Singapore’s aged care homes fall short

Their services are routinary and not personalised mainly due to resource constraints.

Most nursing homes barely feel like a home and are mostly perceived as a healthcare assembly line, failing to attract ageing Singaporeans who prefer to stay home and live independently.

“There’s limited customisation to meet residents' psychosocial needs,” Phyllis Tan, head of Nursing at Allium Care Suites, told Healthcare Asia. “Care is also often routinised, lacking a person-centred approach due to resource constraints.”

A fifth of Singapore’s population is aged 65 and above, and this is expected to increase to 24.1% by 2030, according to the National Population and Talent Division. A study by the Singapore Management University found that eight in 10 elderly Singaporeans prefer to stay home as they age.

“As our population ages, ensuring this option (nursing homes) is safe and sustainable through integrated resources and support systems is crucial,” Tan said.

As more elderly Singaporeans prefer to stay home, the industry should also address gaps in caregiver training, burnout, and communication barriers, said Vincent Wong, co-founder at Anglo Caregivers.

Stay-at-home caregivers, who usually have one or two rest days a month, often suffer physical and emotional burnout, he added.

“A common situation is not having enough sleep or rest,” Wong said. “A live-in caregiver has to be by the elderly’s side day and night compared to part-time ones.” he pointed out

Wong noted that some domestic helpers and caregivers lack both the skill and patience to deal with elderly patients. “Some problems we commonly hear include the inability of the current helper to pick up tasks, despite multiple training with nurses and physiotherapists in the hospital.”

“Our viewpoint is that training is important,” he said. “However, as caregiving is demanding and complex, sometimes even with training, it might not work out.”

Wong said Anglo Caregivers has started recruiting experienced foreign domestic caregivers, particularly those who can speak Mandarin or English. “It’s easier than training inexperienced ones.”

The local industry could draw inspiration from best practices overseas to foster discussions between caregivers and seniors and improve service, said Janice Chia, founder at Ageing Asia Pte Ltd.

On the other hand, providing emotional support to seniors may be more complicated. “Some may require it immediately, whilst some may seek it years into their caregiving journey,” she said.

“Singapore has organisations dedicated to this,” Chia said. “The key now is to raise awareness about the resources already available.”

Technology to the rescue

The early adoption of new technologies has led many assisted-living facilities in the city-state to tackle individual issues without addressing the bigger picture of aged care, EZ Bala, CEO at Alphind Healthcare, said in a video interview.

“For example, electronic health records are designed for episodic care,” he said. “This results in a limited view of the patient's health.”

While the city-state is known for coordinated transitions between hospitals and home care services, Bala said electronic health records don’t contain information about diet, the environment, and personal lifestyle. “We need to integrate additional information from other systems.”

Despite aged care facilities’ fragmented environment, Bala expects the emergence of one seamless platform that will integrate individual solutions. “This integration could be driven by government regulations and standardisation on how different systems communicate with one another.”

He cited the need for 24/7 monitoring and privacy-protected solutions to track people even as they sleep. “Augmenting the workforce’s abilities and providing them with more efficient, user-friendly workflows would be the first step to improving the care system.”

Tan cited the use of wearable health devices and robotics, including emotional support companions and automated medication dispensers. “This will help allow for timely interventions while keeping seniors’ independence.”

With 20 years of experience as a nurse, Tan said ageing-in-place — remaining in one’s home of choice as long as possible — has its benefits, including letting seniors keep their routines and social connections whilst reducing isolation to enhance their overall well-being.

Hospitals play a key role in ensuring continuous care for seniors at home, the head nurse said. “This can be done by developing strong discharge planning processes for clear follow-up care plans, or post-discharge support like home visits or regular check-ins.”

Hospitals can also invest in telehealth services and remote monitoring and share medical information with primary care providers and community care teams, said Chia.

Bala said the government and private sector should work together to develop the technology that would make healthcare affordable and ensure that people can live happy, healthy lives “in the same place.”

“In this ecosystem, all players would be able to communicate and share information, ensuring access to complete and seamless data,” he added.

Chia also advocated the use of technology. “We can offer more chat lines for caregivers to connect and share experiences.”

But artificial intelligence (AI)-driven solutions should consider the real-world needs of both caregivers and patients. “Successful collaborations include AI-powered fall detection systems and the use of predictive analytics for chronic disease management in seniors.”

“AI should augment human care, not replace it,” Chia added.