Why do our nursing homes look more like a hospital than a home?

By September 27, 2017Current

TL;DR – Nursing homes need not, and should not, be a depressing place.

If you’ve stepped in a nursing home in Singapore, you might find these scenes familiar.

Wheelchair-bound residents hanging their heads in despair while watching their friends catch up with their families. Residents staring blankly into space while being seated in front of a smart TV airing the latest Korean dramas. Come lunch time, everyone would be congregating around tables and waiting for their food to be served in metal trays.

Peek into their dorms and you’ll find six to eight beds lined up like those in hospital wards. Minus the ward curtains. The environment looks the same – even the bedside cabinet!


Now that’s for newer homes.

A recent study on nursing homes titled “Safe but Soulless” revealed that there are still homes where 25 to 30 residents live in one long room, with 15 people sharing one toilet.

It’s no surprise why Singapore’s nursing home model is medicalised and in dormitory-style. Land is scarce in Singapore so we cannot afford to build many habilitative homes (usually with single or twin dorms).

Given the Government’s push for standardisation and cost efficiencies – building nursing homes with hospital-like environments was a pragmatic move.

We currently have about 12,000 nursing home beds and the Health Ministry intends to have 17,000 beds by 2020. However, given our rapid growth of ageing population, about 50,000 elderly will need some form of residential aged care by 2030.

Singapore is definitely pressed for time to ramp up these facilities, but is it really the right way forward to continue building cookie-cutter, dormitory-styled nursing homes?

Or should we, press the pause button, as rightfully pointed out by industry experts, to rethink how we want to provide better care for “the most fragile threads that stitch together the greying tapestry making up modern Singapore”?

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If given a choice, elderly would surely prefer to age in their own homes. Who doesn’t?

They can have their own living space, furniture and live comfortably in an environment which they are familiar with. Relocating to a new place at an old age, in fact any age, causes psychological stress.

Single bedrooms are the norm in Japan

In Japan where a quarter of its people are over 65, there are more than a million beds for the elderly – be it for those with severe physical or mental disabilities or those in private housing with optional care services.

Multiple beds in a room used to be the norm in the 70s to 90s, but Japan has shifted to single-bed rooms since the year 2000.

Dr Kenichi Sato, Consultant at Japan Primary Care Association, said that Japan originally focused on the quantity of beds but they have gradually changed to consider the quality of life.

In single-bed rooms, elderly residents can enjoy privacy.

The Sakura nursing home in Tokyo even encourage their residents to decorate the rooms with their own furniture and personal belongings so they will feel at home.

For 100-year-old Ms Kuni Kuriyama, the 5m-long stretch of wooden cabinets below the windows is the favourite part of her room. There is an altar dedicated to her late husband, photos of her sons and flowers as well as animal figurines.

In a private residential home, elderly are given the autonomy to decide what they want in the facility.

A lady with dementia wanted a traditional candy shop so they created one for her. When children drop by to buy sweets, it helps them to connect naturally and it brings back memories for the elderly.

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Nursing homes in Japan are affordable because of the long-term care insurance scheme (LTCI). The Japanese start contributing $40 to $70 a month to LTCI and when they turn 65, they can receive a range of eldercare support.

While they only need to pay 10 to 20 per cent of the care costs, this “ideal” system also has its own sets of challenges which Singapore is conscious of and faces as well.

Japan is also suffering from a shortage of care workers and this has caused nursing homes to not be able to take in more seniors. In 2013, some 524,000 people were on the waiting list for a spot at Japan’s public nursing homes.

Furthermore, the Government is footing half of the bill (the other half is by LTCI) and the tax-paying workers will decrease as the population ages.

Japan is looking at spending 19.8 trillion yen (S$260 billion) on elderly’s care services in 2025 – this is more than double compared with 2012!

How do we balance pragmatism with aspiration?

Precisely because of this, Singapore’s Ministry of Health (MOH) is extremely cautious about building single- and double-bedded rooms.

MOH believes that development costs could “double” if all nursing homes only have single- and double-bedded rooms. It will “hurt the affordability of care”.

For a pragmatic society like Singapore where land is scarce and tax is low, how can we find the perfect model of care to help our elderly preserve their dignity?

With 80% of Singaporeans living in HDB, can we turn some of these flats into assisted-living facilities for elderly who require more personal care than medical care?

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Can nursing homes become more home-like for those who need intensive care services?

We need to think creatively and add more soul in caring for our elderly. By the time we become elderlies ourselves, it will be too late.  


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Joey Wee

Author Joey Wee

I am nice, most of the time!

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