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, with one in four citizens projected to be aged 65 or older 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.
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