The other paradigm shift in debate on nursing home care model

What sort of society do we want to live in when we are old and needing constant care? This question weighed heavily on the minds of Singaporeans in the aftermath of the Jade Circle saga.

In February last year, the Lien Foundation, Khoo Chwee Neo Foundation and the Salvation Army announced a new nursing home model termed "Jade Circle" that would be piloted in an existing facility. In this model, for which the partners were to contribute $10 million for construction, the ambition was to move away from dormitories and towards single or twin rooms with en suite bathrooms, clustered into intentional communities of 12 residents with their own kitchens and dining areas.

The project was subsequently aborted after the Ministry of Health declined to provide funding for ongoing operations, stating: "As a matter of policy, it will be difficult for MOH to provide ongoing subsidies for patients staying in wards that are designed to proxy private or A-class ward configurations such as single or double-bedded rooms only. Such parameters will be hard to scale or to be financially sustainable, if applied to the rest of the aged-care sector."

There was a flurry of commentaries both supporting and condemning the ministry's decision. Broadly, the supporters warned of over-extension and committing the Government beyond what could be affordable while critics decried the "Third World" standards required by the Government of nursing homes.

This backdrop framed the research consulting agency Oliver Wyman subsequently undertook on behalf of the Lien Foundation and the Khoo Chwee Neo Foundation. In the report titled The Economics Of Nursing Homes In Singapore, we worked with a number of nursing home operators, geriatricians and other aged-care experts as well as architects to model out, based on current costs, the impact of transforming the model of care from the current to what was envisaged in Jade Circle. We also reviewed models in other developed countries to understand the latest in nursing home care globally.

Our findings: Transitioning the 5,000 nursing home beds in the pipeline to a Jade Circle type model would cost Singapore an additional $8 to $13 per nursing home resident per day or less than $20 million a year in total.

We should be encouraged at the positive approach groups like the Lien Foundation have taken, not complaining about the status quo or asking the Government to think through and solve the "problem" but proactively using its resources to shed further light on issues and bring the debate to the next level...The more important paradigm that is shifting is how the Government and civic society... are working together to make our country better.

The second major finding was that peer countries started out much as Singapore had with dormitory-style nursing homes but have already made the transition to mostly single rooms in aged-care facilities.

Why did we conduct this research? The report, which is intended to be akin to an amicus curiae (friend of the court) contribution, had two motivations.

First, to move us away from discussing in generalities, and unhelpful, "throw away" phrases like "too expensive". Policy analysis should be precise wherever possible and we wanted to support a deeper and more specific conversation. What is "too expensive"? $10 a day, or maybe $20 a day? One per cent of the total healthcare budget? Or maybe 10 per cent?

The hope is that by modelling out the costs of the different models, we could support society engaging in a far richer dialogue, grounded in facts and biased towards action.

Second, we wanted to provide stakeholders with a keen sense of what the rest of the world was thinking and doing. It is a very real danger for us in Singapore to be insular in our thinking and be smug in the satisfaction of how far we have come, without realising that others may have progressed even faster. While Singapore has to find its own way, the experience of others provides useful signposting along the journey.

Taking a few steps back, the report and related work by the Lien Foundation and allies offer a glimpse into what Government- civic society interactions can be. Singapore and Singaporeans cannot be over-reliant on the Government, and as prominent social commentator David Chan of the Singapore Management University puts it, "The man in the street needs to step up and stop relying on the Government to do everything".

We should be encouraged that civic society is responding to the Government's call to contribute to the national debate around complex social issues such as aged care. We should be further encouraged at the positive approach groups like the Lien Foundation have taken, not complaining about the status quo or asking the Government to think through and solve the "problem" but instead proactively using its resources to shed further light on issues and bring the debate to the next level. Finally, we should be most encouraged by the Ministry of Health's mature response to the report, saying it would study the report carefully and hold further discussions with the Lien Foundation.

The MOH further emphasised it "appreciates the aspiration for our seniors to age in more homely environments that provide dignified and enabling care" and would "work with providers to explore new models of care that give residents greater independence and autonomy".

Nursing homes are the issue here but the more important paradigm that is shifting is how the Government and civic society, despite starting with ideological differences, are working together to make our country better.

•Dr Jeremy Lim is a partner in Oliver Wyman's global health practice and is the lead for the firm's social impact projects in Asia.

A version of this article appeared in the print edition of The Straits Times on August 03, 2016, with the headline 'The other paradigm shift in debate on nursing home care model'. Print Edition | Subscribe