Table 3: Care plan for aging Hansen’s disease survivors in order to minimize the negative effects of relocation.
1) Government medical administrators responsible for planning nation-wide integration, sanatorium administrators responsible for planning and implementing relocation in sanatoria, and nurses and sanatorium staff who care for aging residents must fully understand the meaning of the living environment and of relocation for aging Hansen’s disease survivors.
2) The above parties must aim to minimize the burden of relocation in the context of a survivor community whose mobility and mutual aid ability has been degraded by aging. (1) Sanatorium staff must compensate for the above age-related degradation in order to avoid fatiguing the residents during relocation a) Assist with packing and unpacking baggage, and tell residents not to pack things themselves.
b) Help residents to pack who do not require support in their daily life.
c) Have places prepared for residents to rest during packing and transporting baggage.
d) Actively assist in ADLs following relocation.
(2) Strengthening care that supports age-degraded physical and psychological functioning a) Prioritize physical assessment for early detection of physical deconditioning and chronic illness.
b) Continue early detection of and suitable care for dementia
c) Particularly provide care to prevent accidents (e.g. falling).
d) Detail-oriented care supporting residents’ ADLs.
(3) Future research should confirm the effects of relocation; subsequent strategies should be revised to reflect the confirmed effects.
3) Care aiming to alleviate the burden of developing new strategies to live with multiple and severe sequelae in a new environment (1) Educate nurses and residents regarding the need for the living environment to accommodate multiple severe sequelae; support this environment’s recreation. a) Nurses should assess and understand each resident’s requirements.
b) Before entering new accommodation, nurses and residents should repeatedly and collaboratively consider how to best prepare the new house to meet the resident’s requirements.
c) After entering the new accommodation, nurses should identify and improve unsatisfactory elements.
(2) Supporting blind residents with sensory paralysis a) Nurses should empathize with residents’ grief over losing their mental map of their accommodation, and understand the resulting inconvenience.
b) Nurses should aim to prevent accidents and minimize inconvenience due to residents’ loss of their mental map. i) The nurse and resident must repeatedly preview the new house in a preparatory period before moving into the house.
ii) The layout and position of objects should be as similar as possible between the resident’s old and new houses.
iii) Blind persons with sensory paralysis require the most considerate care; nursing administrators should therefore implement systems permitting nurses to care thoroughly for such residents.
iv) Thinking collaboratively about how to use residents’ remaining functions, for example if blind residents aim to determine their orientation using their hearing, staff should consider using the sound of radios or bells. Likewise, if blind residents aim to recognize distance by feeling resistance on colliding with a known object such as a door or pole, staff should cover that object with protective padding.
v) If a spouse with good eyesight is supporting a blind resident, staff should particularly monitor the spouse for fatigue or loss of physical condition. If the spouse feels burdened by a particular care requirement, for example helping the blind resident to bathe, staff should discuss supporting that care requirement with the spouse and the resident.
vi) Provide adequate support for residents’ ADLs.
vii) Implement strategies that prevent accidents.
c) Prevention of withdrawal i) Staff should plan to regularly interact and have conversations with residents and other staff in order to prevent withdrawal due to relocation.
d) Promoting creation of new mental maps i) Nurses should encourage residents to take their time and be patient, as residents’ memory functioning may have decreased since they first created mental maps of their living environment. If residents remember a little, staff should recognize and affirm it.
ii) When previewing and attempting to mentally apprehend a new house, a blind resident may feel his or her way into the new house using remaining sensory functions, for example by using tactile sensory function in the tongue or by feeling bodily resistance on collision with an object. Staff should aim to identify further means of helping residents to use their remaining functions to understand the building’s structure and layout three-dimensionally, for example by using a three-dimensional printer to create a model of the building.
e) Staff should avoid relocating blind residents with sensory paralysis and no spouse.
(3) Care aiming to diminish injury risk among residents with sensory paralysis a) Nurses and residents should conduct a safety patrol to identify high-risk places and consider strategies for preventing injury. Including residents and nurses in such patrols will help to minimize rebound and preserve the chosen strategies by increasing resident acceptance of those strategies [12].
b) Any dangerous places that cannot be made safe due to resident opposition should be recognized as hazardous by nurses and nurse assistants; nurses should particularly monitor such places to prevent injury.
c) Regarding residents with good eyesight and sensory paralysis, nurses should develop strategies to make risks easily visible, for example by using a thermometer to prevent burn injuries in bathing.
(4) Support residents’ privacy while eating a) Nurses should prepare private dining rooms for blind residents.
(5) Support for managing neuralgia and heat accumulation a) Nurses should suggest using air conditioners during hot and humid days.
b) The air conditioner’ temperature should be set slightly high and combined with an electric fan.
4) Managing displeasure at having daily routines disturbed (1) Nurses should value long-standing daily schedules, and adjust the timing of complete sections of residents’ schedules.
5) Care aiming to alleviate multiple losses and make life worthwhile (1) Preventing residents’ descent into an exhaustive crisis; understanding residents’ suffering due to multiple losses a) Facility administrators should arrange for nurses to form relationships with the residents, and implement systems encouraging nurses to listen to residents’ accounts of their suffering.
b) Nurses should understand and empathize with multiple losses, including that of the resident’s house, spouse, friends, or community.
c) Nurses should care for residents as quasi-family until the end of the residents’ life, and then pass on the residents’ life stories.
d) In order to prevent residents falling into crises of exhaustion, nurses should use Aguilera’ crisis intervention model to promote realistic perception of situations and provide adequate situational support [9].
(2) Care aiming to sustain and ensure acceptance of relocation and enjoyment of life a) Nurses should maintain a positive attitude.
b) Nurses should identify potential sources of pleasure in the new houses with the residents, and work to actualize them.