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Assisted living developments to be piloted, nurses and pharmacists to play bigger role

SINGAPORE — Healthcare services provided close to where people live will undergo a sea change with nurses and pharmacists set to play a bigger role, and the Government studying future housing developments that come with care services for residents.

Home Nursing Foundation nurse Chitra Kumarasamy on a home visit. Community nurses, advanced practice nurses and pharmacists will play a bigger role in community care. Photo: Najeer Yusof/TODAY

Home Nursing Foundation nurse Chitra Kumarasamy on a home visit. Community nurses, advanced practice nurses and pharmacists will play a bigger role in community care. Photo: Najeer Yusof/TODAY

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SINGAPORE — Healthcare services provided close to where people live will undergo a sea change with nurses and pharmacists set to play a bigger role, and the Government studying future housing developments that come with care services for residents.

The ministries of Health (MOH) and National Development (MND) are studying potential sites for assisted living developments in the public and private residential markets, said Senior Minister of State for Health Amy Khor on Wednesday (March 7).

The developments could offer housekeeping, laundry and 24/7 monitoring services to enable frail seniors to continue living independently.

Home care could be “layered on” if needed. The Government will study ways to incorporate more age-friendly design to help seniors age-in-place, said Dr Khor.

The pilot will go hand-in-hand with other measures to help seniors living in existing housing estates.

Home and community care services have gained traction in Singapore – about 14,000 clients have tapped subsidised home and community care services as of the third quarter of last year, more than the 10,000 who took up subsidised nursing home places, said Dr Khor.

TIME FOR NURSES, PHARMACISTS TO SHINE

From July, qualified senior pharmacists and advanced practice nurses (APNs) in the public sector will be legally empowered to prescribe medicines and order tests without the need to obtain a doctor’s counter-signature, said Dr Khor. For instance, they may order a blood test for a diabetic patient.

Safeguards will be put in place to ensure safe and effective prescribing services, which will be within a “collaborative framework overseen by doctors”, said the MOH.

Only those who have completed the three-month Collaborative Prescribing programme – which will begin this month – organised by the National University of Singapore (NUS) will qualify. The programme’s first intake of 38 is evenly split between nurses and pharmacists, who are from the three regional health systems.

In addition, the healthcare institutions offering the service will be required to set up committees to verify and approve the participating nurses and pharmacists, and to monitor and audit the service.

The move will increase patients’ access to healthcare in the community, while senior pharmacists and advanced practice nurses will have enhanced scopes of practice, Dr Khor said.

A new pilot programme will also be launched in the second quarter of this year, for pharmacists from community retail pharmacies and polyclinics to visit senior care centres and integrated home and day-care centres in Ang Mo Kio, Geylang East, Marsiling and Serangoon to advice and streamline medication for seniors.

This will save them multiple trips to the doctor.

The MOH is also looking to increase the number of community nurses with the three regional health systems – SingHealth, National Healthcare Group and National University Health System – from the current 130, to 200 by end-2019.

Training for nurses will be boosted.

From August, NUS will offer a new part-time, modular graduate diploma in Community Health Nursing. Applicants must be nursing degree holders with at least one year of working experience in a community setting.

An initial intake of 15 to 20 students is expected, and nurses will have the flexibility to either take up the full programme – which will take two to five years to complete – or specific modules such as clinical decision-making, chronic disease management and community health practice.

In July, the NUS’ Alice Lee Centre for Nursing Studies will take in its first students for a new two-year Bachelor of Science (Nursing) programme under the professional conversion programme for registered nurses.

ADDING VALUE FOR PATIENTS

Community nurses and pharmacists welcomed the announcements.

Said Ms Chitra Kumarasamy, a registered nurse at Home Nursing Foundation: “It is time to increase the nurses in community care, (we) help to re-integrate patients back into their community and provide holistic care, which doesn’t stop at the outpatient stage.”

Ms Chitra, 42, made the switch from working in a public hospital about eight years ago and enjoys getting to know her patients better.

“When I first meet them, sometimes (the patients) throw tantrums and others have given up hope... Gradually, as they become more cheerful and open, that’s when they open up and tell you their problems,” she said.

For example, when Ms Chitra learnt that one of her patients with slightly impaired vision, and who lived alone in a rental flat, found it difficult to leave home to buy food, she signed him up for a meal-delivery programme.

Watson’s Personal Care Stores pharmacist Grace Kng is looking forward to working more closely with senior care and day centres under the community-based Pharmaceutical Care Services pilot. She joined Watson’s in 2014 and later opted into its nursing home portfolio.

Among other tasks, Ms Kng, 28, currently reviews the medication of nursing home patients and assists staff in managing their medication stock safely.

“Each healthcare professional has their own expertise that can value-add to patients. For us as pharmacists, we are medication experts, we will know more about specifics, dosing, drug interactions and their side effects,” she said.

Patients’ consultations with doctors may also be take place once every few months, she noted.

Ms Kng is also looking forward to the Collaborative Prescribing programme. “The opportunity for healthcare professionals to work together more closely together will result in greater benefits for our patients," she said. 

OTHER COMMUNITY CARE UPDATES

- Two new polyclinics to be completed by 2023 will be located in Nee Soon Central and Tampines North, adding to the four in Bukit Panjang, Eunos, Kallang and Sembawang to be completed by 2020. The locations of four to six more polyclinics to be completed by 2030 will be announced later. By 2030, Singapore will have a total of 30 to 32 polyclinics.

- Care Close to Home programme to be expanded to four new sites (Beach Road, Chai Chee, Chin Swee and Lengkok Bahru) in 2018, up from the current 11. It enables seniors in rental flats to receive care from Senior Activity Centres, and has benefitted 2,500 people so far.

- Nine more Dementia Friendly Communities (DFC) to be added over the next three years, up from six currently.

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