THERE WAS sadness the other Sunday when my mother’s two private nurses, Rose Cabibihan and Marie Ferrer, finished their shifts and said goodbye. After providing special nursing caring for “Lola” (my mother) for more than two months, they were moving on to other patients who needed them even more.

Some of our family friends guessed the identity of the “close relative” I’ve been writing about in relation to stroke and other problems of the elderly. My mother had a hemorrhagic stroke (a stroke involving bleeding in the brain) late in October, which kept her in the hospital for a month, the first week in intensive care. Before moving her out of the ICU into a regular room, the doctors required us to get private nurses because her situation remained critical. That was how I discovered the world of private nursing and the very complicated situations around caring for the elderly.

Our hospital recommended that we contact the Association of Private Duty Nurses Association of the Philippines (APDNAP) which is under the Philippine Nurses Association. The APDNAP was quick to make the arrangements since they have pools of private nurses in several hospitals.

The private nurses stayed with my mother all through her confinement, and continued with us after we came home. Eventually, we knew we could transition to a midwife, and for a week, Rose and Marie trained a midwife and a new nursing graduate to take over.

Special
What do the private nurses do? When the patient is still in the hospital, the work is mainly medical. With doctors having only a few minutes each day to check the patient, the private nurses are, well, special in every sense of the word. Besides taking care of many medical tasks, they update the doctors on small but significant changes, even recommending changes in feeding and medication. My sister (who works in Canada as a speech pathologist, with a specialization in neurological disorders) and I had many discussions with the nurses and came away very impressed, seeing how the nurses blended textbook knowledge with extensive practical experiences.

When we shifted to home care, the work involved more variety. There were the usual medical procedures but more time went into day-to-day activities, including preparing food, exercise, reading—even going to Mass and praying. When our nurses came up with a list of important phone numbers for the new team, it included my mother’s hairdresser.

The nurses are fairly expensive, their monthly pay even higher than what I get as a UP professor. There are nurses and midwives who will work at lower rates than APDNAP’s and I am sure some are well qualified, but you have to be very careful. As we began the transition from our private nurses and I had to interview some applicants, I was shocked with the variations in quality. There were applicants who had never even worked in a hospital. In one case, the applicant could not even show me a diploma and license and yet had the names of several patients she had cared for.

Underpaid
In retrospect, the APDNAP nurses’ pay might even be considered low, relative to what they do. I feel that for stroke patients they are indispensable. Strokes are treacherous, often striking at night or early in the morning, when we are least prepared. Private nurses are there to monitor fluctuations in blood pressure, changes in the way the patient is breathing, even sleeping. Transient strokes can cause changes in the patient’s speech or body movement, all often undetectable signs unless someone is around and really knows the patient.

Ironically, private nurses become even more important for mobile, rather than bedridden, patients. The elderly often forget their limitations, and might insist on getting out of bed and walking on their own, even if they’re not ready yet. I had an aunt who recently had a stroke, and the first day she got home after the hospital confinement, she fell and had a hip fracture, landing her back in the hospital.

Another way of looking at all this is to anticipate what could happen if we let our guard down on care for the elderly. A new stroke, or complications like pneumonia, or a fall and a hip fracture, could lead to a stint in the hospital, the cost of each confinement easily running into P1 million.

Deciding on special care is something family members will have to think through, evaluating the elderly relative’s needs, as well as the family’s resources. In our case, there was no way we could do without additional caregiving, given that my father is also quite old and I’m the only child here in the Philippines with heavy work responsibilities and young children to raise. Even with changes in work routines and a moratorium on consultancies, and the private nurses, I have never felt I had a tighter schedule than I do now. The bottom line is that even with special care, relatives still need to pitch in their time, their presence.

Whether you get nurses, midwives, caregivers or tap a trusted household helper, be sure they can relate to the very special needs of the elderly, especially those who have Alzheimer’s or one of the other dementias. I’ve heard horror stories of the elderly ending up being abused—physically, verbally or mentally—by their caregivers.

Moral obligation
I am all too aware that the costs of private nursing care are beyond reach for most Filipino households and wish we had more options. But if families can afford the costs, I strongly feel they are morally obligated to go for the extra professional care. In many households, even if they have the financial resources for special care, the temptation is to ask one of the relatives, usually a woman, to quit working and go full-time caring for the elderly relative. I think it’s unfair to force someone, even a relative, to make such sacrifices and to take the risks that come with having someone who is not professionally trained to handle the medical challenges in geriatrics.

Filipino-style, our nurses became part of the family, comforting us during the times when we weren’t sure if my mother would make it, assuring us that some changes were not as critical as we thought them to be, and sharing in the joys and excitement of significant improvements in my mother’s conditions. Many times, especially when there were problems, they would stay an hour or two beyond their shift.

Filipino-style again, Rose and Marie have kept in touch, and have emphasized that they’re “on call,” ready to advise the new team if needed. To them, and to all the other private nurses, midwives and caretakers in the Philippines—many of them choosing to stay in the Philippines even when offered high-paying jobs abroad—maraming, maraming salamat.