Long-term geriatric care both science and art

Associate Professor Gerald Koh and Dr Philip Yap's commentary ("Would you want to grow old in today's nursing homes?"; Jan 5) offers insights into the potential benefits of an enabling environment and a person-centred care approach in nursing homes, particularly for people with dementia.

Those with dementia can become increasingly disorientated as their attention span and ability to register, retain and retrieve new information become more impaired.

Clear distinctions in personal and common spaces, with proactive routine setting by support staff skilled in listening, engaging and encouraging, can significantly reduce the quantity of care (and the quantity of medication) needed to contain behavioural and psychological symptoms of dementia.

Opinion editor Chua Mui Hoong, in turn, recognises the immense challenges facing our regulators today, and reflects on the current paradigm of subsidy entitlements ("If a new player disrupts the rules, maybe it's the rules that need to change"; Sunday).

The Government has injected significant funds in response to the increasing demand for nursing home beds. The current discourse raises concerns about sustainability.

There seems to be the assumption that single or twin-shared rooms are more expensive to operate and should not be subsidised unnecessarily by the Government.

We do need a test bed for whole system redesign and learning, including exploring the many alternatives to dormitory and custodial living, particularly in the care of people with dementia.

Innovations may disrupt current norms, but we also need to discover new ways of delivering care that is better, cheaper and more meaningful.

Long-term care is both science and art. Across the world, the walls of acute institutional hospitals and specialist consultation clinics are increasingly being broken down in recognition that truly effective healthcare requires an interconnected network that stretches into the community and the home.

This conversation is really not just about the single room, but it does make us think about the purpose of long-term care, and how it is resourced.

Much of this ground remains uncharted in Singapore. Experiments, improvisation and learning from our mistakes are key ingredients for creating the model we need.

Our profession has a lot to learn, too, and is ever ready to support the Ministry of Health with our skills and understanding, as we collectively seek to serve the best interest of our ageing population.

Christopher Lien (Dr)


Chapter of Geriatricians

College of Physicians

Academy of Medicine, Singapore

A version of this article appeared in the print edition of The Straits Times on January 15, 2016, with the headline 'Long-term geriatric care both science and art'. Print Edition | Subscribe