May Chan
Senior Case Manager
Agency for Integrated Care (AIC)

Eighty-year-old Madam Lim lived alone in a one-room rental flat. The single elderly lady had no relatives as her siblings have migrated to Hong Kong and she had lost contact with them.

Madam Lim was admitted to the hospital on several occasions due to her functional decline and urinary tract infections. She was then referred by a hospital social worker to the Community Case Management Service (CCMS) for community support.

During a home visit by the Community Case Management Service (CCMS) team, we learnt that Madam Lim received financial support from the Public Assistance Scheme. Volunteers from the Senior Activity Centre (SAC) would accompany her to the bank every month to withdraw money and help her with her grocery shopping.

Although her flat was not cluttered, Madam Lim placed her daily necessities on chairs around the room so that she knew where her things were located. This arrangement was not ideal as items such as a bucket of rice in the middle of the room presented a fall risk to her. There were also marks of bed bug infestation on the wall, and rat droppings on the floor.

Her dementia with behavioural and psychological symptoms contributed to her hostile, aggressive and paranoid demeanour. For example, she had terminated home help services previously because she believed her valuables were stolen by the workers. As Madam Lim did not have friends, she spent her time by going to the SAC many times a day but stayed for less than five minutes each time. As she frequently quarrelled with the people there and due to incidents of hitting people with her walking stick, she was not welcomed at the SAC. She also refused to attend the Dementia Day Care Centre, which she had been referred to, as she did not like to socialise.

It was recommended that Madam Lim be placed in a nursing home for better care and supervision, but the feisty lady was adamantly against it despite her dementia and severely impaired vision.

There was an urgent need to regulate her medication intake as her aggressive behaviour was a result of her not taking her medication correctly. This was compounded by her dementia and visual impairment conditions. Her physician was consulted and her medication dosage was adjusted to once a day. The amount of medicine Madam Lim was supplied with was also controlled and replenished twice weekly to prevent over-dosage.

The case manager helped with simple housekeeping during home visits and arranged for volunteers do a thorough cleaning of her flat once every few months. Madam Lim’s clothes were sent to the laundromat for thorough washing periodically. Her clothes were also altered to better suit her lifestyle and reduce fall risk.

Eventually, Madam Lim realised she could no longer manage on her own and voluntarily requested to be admitted to a nursing home. She passed on during her second year of stay there. A few months after her passing, the case manager received a call from Madam Lim’s relatives in Hong Kong to claim her remains. They were shown photographs of Madam Lim doing some daily activities during the last three years before her passing, which helped them to cope with their grief knowing that she was being cared for. The case manager also helped to liaise with the local authorities to locate Madam Lim’s remains for her relatives’ collection. With that, the case finally came to a close.

Key Learning Points:

  1. It is possible to support an older person living in the community despite her dementia and severe visual impairment conditions. Even with dementia, a person is capable of deciding when she needs institutional care.
  2. Regular home visits provide clients with emotional support.
  3. Not all cases are closed when the client passes on. Be prepared to deal with unexpected enquiries.