More than a year since new licensing requirements kicked in for nursing homes in Singapore, many operators have set the wheels in motion in refining the way they work.
These include sending staff for further training in aspects like clinical care and language, as well as improving operational processes, such as for wound management.
Private nursing home provider Econ Healthcare Group, for instance, started a Mandarin language course in 2015. As a result, more than half of its nursing staff now speak basic Mandarin, up from 30 per cent previously.
The Ministry of Health's (MOH) Enhanced Nursing Home Standards (ENHS) took effect in April last year.
The tightened rules, which all nursing homes have to abide by, aim to articulate three aspects - clinical care, social care, and governance and organisational excellence, said an MOH spokesman. There are more than 70 such facilities here.
For example, each home has to engage a registered pharmacist to review patients' medication, among other tasks; do a mental health screening for clients upon admission; and ensure that restraints are "used only as a last resort".
So far, the ministry has not de-licensed any nursing homes for not meeting the standards, it said.
Overall satisfaction level of nursing home residents.
Since April last year, three nursing homes have chosen to cease or consolidate their operations "due to business considerations", said the spokesman, who declined to disclose further details.
A spokesman for Lions Home for the Elders, which runs two facilities with a total of 384 beds, said that the ENHS "enabled us to review and fine-tune our policies, guidelines, standard operating procedures, workflows and service standards".
Fresh initiatives at Lions Home include a rehabilitation programme introduced last year that uses a motion-sensing video game system for residents to exercise their range of movement, coordination and other physical functions.
GOING BEYOND REQUIREMENTS
For many operators, meeting the requirements is part of ongoing efforts to improve the quality of care, said the MOH spokesman.
"Over time, the nursing homes have built up a strong quality improvement culture," she noted.
"After the enforcement of ENHS, this spirit of continuous improvement continues to drive the nursing homes in going above and beyond the standards."
At Bright Hill Evergreen Home, external consultants have been roped in since last year to create a more person-centred care culture for its residents, many of whom are above 70 and have chronic issues such as dementia, stroke and diabetes. This includes relooking care routines and enhancing knowledge of dignified care among the staff.
The residents of the non-profit 248-bed home in Punggol are also given more autonomy in their routines, such as when to retire after the day's programmes end.
Said Ms Cheng Siok Khoong, chief executive officer of Bright Hill: "As people become more affluent, the traditional model of providing medical care is no longer sufficient. We see the importance of providing more quality care."
Nationwide surveys have shown that the overall satisfaction level of nursing home residents stands at more than 90 per cent, said MOH.
Some areas for improvement, according to those surveyed, are meals, and communication with caregivers and their families. These surveys are done every two years and are voluntary, with 55 homes taking part last year.
"Even with the enforcement of the enhanced standards, we continue to engage and work closely with the nursing homes to meet the requirements and give them time to address their deficiencies," added the ministry spokesman.
Conversely, the MOH also considers feedback about the regulations.
In July, it issued an addendum to relax the licensing rules for medication labelling to help reduce administrative work. Initially, nursing home providers had to label stored medicines with the resident's name, NRIC, ward and bed numbers.
Now, they can label medicines with at least two of the four pieces of information, one of which must be the resident's name, said MOH.