Rehabilitation Team, comprising of experienced Occupational, Speech and Physio Therapists, help in improving long-term outcomes of patients, especially those with good potential for recovery.
Medical teams are experienced in helping patients with debilitating conditions such as Stroke, Dementia, Parkinson’s Disease, Pathological Fractures, Head and Spinal injuries, as well as medical conditions that require long-term nursing care. For patients who are terminally ill and in need of comprehensive nursing care, the hospital also provides palliative care.
What is long-term care?
To put it simply, long-term care is the division of healthcare that deals with severely disabled patients, on a long-term basis. The National Institute on Aging USA defines long-term care as one that involves a variety of services designed to meet a person’s health or personal care needs during a short or long period. These services help people live as independently and safely as possible when they can no longer perform everyday activities on their own.
The most common type of long-term care is personalized assistance for “activities of daily living.”
ADL’s are important because these skills affect a person’s ability to carry out household chores, prepare his or her own meals, do shopping, driving or use public transportation and take prescription medications.
Profile of patients
Persons requiring long-term care are usually the elderly. However, many accident victims will require long-term care at a much younger age. Certain congenital medical conditions may also result in the need for such care right from infancy.
Who needs long-term care?
- Age – the older you are, the more likely you will need long-term care.
- Gender – generally women outlive men, resulting in a single parent status and are more likely to live at home alone.
- Disability – accidents and chronic illness can cause disabilities, resulting in the need for long-term care.
- Health status – chronic conditions associated with ageing, poor diet and lack of physical activity increase your chances of needing long-term care.
Services and facilities
Columbia Asia Extended Care Hospital – Shah Alam is a licensed private hospital. Clinical care is rendered by three Resident Medical Officers, one Pharmacist, two Pharmacy Technicians, 24 State Registered Nurses, 26 Patient Care Assistants, one Occupational Therapist and eight Physiotherapists. A visiting Dietician and Speech Therapist also participate in patient care, as and when required.
The facility offers different types of patient rooms, including Single Occupancy (varying sizes) and a four-bedded room. Majority of rooms are of the double-bedded variety. In total, the hospital houses 66 beds and the building has many special features to enhance the quality of care provided to each patient. Among others, these features include an internal garden cum courtyard, a dining hall and a dayroom for social activities.
The ageing population
The world’s population over-60 years old is nearing a billion and is growing at a faster pace. Countries globally are faced with the reality of the aged outnumbering the young, posing serious health and social issues. Life expectancy has been on an uptrend, in tandem with medical advances. However, many elderly persons continue to have debilitating diseases and they remain dependent on caregivers for their activities of daily living. Some of these elderly persons are also dependent on frequent medical intervention by doctors, nurses and therapists. For patients who are unable to access such services at home, long-term institutionalized care may become inevitable.
Increasing life expectancy is a triumph of the century. However, it also means as the population gets older, there will be a proportionate rise in the amount of care needed.
With the availability of newer and more effective treatment options, average lengths of stays at acute care hospitals have decreased significantly. However, some patients and especially the elderly, may require longer periods of time to get back on their feet. Continuing their rehabilitation program at a ‘step-down’ facility is one of the options available for such patients. Besides reducing the risk of cross-infections within an acute care setting, ‘step-down’ to a long-term care facility would also result in significant cost savings.
Interview with Dr Ramnan Jeyasingam
Dr Ramnan Jeyasingam, the General Manager of Columbia Asia Extended Care Hospital – Shah Alam has been with the facility since 2001. He has defined the hospital’s services and expertise which is catered towards meeting the medical and non-medical needs of people with a chronic illnesses or disabilities, who cannot care for themselves.
The hospital has its own electronic hospital information system, and Dr Ramnan shared with InfoMed the extensive time the admitting doctor takes to ascertain the patient’s medical history at the point of admission. On the average, each patient getting admitted at this hospital stays more than two months and having a full understanding of past medical history will help in planning individualized future treatment options
The hospital’s services often extend to the homes of discharged patients. Medical staff travel throughout Malaysia to manage discharged patients with special needs, such as gastrostomy and tracheostomy tube replacement.
InfoMed: Your perception of extended care and why Columbia Asia Extended Care Hospital is unique?
Dr Ramnan: It is the only stand-alone, purpose-built long-term care facility in Malaysia, which operates on a Private Hospital license.
InfoMed: Patients and family’s expectations – how is it met?
Dr Ramnan: The process of managing family expectation needs to be assessed even before admission. This is addressed by providing a tour of the facility and conducting extensive discussions before any patient is accepted for admission. Post-admission, our medical staff (doctors, nurses and physiotherapists) will continue to engage with family members and provide frequent feedback regarding the progress of each patient. Such discussions would also address any arising complication or potential complications.
By frequently engaging with family members, consensus for treatment options can be made, thus addressing family expectations.
