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Lien Foundation urges shift away from ‘archaic’ nursing care models

SINGAPORE — If the nursing homes housing the 5,000 beds the Government wants to add by 2020 are built according to a new model that affords patients more privacy with single and double rooms, it would cost about S$19 million more a year, a study commissioned by two philanthropic foundations has found.

Renci's Bukit Batok Nursing Home in January 2016. Photo: Wee Teck Hian/TODAY

Renci's Bukit Batok Nursing Home in January 2016. Photo: Wee Teck Hian/TODAY

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SINGAPORE — If the nursing homes housing the 5,000 beds the Government wants to add by 2020 are built according to a new model that affords patients more privacy with single and double rooms, it would cost about S$19 million more a year, a study commissioned by two philanthropic foundations has found. 

This is equivalent to 0.2 per cent of the Ministry of Health’s (MOH) S$11 billion budget for the current financial year, and amounts to each resident paying about S$8 to S$13 more a day from the current daily average cost of S$106.20 per resident. 

Lien Foundation, which commissioned the study with Khoo Chwee Neo Foundation, shared these figures on Thursday (July 28), with the aim of quantifying the argument for single- and double-bedded nursing homes which feature en suite toilets, communal living and dining areas — a departure from the six- to eight-bed dormitory-style layout that is common here. 

The foundation has been lobbying for a shift towards nursing homes providing “people-centred” care, an effort that hit a roadblock last year when the MOH said it could not provide subsidies for the proposed Jade Circle home, a joint effort between Peacehaven Nursing Home, the Lien Foundation and Khoo Chwee Neo Foundation. 

The ministry had said it would not be “financially sustainable” to provide subsidies to patients staying in wards “designed to proxy private or A-class ward configurations”. 

On Thursday, Lien Foundation chief executive Lee Poh Wah urged the authorities to move away from “archaic” models of nursing care. “The elderly (in Singapore) are stripped of their privacy, dignity and autonomy, and reduced to living a regimen — all in the name of safety and efficiency,” he said. 

Commenting on the ministry’s decision on Jade Circle, Mr Lee, stressing that they were not asking for additional subsidies, said: “I am completely baffled. Why were we penalised for wanting to care for the poor, for delivering care that far exceeded MOH’s standards?” 

The additional 5,000 nursing-home beds that the Government aims to build by 2020 provide an opportunity for a new model of care to be introduced, he added.

The study, conducted by strategy consultancy Oliver Wyman, sought opinions from geriatricians, nursing-home practitioners, and architects.  

The cost estimates are based on hypothetical nursing homes with 20 per cent single rooms and 80 per cent double rooms. Homes with only single rooms will cost about 36.8 per cent more, according to the study.

Besides infrastructural changes, the model would see a dedicated Senior Care Associate tending to each “household” of up to 10 residents. The associate will engage the residents on daily activities and will be supported by roving teams who provide clinical and nursing support.

At the Salvation Army Peacehaven Nursing Home, 56 residents with dementia are currently housed in such a living community, where they are encouraged to make their own decisions, such as choosing activities they wish to take part in. 

Residents have shown a 30 per cent increase in well-being since moving into the facility in 2006, based on a profiling assessment, said the home’s executive director Low Mui Lang.

The study noted that in countries with ageing populations, such as Japan, Australia, the United Kingdom and the United States, single and double rooms in homes are already the norm.

For instance, residents at the Green House Project in the US live in cottages with private rooms and baths. Those who are able help with food preparation and eat in a communal setting. Unlike the regimented meals in nursing homes, Green House residents are free to choose when to eat. 

In response to the study, the MOH, which received the report on Wednesday night, said it hopes to discuss the findings with Lien Foundation and understand the assumptions behind the economic analysis. 

Commenting on the Jade Circle episode, the MOH said it had made various offers to Peacehaven, such as providing financial support if part of the new facility could be converted into four-bedded wards. “Our offers still stand and we look forward to engaging Lien Foundation on experimenting with new models of care for our seniors,” said the MOH.

It also pointed to ongoing efforts to try new models, such as the Ang Mo Kio Build-Own-Lease  Nursing Home to be operated by Ren Ci, which will have a “cluster concept” of four beds in each room, sharing a common living area. 

In Financial Year (FY)15, the MOH’s investment in the nursing home sector was estimated at more than S$360 million, including manpower funding and capital investments. In comparison, expenditure in FY11 was around S$100 million, the ministry said.

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