Experts back regular spot checks as smaller nursing homes struggle with rising costs and standards

SINGAPORE – The Ministry of Health’s (MOH) regular spot checks on nursing homes, as part of its oversight to address lapses in a timely way, are still the best way to ensure standards and safety are maintained, experts said.

This is especially true for smaller privately run homes, which often cannot achieve economies of scale because of a lack of staff and inability to influence pricing, dictate care terms or reduce competition.

Zhang Xuan, assistant professor of economics at Singapore Management University, told The Straits Times that the challenges of running a nursing home have grown in recent decades, with residents having more complex needs and operating costs rising.

As Singapore moves into a super-aged society in 2026, and with the projected share of citizens aged 65 or older further increasing to one in four by 2030, the race to expand eldercare has intensified, with the Government tightening regulations to ensure the standard of care is not compromised

“The real concern is market power. A concentrated operator pool (with few players) weakens competition for tenders and (gives them greater) pricing power in the private-pay segment, making MOH’s monitoring and contract design the binding safeguard,” Zhang said.

Sharing this view, sociopolitical commentator Eugene Tan said: “It should not surprise us if smaller homes find their operations to be unsustainable. As nursing and care standards rise – and they have to – smaller homes may have difficulties reaping economies of scale.

“The cost of doing business, especially rental and manpower, will continue to exert growing demands on all homes. There may be a niche for smaller homes to occupy, but the challenge is always to balance the competing demands such as affordability, quality care and profits.”

Lee Ah Mooi Old Age Home administrator Then Kim Yuan said that for smaller operators, the challenges are not just about managing daily care.

The challenges include funding adequacy, delayed funding flows, rising manpower and compliance costs, lease uncertainty, ageing premises, staff retention, and meeting rising standards without the scale and central resources of larger operators, he said.

Zhang said that although there is no conclusive evidence comparing the costs and quality of small independent nursing homes with those of large chain homes, quality inspection has been shown to be important in improving standards.

“While rating score is still a strong predictor of a nursing home’s performance, unpredictable inspection timing might be more efficient,” she said.

The importance of monitoring was highlighted by the licence revocations of Windsor Convalescent Home and LC Nursing Home, which put Singapore’s oversight of nursing homes under the spotlight.

Lapses in clinical and nursing care and medication management, discovered in an audit in December 2024 at Windsor Convalescent Home in Pasir Panjang, resurfaced in April 2026 during a spot check.

Similarly, a follow-up audit of LC Nursing Home in Jalan Ulu Siglap, also conducted in April, found a number of repeated violations.

But some people who witnessed the lapses did not report them.

When ST visited LC Nursing Home on June 30, a 70-year-old retiree, whose brother has been a resident there for more than 20 years, admitted she had seen boxes of expired food. Concerned that her complaints might cause problems for her disabled brother, she did not report the incident.

Senior Minister of State for Health Tan Kiat How told Parliament on July 7: “When we ascertained that the remediation efforts were inadequate or were not sustained for the two operators, we revoked their licences and arranged for Vanguard Healthcare to step in.”

Vanguard Healthcare is a wholly owned subsidiary of MOH Holdings. Established by MOH in 2015, it focuses on eldercare services to support Singapore’s ageing population.

As at 2024, there were 88 nursing homes in Singapore, comprising 35 public, 30 private, and 23 not-for-profit operators. The number of private nursing homes dipped to 29 at the end of 2025.

Lee Ah Mooi Old Age Home’s Then told ST that while the revocation cases are serious and lapses affecting resident safety should not be downplayed, “they also raise broader questions about the sustainability of the nursing home ecosystem in Singapore”.

With the challenges of running a nursing home growing over the past decades, the consolidation of nursing homes into larger groups “has been a trend for some time in many developed countries”, noted board member Goh Yew Lin of Allium Healthcare, a premier eldercare provider.

One example is alternative asset manager TPG’s establishment of a healthcare services group for senior citizens in Singapore and Malaysia in March. Called One Aged Care, it has 16 nursing homes, along with ambulances and other medical transport services.

The group was formed by combining Econ Healthcare, Orange Valley Nursing Homes and Ambulance Medical Service. The sharing of resources will enhance coverage and standards, the healthcare services group said in a media statement.

Public health specialist Jeremy Lim, author of Myth Or Magic – The Singapore Healthcare System, said that as quality and regulatory standards are raised and the cost of compliance increases, “scale to spread these costs will become more and more important for financial sustainability”.

“The small, single-site legacy nursing homes will struggle, and instead of reacting to the inevitable and scrambling, perhaps a proactive, orderly consolidation of the sector in accordance with a national masterplan is worth considering,” he said.

“If well structured and closely shepherded by the regulators, with government-linked operators like Vanguard (Healthcare) being exemplars of such future models, Singaporeans could benefit from an uplifting of long-term care. Costs could be managed better by greater efficiency and scale, whilst adding beds and facilities would be easier for large and experienced operators.”

Tan, the sociopolitical commentator, believed there is a need to look at alternative care plans for smaller operators.

He said nursing homes should promote active living among residents who remain mobile to help maintain their independence and slow cognitive decline.

“The key is whether home operators can innovate, deliver quality care and enthuse society on alternative care and living arrangements that go beyond what we are accustomed to,” he said.

But Then felt there is still a place for smaller nursing homes.

He said Lee Ah Mooi Old Age Home, a family-run social enterprise since the 1960s, is not asking for lower standards but “whether the system gives responsible smaller operators enough stability and support to continue serving residents safely and sustainably”.

“As Singapore ages, we should be careful not to let smaller homes quietly disappear simply because the system is increasingly designed around larger-scale operators,” he said.