The physical condition and mental health of some seniors in nursing homes had deteriorated and staff were working longer hours while coping with the stress of keeping up with fast-changing government advisories and rules amid the Covid-19 pandemic.
Despite these challenges, the nursing home sector - with 80 homes and about 16,000 residents - was able to keep the number of Covid-19 cases to 20 residents.
These are among the findings in a report by management consultancy Oliver Wyman, based on interviews conducted between June and August with about 50 people, including long-term care operators, academics, policymakers, technology providers and international experts.
The report, released yesterday, also found that in Singapore, five staff from nursing homes were infected with the coronavirus.
The number, the report said, is low compared with that in other countries, where clusters in nursing homes have spread quickly and led to many deaths.
The report, a collaboration between Oliver Wyman and local philanthropic organisation Lien Foundation, also touched on the challenges faced by long-term care operators, which include nursing homes, daycare centres and home care services.
It also provided recommendations on how the sector can innovate and develop beyond the pandemic.
Ms Kitty Lee, partner and head of the health and life science practice for the Asia-Pacific at Oliver Wyman, said: "We want to raise the conversation.
"There will never be progress or an impetus for something different if we don't have a conversation around what happened and how we can make things better."
Ms Radha Basu, research director at Lien Foundation, said that while the sector did face challenges due to unprecedented risks, in many cases it was difficult to think of alternatives for the situation.
The report said nearly 100 updates were sent out by the authorities during the first six months of the crisis, and some operators said it was a struggle to cope with the short turnaround times.
But operators also said there was sufficient support from the Government, which listened to feedback and modified policies to adapt to changing situations.
For example, nursing home operators were scrambling to prepare for visitors when it was announced in June that visits could resume in two days.
So the Ministry of Health encouraged family members to plan visits over subsequent weeks, although many people rushed to book the first available slots.
Another challenge operators faced was the strain on staff, in a sector where about 80 per cent of direct care staff are foreigners.
Some had their eight-hour shifts changed to 12-hour shifts, while about 3,600 resident-facing staff - about 40 per cent of nursing home staff - had their lives disrupted when they were moved to designated on-site accommodation facilities or hotels.
Senior citizens also felt the impact of the pandemic.
Their emotional well-being was affected with the many changes, and a period without visits from their loved ones led to disengagement and stress, said the report.
Mr Sairam Azad, deputy director of health and senior care at social service agency Awwa, said some clients had behavioural and adjustment issues when they could not go out during the circuit breaker period, while others, such as those with dementia, were reluctant to wear masks.
Some operators, especially daycare centres that had to be closed for some time, turned to online platforms to continue engaging the seniors, but with mixed success.
The report said that while there was reasonable take-up of digital services among less frail and younger seniors, operators in the study found that this translated to only between 20 per cent and 50 per cent of seniors regularly engaging in virtual activities.
Meanwhile, the pandemic has also been a catalyst for more people to adopt home-based care, as well as technology such as telehealth services.
Demand for home nursing services saw an increase of up to 20 per cent, operators said, while there was a 25 per cent to 50 per cent rise in demand for home medical care.
The report recommended that operators put more focus on digital-led models, as technologies such as telehealth are here to stay.
Awwa is one operator looking into providing more telehealth services. It is also developing a communication app where staff can discuss with clients and their families about care plans, home exercise programmes and other matters through one channel, said Mr Sairam.
The report also called for a renewed focus on preventive health and wellness, as well as adoption of technologies such as remote monitoring.
It added that the mental health and well-being of seniors must be included in overall care planning, and the well-being of staff also has to be prioritised.
Caregivers also need more support, it said.
Said Ms Basu: "We hope some of the technology and other opportunities highlighted in the report can pave the way for a stronger, more resilient and integrated sector that is better able to balance safety with well-being during this pandemic and beyond."
