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    Dec 21, 2015

    Nursing home plans end on lack of subsidy

    PLANS for a new $15 million nursing home have been aborted after it failed to secure government subsidies for its residents.

    Work on Jade Circle, a four-storey building next to the current Salvation Army's Peacehaven home at Changi, was supposed to start this year.

    The project, which was developed jointly by Peacehaven, Lien Foundation and Khoo Chwee Neo Foundation, hoped to pioneer a different model of care for dementia patients by doing away with the usual six to eight-bed hospital ward layout common in nursing homes here, and instead provide single or twin rooms with en suite toilets.

    Each small group of 12 residents would also have their own dining area and kitchen.

    Such a design is meant to create a home-like environment and provide them with more privacy, autonomy and well-being, said Peacehaven.

    The two foundations had intended to commit $10 million to the project and the home was meant for both full-paying and subsidised patients who are mobile, with moderate to severe dementia. Fees before means testing and subsidies were estimated at $2,800 to $3,500 a month.

    Though the project was announced by the funders in February this year, the Ministry of Health (MOH) told Peacehaven last month that it could not provide subsidies to residents staying in such rooms.

    In response to queries from The Straits Times, MOH said: "As a matter of policy, it will be difficult for MOH to provide ongoing subsidies for patients staying in wards that are designed to proxy private or A class ward configurations such as single or double-bedded rooms only. Such parameters will be hard to scale or to be financially sustainable, if applied to the rest of the aged care sector."

    Unlike countries such as Australia, Britain and Japan where the maximum number of people for each room is two, eight-bedded rooms are the norm here. Single rooms are used usually for interim infection control purposes.

    MOH suggested that Jade Circle convert more than half of the 60-bed facility to four-bedded wards in order to enjoy the subsidy, said Peacehaven. However, having this arrangement would just add four more beds.

    Lee Poh Wah, the chief executive of Lien Foundation, said: "Unfortunately, we are aborting the project because reconfiguring the number of beds to a ward-like setting goes entirely against our ethos and vision of a future nursing home that helps persons with dementia age with dignity regardless of their socio-economic standing.

    "We can't use the same funding model for different care settings as patients only stay for days or weeks in hospitals but those in nursing homes typically spend the remaining years of their lives there.

    "With the policy rules in place, innovation has suffered a setback and there is a limit to filling in gaps."

    Peacehaven executive director Low Mui Lang added that they had converted some of the wards to single and double rooms in the existing Peacehaven in 2006 and they saw the impact of the change on its residents.

    "They began taking pride in dressing up and initiating their own activities instead of being passive. Dementia patients also tend to get disoriented in a room with so many identical beds or fight with their roommates due to the lack of personal space," she said.


    Research has shown that there are benefits to staying in private rooms compared to shared ones. A British National Health Service study found that such residents have less infections and hospitalisation and a study from Japan found the level of satisfaction of residents improving after they moved from shared to single rooms. Another Canadian study found a reduction in conflict among those with disabilities and less medications required for them to fall asleep at night.

    Jeremy Lim, a partner in global consulting firm Oliver Wyman and former senior official at MOH said: "Superficially, it may appear as if bureaucracy is rearing its ugly head and trying to force fit innovative models into existing funding frameworks.

    "However, this issue may be the symptom of a larger and more fundamental divergence on what is considered medically necessary and what is considered a 'luxury' or a 'frill' and therefore what degree of 'creature comforts' would be appropriate for residents funded by government subsidies."

    MOH said it is prepared to consider extending the portable subsidy scheme to Jade Circle. In this scheme, private homes can offer some of its capacity to serve subsidised patients if there is a need for the beds on a national level.

    MOH said it is also seeking to make the environment of its purpose-built nursing homes more familiar and friendlier to the seniors. For instance, it will group a smaller number of beds in a cluster concept in some new nursing homes and patients in each cluster will share a common living and activity space.

    "MOH supports innovation on new models of care that can enhance care outcomes for patients. However, this has to be balanced with the need to ensure that the new models of care will be sustainable over the longer term," said its spokesman.

    She added: "We will be meeting Peacehaven and its funders to discuss how we can work together to support the project and enable it to proceed."