Small nursing homes feel the squeeze as new rules kick in

Nursing homes were given a one-year grace period to adapt to enhanced standards that specify more clearly what these care facilities are expected to provide, as part of licensing conditions.
Nursing homes were given a one-year grace period to adapt to enhanced standards that specify more clearly what these care facilities are expected to provide, as part of licensing conditions.ST FILE PHOTO

Stricter standards since last month have compelled at least 5 to either reduce bed capacity or make plans to wind up

Some small nursing homes here are downsizing or winding up after finding it hard to keep up with tighter enforcement when stricter standards kicked in last month.

At least five nursing homes, The Sunday Times understands, have reduced their bed capacity or plan to shut down for good soon.

Nursing homes were given a one-year grace period to adapt to enhanced standards that specify more clearly what these care facilities are expected to provide, as part of licensing conditions. To prepare themselves for the new rules, most of the 72 nursing homes here signed up for mock audits by the Agency for Integrated Care to see if they matched up in areas such as patient care.

Following the checks, some nursing homes have been told by the authorities to house fewer residents so as to meet new requirements.

Soo's Nursing Home, which has been providing nursing care services since 1985, was told by the authorities last year to gradually reduce its 24 beds to 18. It has decided to call it a day as it lacks the facilities needed to meet the mark. The Sunday Times understands there are plans for another nursing home in the north to close down soon.

RISING COSTS

Small nursing homes are struggling and how long they can survive is a big question mark. Getting in an architect to cater for fire safety design and equipment can easily set us back by $20,000 each time.

MR PATRICK TAN, who runs Our Lady of Lourdes Nursing Home, on rising costs that come with complying with the regulations.

The operators of small nursing homes, including those with 30 beds or fewer, are calling for more funding support and flexibility from the authorities as they cope with rising costs that come with complying with the regulations.

"Small nursing homes are struggling and how long they can survive is a big question mark. Getting in an architect to cater for fire safety design and equipment can easily set us back by $20,000 each time," said Mr Patrick Tan who runs Our Lady of Lourdes Nursing Home in Toh Drive, in Loyang. It was told to reduce its 19 beds to 16.

"There seems to be fewer than 10 nursing homes with under 30 beds left and it will be a sad thing if they close down because people will no longer have the choice of living in small homes which provide quality, personalised care instead of those huge homes with hundreds of beds," he added.

Moonlight Home For The Aged and Handicapped in Yio Chu Kang Road said it has raised its fees by 10 per cent since February this year, amid rising operational costs. It was told to reduce its 26 beds to 16.

"Our priority is to take care of our elderly residents and we will do what we can to stay afloat instead of shutting down and sending them elsewhere," said Mr Nicholas Ong, who runs Moonlight.

The squeeze on smaller nursing homes comes even as the Ministry of Health (MOH) ramps up nursing home capacity to meet an anticipated increase in demand for nursing care, given the rapidly ageing population. It targets to have 17,000 beds by 2020, up from 12, 000 beds as of the end of last year.

Several mega nursing homes, such as an 11-storey, 342-bed home in Chai Chee run by NTUC Health Co-operative and a 290-bed home in Hougang run by Thye Hua Kwan Moral Society, are expected to be ready this year.

Small operators worry about being gradually phased out as potential big players such as the National Trades Union Congress (NTUC) join the sector. NTUC announced its entry into the sector in 2014 and said then that it is prepared to invest in another five homes in the next three to five years.

"Smaller nursing homes should be allowed to co-exist with large ones, but we are having a tough time because we are unnecessarily marked down for aspects under the new standards," said Dr Belinda Wee from Good Shepherd Loft in Bukit Timah. It has 33 beds now.

Dr Wee said she complied with the new rule to engage a registered pharmacist once every six months for review, by arranging for two such visits last year. But the home was later still found to be in breach of 11 medication management issues, such as failing to ensure that the expiry date of tablets is listed on the metal foil. Dr Wee said this happened as some supplies from the hospitals came without the dates.

"I was also told to have a food safety officer on site but we cater food instead of cooking so that doesn't make sense," she added.

Mr Andrew Soo from Soo's Nursing Home in Bukit Timah said he is closing the home in the next few months partly as it does not have space for facilities such as a holding room, isolation room and sluice or disposal room. "I was informed only in October last year that I need those facilities," said Mr Soo.

MOH said it expects most nursing homes to meet the enhanced standards. Nursing homes will face a shorter licensing period, such as six months, if they do not meet the requirements. Persistent non-compliance may lead to the licence being taken away.

In the last two years, MOH has tried to help nursing homes understand and implement the new standards with briefings, for example.

"Nursing homes that face challenges are those that are observed to need improvements in a number of areas - including important areas such as medication management, which directly impacts patient safety," said the MOH spokesman, who added that the ministry hopes to work with them to develop plans to meet the licensing requirements.

"Even as we ramp up capacity, we want to build a vibrant and diverse sector, which includes small operators who can provide more personalised care, to cater to the varied needs of our seniors," she said.

Mr Soo hopes that small nursing homes will still be around in future.

"Small homes provide a homely environment that is hard to replicate and the quality of care can be more closely monitored."

A version of this article appeared in the print edition of The Sunday Times on May 15, 2016, with the headline 'Small nursing homes feel the squeeze as new rules kick in'. Print Edition | Subscribe