This is a ward for children and young people who require long-term medical care, the only such ward in a nursing home in Singapore.

Located on the seventh floor of SCH, it is home to 23 residents of different races and religions, from five to 30 years old – each with four to six chronic medical conditions that require round-the-clock care.

All but two of the residents have intellectual disabilities.

A young resident being tube-fed through his stomach. About 80 per cent of the ward’s children are fed through a tube inserted into their stomach due to difficulties with swallowing.

For example, there is an 11-year-old boy with Duchenne muscular dystrophy, which causes progressive muscle degeneration. He also has kidney problems, metabolic deficiency and developmental delay. On top of that, he has dysphagia, or difficulty in swallowing. All this requires constant attention and extensive care support.

The ward is not like disability homes for children, which are equipped to deal with disabilities and behavioural issues, but not medical conditions.

It was set up in 2017 within SCH, a not-for-profit nursing home that was established by three Christian friends in 1960. The home has 190 elderly residents, who occupy four floors of the building.

The children's beds are often wheeled to brighter areas near windows so they can feel the wind and get a dose of vitamin D. Cot beds are used for some of the older children who may climb out of their beds and injure themselves.

Once the residents turn 21, they are expected to move to the adult ward. However, due to the complexities of their conditions, many remain in the paediatric ward after reaching adulthood and continue to be closely monitored.

For instance, a seven-year-old child with global developmental delay (above) may demonstrate cognitive and physical abilities comparable to that of a toddler aged one to three years. As a result, the child may remain in the specialised ward well into adulthood.

While several hospitals in Singapore have paediatric wards, they are meant for acute care and short-term stay.

Before 2017, children who needed round-the-clock nursing care were placed in various nursing homes, living alongside the elderly residents.

Staff nurse Stephanie May Tijam (left) and nursing aide Bway Hway changing a young resident’s tracheostomy tube, which helps with breathing.
Ms Boan Ingyin, one of the three in-house therapy aides, assists a child with stacking activities to improve the dexterity of her hands and fingers.

At SCH, nurses and therapy aides work tirelessly to meet the different needs of the residents.

Nurses at level seven require skill competencies specific for complex child care, and some of their daily routine includes helping the children with stomach decompression, or the removal of air from the stomach, and caring for their vesicostomy tube inserted into the bladder. The nurses also use a suction to remove mucus or saliva from the back of the children's throat when they cannot cough it out.

On top of medical-related duties, nursing staff also groom the children’s hair, trim their nails and help brush their teeth (above).

“Due to some of their conditions, the children can be abusive as they lack the social engagement skills to express themselves adequately. Hence, they pinch, punch, bite, slap and scratch nursing staff at times,” said director of nursing, Dr Betty Khong, who helms the ward’s 27 nurses and therapy aides.

A young resident hugs Ms Stephanie after she put on his favourite video of BTS, a K-pop boy band, on the television.

One of the nurses, Ms Stephanie May Tijam, said: “Besides taking care of their medical needs, we also pay attention to their social and emotional needs, which play a big part in their behaviour as they grow up.”

“It’s like raising a child,” added Ms Stephanie, who has been at the ward since 2017.

A young resident dances to a K-pop music video in front of the ward’s common television.
Nursing staff hold flowers before attending a funeral for a young resident who died in October 2024.

While 90 per cent of the residents belong to low-income families, almost half come from socially complex backgrounds. Home care can be difficult, with some family members absent because of reasons such as incarceration.

The nurses naturally step into the role of parental figures.

“Our nursing staff are a part of the residents’ surrogate family – being mothers, sisters and friends to our children,” said Dr Khong.

Although the general staffing ratio is one nurse to one resident, only two nurses cover the night shift.

During that time, ward lights (above) are dimmed but not switched off, and children who are more prone to emergencies are moved to sleep next to the nurses’ station. The rest of the ward is kept under constant supervision.

A young resident (background) sleeps in a cot bed while another wears a CPAP (continuous positive airway pressure) mask to sleep, which allows his airways to remain open and for adequate airflow.

As many residents have reduced bed mobility, the nurses turn them every two hours to improve blood circulation and to prevent bed sores.

For tube-fed patients, feeding has to be spaced out throughout the day to aid digestion, with the nurses managing the feeding routines till about 1am daily.

With the help of special mobility devices and transport arrangements, about two-thirds of the children go to special schools or daycare centres on weekdays. Back in the ward, their time is spent on physiotherapy and other forms of therapy such as art and music.

Ms Boan helps a child stand as he learns how to balance and find his own centre of gravity.

Physiotherapy helps the children maintain their maximum physical capabilities for as long as possible through various customised activities to live independently and meaningfully, despite their developmental, motor and musculoskeletal challenges.

Ms Boan (left) conducts physiotherapy with a resident to improve his motor skills and coordination.

Some children do not attend school or leave the nursing home compound due to their complex care needs. The SCH organises many activities like Children’s Day celebrations (above) and puppet shows, and even invites cosplayers, to bring the world to them.

A therapy aide removes some balloons from a child’s mobility device after Children’s Day celebrations on Oct 4, 2024.
A child plays with a cosplayer who came dressed up as Wonder Woman during Children’s Day celebrations on Oct 4.
Theatre practitioner Grace Lee-Khoo (centre), the founder of Access Path Productions, Singapore’s first disability-led theatre company, carries out a storytelling session for the young residents with other volunteers and their children.

These activities are heavily dependent on volunteers, and SCH is always in need of groups who can offer different kinds of expertise. These include arts and crafts, balloon sculpting, children’s drama and volunteers who can play a variety of instruments.

There are also a small number of regular volunteers who come weekly to visit the children.

Monday nights are usually reserved for volunteers – such as 26-year-old leasing executive Kimberly Ho (below) – who take part in SCH’s bedtime stories programme. Just as normal children have parents to put them to bed, SCH tries to replicate this experience, although it is limited to just once a week.

“A lot of the kids here were born into bad environments, both medically and socially, so we try to mitigate as much as we can, to show them whatever that is lacking in their environment, which includes love,” says Dr Ong Woon Hong, a volunteer who believes no child should grow up without love.

Dr Ong (right) and his wife (left) have been diligently visiting the children once a week since 2020.

The 63-year-old paediatrician closes his clinic early every Wednesday evening to visit the ward with his 57-year-old wife, Ms Tan Lee Lee.

They usually bring a trolley bag full of toys that the children can pick from, and make it a point to have conversations with them through the games they play.

“Initially, when we first came here, they looked at us like strangers and didn’t really want to talk to us,” says Ms Tan.

But after more visits, the children warmed up to them after realising that the couple were not just temporary faces and were sincere about their intentions.

Ms Tan also likes to use tubes of retro balloon mixture gels (above, right) and gets one of the young residents to blow bubbles. Ms Tan hopes that this could be a fun way to help strengthen the resident’s lungs.

“A lot of them also haven’t seen the outside world and what the real world is like,” says Ms Tan, who, along with her husband, invited a small group of children to their home to celebrate Chinese New Year in February 2024.

SCH is currently partially funded by the Government and private donors, with all its extra programmes such as art and music therapy depending on funding by private individuals.

Although running the ward is a mammoth task, the reward comes in the form of unbridled affection from the children.

Nursing aide Je Naw releases bubbles in the air to entertain the children before lunch.

“They will run to you and hug you. When we come back from a day off, they will tell us that they miss us,” said Ms Stephanie.

“There are definitely bad days, and they are bound to throw tantrums, but we always remember that because they are... special kids. They need a lot of understanding, a lot of patience, and really, a lot of love”.

Ms Stephanie consoles a young resident who was missing his mother and sobbing during her lunch break.