InfoMed: Regarding the affordability how do you manage the cost of long-term care?
Dr Ramnan: Rising cost of healthcare is a major challenge for any medical institution. As the term would suggest, the cost of long-term care can easily continue for months or years.
At Columbia Asia Extended Care Hospital, the building set-up is a cost saving measure in itself. For example, with the absence of certain ancillary medical services (such as medical laboratory, operating theatres and radiology facilities), overhead operating costs are kept to a minimum. These and other ancillary services can be easily outsourced, if and when required by patients. If needed, the large network of Columbia Asia Community Hospitals in Klang Valley aids in this referral process.
Regular negotiations with our suppliers and external contractors are also part and parcel of managing costs. By sourcing for cheaper medical products and suppliers, including e-commerce vendors, we believe that cost savings can be passed on to our patients and their families. Despite such cost-saving measures, we will not compromise on patient safety.
We also subscribe to several basic principles to ease the financial burden of our patients, including:
- Lowering room rates for patients who are tube-fed. This is only fair as we do not incur any F&B costs for these group of patients.
- Allowing patients to bring their own supply of medications, if these are obtained from government hospitals.
- Taking budget constraints into consideration when designing rehabilitation programs.
- Offering the choice of generic medications which are of comparable efficacy to patented drugs.
InfoMed: Do you have follow-up services after patients are discharged?
Dr Ramnan: Yes, we offer post-discharge follow-up services to patients. Such follow-up may be in the form of outpatient visits by patients (including therapy) or home visits by our medical team. Distance would be a limiting factor, especially if patients return to their hometowns. However, on a case-to-case basis, we even provide home visits to places as far as Alor Setar, Kedah.
InfoMed: How do your services support and complement the tertiary care hospitals?
Dr Ramnan: In general, tertiary care hospitals deal with illnesses which are more advanced. Naturally, patients who suffer from more advanced forms of illness would take a longer time to recuperate. Some of them, may not even recover from the illness at all.
By accepting patients who have been treated and stabilized, we help to ‘clear beds’ in acute care hospitals. This, in turn, helps the acute care hospitals to focus on patients in dire need of such services and treatment.
InfoMed: With the increasing ageing population, how is the hospital positioned to offer the services?
Dr Ramnan: In fact, we have positioned ourselves to address the issue of ‘ageing population’ more than 20 years ago. To date, we continue to address the medical needs of the elderly who are severely disabled. However, having only 66 beds which are fully occupied at most times, we have taken a different approach to long-term care in the past few years.
Currently, we are strong advocates of caregiver training, so that patients can eventually return to their home setting. Having said that, we still continue to provide institutionalize care on a long-term basis. At present, our longest inpatient has been under our care since July 2006 (more than 12 years).
InfoMed: Any plans for expansion considering the increasing need for extended hospitalization care?
Dr Ramnan: There are no immediate plans for such expansions. However, the management of Columbia Asia would always be looking into opportunities to serve this group severely disabled patients.
InfoMed: The importance of rehabilitation and how that is catered for in the facility?
Dr Ramnan: Rehabilitation is important for all patients with severe disabilities. In the early phase, aggressive rehabilitation is likely to improve functional outcomes of patients with severe disabilities. Inevitably, there will be some patients with little or no recovery. Even for such persons, slow-stream rehabilitation may be able to prevent certain complications, such as disuse osteopenia of bones and limb contractures.
Physiotherapists, one Occupational Therapist and one Visiting Speech Therapist. We work closely with Rehabilitation Physicians, both from government and private hospitals, and make appropriate referrals to them when deemed necessary.
InfoMed: Do your staff possess any special skill sets?
Dr Ramnan: To be honest, the provision of long-term care is not exactly ‘rocket science’ material. More importantly, employees in this field of medicine need to be passionate about their work. I believe that many of the long-serving employees of Columbia Asia Extended Care Hospital possess that burning desire to make a positive difference in the lives of severely disabled patients.
InfoMed: What is the difference between long-term care and skilled nursing facility? Do you offer both?
Dr Ramnan: In general, long-term care facilities may include those which are operated and managed by non-medical persons. A skilled nursing facility is one that employs an adequate number of qualified nurses to deliver care. In summary, we are a skilled nursing facility offering long-term care by qualified medical personnel.
InfoMed: Do you admit persons with dementia or Alzheimer’s with unique needs?
Dr Ramnan: In my opinion, persons with early Dementia should be managed within the setting of their own homes. However, as we all know, Dementia is a progressive disorder. We have many inpatients with advanced Dementia, wherein family members can no longer manage them at home. Typically, such patients would be bed-ridden with the need to be tube-fed.
InfoMed: Does your hospital cater to all ages?
Dr Ramnan: We only accept adult and elderly patients. By law, a Pediatrician would need to be present if we were to admit patients below the age of 12.