Wana Seraya Nursing Home (WSNH) integrated services to establish healthy and happy elderly: A qualitative study

Background: The increasing number of elderly people in Indonesia reflects the success in various aspects of service, but on the other hand, these conditions have brought about the consequences of various social problems among the elderly such as physical, spiritual, social, and economic deterioration. Method: The qualitative study was conducted in April 2019. Result: Wana Seraya Nursing Home was founded in 1975 with the aim of developing the nursing home as a service center, guidance and information on social welfare for the elderly. The activities of the elderly include mental/spiritual guidance, exercise, recreation, and routine health services. Received the elderly who were escorted by their family and who were found neglected. Conclusion: Various social and cultural aspects are the reasons for living in a nursing home, and with integrated services, the elderly feel comfortable and meaningful.


INTRODUCTION
The increasing number of elderly in Indonesia shows success in various aspects of service, but on the other hand, this condition brings consequences for various social problems among the elderly. 1,2 Social problems usually faced by the elderly such as; 1) decreased physical, spiritual, social and economic conditions that cause the elderly unable to meet their daily life needs properly; 2) shifting family values from extended family to nuclear family; and 3) in the globalization era, family members are increasingly being busy and demanded to work hard, which cause the family or environment is unable to give the best attention and services to the elderly in their care. 1,2 Responding to the complex social problems experienced by elderly, the government deems it necessary to establish an elderly service institution with a nursing system, which can provide 2 guarantees and protection and social welfare services especially for the elderly in poverty and neglected state. To establish this goal, the Wana Seraya Nursing Home was built.

METHOD
This qualitative study was conducted in April 2019 with a qualitative method to find out about Wana Seraya Nursing Home in Denpasar, Bali, and the psychiatric aspects of the elderly who live there.

RESULT
Wana Seraya Nursing Home is owned by the government and has been established since October 25 th , 1975. The aim is to accommodate the poor and neglected elderly. This must be done to prevent neglect and violence, both physically and psychologically to the elderly. The nursing home programs consisted of recruitment, mental/ spiritual guidance, spiritual activity, skills training, exercise, recreation and routine health services. Most of the nursing home clients do not have families. The nursing home has an elderly-friendly clinic managed by a senior nurse with simple facilities and provides daily vitamins and medicines.
Wana Seraya Nursing Home is one of the government programs that have the vision to develop an elderly nursing home to be a center for elderly social welfare services, a center for fostering social welfare for the elderly and an information center about social welfare services and social welfare issues both on the local and national level. Wana Seraya Nursing Home missions are providing basic needs for elderly through the fulfilment of food, clothing and housing needs, providing social security and social protection, seeking a harmonious relationship between fellow elderly as peers, elderly with nursing home staff, and elderly with the community around the nursing home, as well as maintaining the elderly dignity properly and humanely. Clients come from different backgrounds, both from Bali and outside of Bali. Some of them even can't be identified. One client who had been treated at Sanglah Hospital was brought to the nursing home because of her unknown origin and did not have a family.
NKS, Male, 72 years old, has been living in a nursing home since 5 years ago after his wife died. His married daughter felt unfilial because she let him stay there, but he convinced her that he feels happy to stay there because he had many peers and many activities. He also helped the staff to work voluntarily.
IAT, a 76-year-old woman, has been living in a nursing home since 11 years ago after her husband died and have no children. She is of Brahmin descent but is married to an ordinary man, so when her husband died, she cannot return to her parents' home. At first, she felt sad, but because the staff were very friendly and have many activities, she could gradually forget her sadness and now feel healthy and happy.

DISCUSSION
Growing old is a part of life that will happen to everyone. At old age, being surrounded by family love is everyone's dream. Living separately from children and grandchildren or loved ones significantly affect the elderly mental condition. Living in a nursing home gives a significant influence on elderly mental health.
A large number of the elderly population in Indonesia in the future brings both positive and negative impacts. Positive impact, if the elderly population is in a healthy, active and productive state. On the other hand, the large number of the elderly population becomes a burden if the elderly have health problems that result in an increase of health services cost, a decrease in income, increase in disability, the absence of social and environmental support that is elderly-friendly. 1 Entering old age, the elderly need social and economic support such as a decent place to live. RI Permensos No. 19 of 2012 concerning Guidelines for Elderly Social Services states that elderly social services are efforts aimed at assisting the elderly in restoring and developing their social functions. The elderly social services include service activities inside and outside of the nursing home; protection; and the development of elderly social institutions. 2 The elderly generally experience physical setbacks problems which have an impact on health setbacks with specific disease patterns. Having limited job opportunities make them jobless and live in poverty, while their families are unable to give proper care that leads them to a neglected state.
Therefore, the nursing home has a vital role in improving the welfare of the elderly through the services provided. The services provided consist of fulfilling physical, psychological, and social needs that are not obtained from their family. Through meeting the needs provided by nursing homes, this can help the elderly to improve social welfare. 3 According to Erikson theory, on the elderly stage, humans experience the phase of ego integrity vs despair. Ego integrity is a condition where an elderly can accept the conditions they experienced, found the meaning of life, and have responsibility for their lives to be successful and happy. The elderly who live in the nursing home are satisfied with the life they are living at the moment and are grateful for what the nursing staff have provided. 4, 5 Self-esteem is a factor that makes the elderly happy, with self-esteem the elderly can recognize themselves, be open-minded, accept the situation, behave well, be optimistic, and have a good relationship with the community. Being able to do things that are useful to other residents of the nursing home makes the elderly happy and feels valued. So that the elderly can accept the conditions they experienced today with a sincere heart.

CONCLUSION
Wana Seraya Nursing Home is one of the government programs that have the vision to develop an elderly nursing home to be a center for elderly social welfare services, a center for fostering social welfare for the elderly and an information center about social welfare services and social welfare issues both on the local and national level. Wana Seraya Nursing Home missions are providing basic needs for elderly through the fulfilment of food, clothing and housing needs, providing social security and social protection, seeking a harmonious relationship between fellow elderly as peers, elderly with nursing home staff, and elderly with the community around the nursing home, as well as maintaining elderly dignity properly and humanely.
Wana Seraya Nursing Home Denpasar has many activity programs that support the realization of the vision and mission, such as recruitment, mental/ spiritual guidance, spiritual activity, skills training, exercise, recreation and routine health services.
Various social and cultural aspects are the reasons for living in a nursing home, and with an integrated service, the elderly feel comfortable and meaningful.