Boost dementia-friendly landscape in nursing homes

Associate Professor Gerald Koh and Dr Philip Yap rightly highlighted the need for nursing homes to move away from the current institutional model to a person-centred care approach ("Would you want to grow old in today's nursing homes?"; Tuesday).

They also cited various research studies to make the case for the provision of single rooms for nursing home residents with dementia.

Indeed, almost all of the more than 20 well-run nursing homes in Canada, Britain, Ireland and the Netherlands I have visited have single rooms. This runs counter to the current notion that single rooms are a luxury item in our public healthcare landscape.

But is this too idealistic, as some have argued ("Unwise to subsidise premium nursing care" by Mr Francis Cheng; Dec 25, 2015 and "Shelved: Plans for different model of nursing home"; Dec 21, 2015)?

Most current evidence comes from the West.

While some evidence may be transferable, variations in socio-cultural, financial and organisational systems mean that generalisation must not be assumed.

One has to be mindful of a few issues too: Some residents in single rooms may complain of feeling isolated. More sociable residents may actually enjoy the company of fellow residents in their shared bedroom, as some studies have found.

Reduced line of sight by care staff can be an issue for residents with behavioural issues. The current shortage of care staff will be compounded.

Land scarcity and cost are also issues that need to be dealt with.

Our hot and humid climate may also pose some challenges in terms of ventilation.

That said, we should still work towards a better dementia-friendly environment in our nursing homes.

Perhaps the number of beds per cubicle can be reduced to no more than four. The bed area can be personalised through clever design to facilitate orientation and familiarity.

The dementia ward can have a few single rooms available on an as-needed basis; for example, when residents become agitated or when there are residents who have a need for more privacy.

Or, a pilot ward with a small number of single rooms can be tested out to gain the necessary local experience.

Beyond bed configurations, other dementia-friendly features in nursing homes should include support for engagement and activities, provision for being alone or with others, appropriate levels of useful stimulation and gardens or wandering paths.

This combination of dementia-friendly features ("hardware") and person-centred care model ("software") will transform our nursing home landscape for those with dementia, leading to better quality of life for the residents.

Joshua Kua Hai Kiat (Dr)

A version of this article appeared in the print edition of The Straits Times on January 07, 2016, with the headline 'Boost dementia-friendly landscape in nursing homes'. Print Edition | Subscribe