Nursing homes have often been seen as a"last resort", not least given Singapore's traditional emphasis on the family as the first line of support.
"This model allows us to encourage quality care as operators are evaluated on the quality of their proposals," says an MOH spokesperson. According to a November 2019 Parliamentary reply, the utilisation rate of nursing home beds in June that year was 85 per cent. In last year's Committee of Supply, then-Senior Minister of State for Health Amy Khor said that with nursing home bed capacity up 30 per cent since 2015, Singapore now has"sufficient capacity nationwide".
To focus on private provision, however, might be to miss the point. As Mr Gee puts it:"That premium end exists anyway." Rather than trying to cap prices or subsidise at that extreme, the issue should be how to develop public provision. The challenge, he says, is for society to agree on minimum standards for non-medical aspects:"Is merely staying alive the key endpoint and funding outcome? Or can we have a cogent and intentional national discussion about mental health, psychological well-being and sense of community in the nursing home setting?"
This has received government support as well, with some of Prof Wee's recent research being funded by grants to design and build sustainable person-centric nursing homes.Kitty Lee, Oliver Wyman partner and head of its health and life science practice in Asia Pacific, identifies several different gaps. First is an overall gap in the supply of services and support for a rapidly ageing population.
Yet a relative lack of alternatives might be precisely what pushes some to nursing homes, even if they might have done well in other settings. In Singapore, the average duration spent in nursing homes can be quite long, from five to six years, to up to 10 to 15 years. In contrast, in the United States - with diverse aged care options such as retirement villages and assisted living - the typical nursing home stay is about two years.
Or as Prof Lim puts it:"Ideally, individuals should be able to remain in the same communities with trusted relationships even as they clinically deteriorate and need more nursing and medical care." To preserve social connections, it would be best if these changing care needs could still be provided for in the same location.
Residents must subscribe to a basic service package including 24-hour emergency monitoring, and may choose optional care services such as help with activities of daily living, meal delivery, and housekeeping. Rather than starting from a business perspective and looking at market structure, the discussion has to begin from"what we want the aged care sector to look like", says Mr Gee.
Yet private-sector enthusiasm does not seem high, when it comes to providing residential care in forms other than the current premium options. In 2020, a tender for what would have been Singapore's first dementia care village at Gibraltar Crescent ended fruitlessly, after the sole bid of S$15 million was rejected by authorities as too low.