Singapore

Plan for home with single, twin rooms for dementia patients back on track

Plans for a nursing home that will have single and twin rooms with en suite toilets, alongside other facilities that promote independence and autonomy, have been revived.

The failure to secure government subsidies had earlier shelved the plans. But now, Jade Circle, a four-storey facility that will cater to dementia patients, is expected to be completed by the end of 2019.

It will be an extension to the north of the current Peacehaven Nursing Home in Changi, and will cost $14 million to build, with Lien Foundation and Khoo Chwee Neo Foundation committing $9 million.

The two foundations are developing the project jointly with Peacehaven.

The new nursing home will be the first in the Republic to adopt an "anti-diaper, restraint-free" policy, made possible with specially imported beds that can be lowered to prevent falls, and which have sensors that can detect movement.

Residents will also be encouraged to use their attached bathrooms independently, although those who still require diapers will still get to use them.

Non-nurses will be trained as senior care associates, who will give the caregiving manpower at the nursing home a boost.

The 22 residents in Jade Circle will be divided into two "households", each cared for by a senior care associate, who will be assisted by a nursing aide.

This care team will receive continual training and have access to nurses and other health professionals from Peacehaven Nursing Home.

Plans for the nursing home were brought to a halt in December 2015, when the Ministry of Health (MOH) said it could not provide subsidies to residents staying in the proposed single or double-bedded rooms.

It had said that "such parameters will be hard to scale or be financially sustainable, if applied to the rest of the aged care sector".

Six- to eight-bed hospital ward layouts are the norm in nursing homes here.

At the time, MOH had offered to extend financial support to the project if some rooms were converted to four-bedded wards. But this was not accepted by Peacehaven and its funders, who said it would go against the concept of the building.

But, following further discussion at the end of 2016, Peacehaven has agreed to add multi-bedded rooms in its existing building, as part of the overall development of the nursing home.

"Based on Peacehaven's revised plans, MOH is considering Jade Circle and Peacehaven as one entity, with regard to (grants) for those eligible for government subsidies, leaving Peacehaven to decide on who they will admit into Jade Circle," the foundations said.

The revised Jade Circle will have 22 beds - eight single rooms and seven twin-sharing rooms. This is a reduction from the 60 beds initially planned for.

But, in tandem, six four-bedded rooms, along with a single-bed isolation room, will be built as well at Peacehaven Nursing Home. These rooms will not be part of Jade Circle.

It will also comprise a two-storey daycare centre that can accommodate 120 elderly people a day - making it four times larger than originally planned in 2015.

"(The seniors) will engage in purposeful play through arcade games that can stimulate their cognitive capabilities and promote well-being," the foundations said.

An MOH spokesman said: "Taken as a whole, Peacehaven Nursing Home's development project will now meet the ministry's requirements for an increased capacity in nursing home beds providing a good mix of bed options for patients, as well as in daycare services.

"Based on Peacehaven's revised plans, the Ministry of Health is prepared to work with Peacehaven to provide funding support on the expansion works to the main building and operating subsidies for the new bed capacity."

The spokesman added that MOH will continue to provide a mix of room types to meet the diverse needs of seniors here as it ramps up the overall nursing home capacity.

Dr Jeremy Lim, a partner in global consulting firm Oliver Wyman and former senior official at MOH, said Jade Circle is an important pilot to set people thinking about long term care and the philosophy of dignity and humanity.

"We should study this model very carefully and quickly and if indeed as we suspect, it is a superior model of care, then work rapidly towards scaling and making this the new national norm," he said.

Associate Professor Philip Yap, senior consultant at Khoo Teck Puat Hospital's department of geriatric medicine, called revival of the Jade Circle project a "progressive step".

"Providing a de-medicalised and more home-like model of care that prioritises resident autonomy beyond safety and risk management, can go a long way to change the image of long term care to one that is more positive and hopeful," he said.

Jade Circle will still feature a rooftop garden with a dining area, a hair salon and a grocery store as earlier planned. Patients will have an open schedule and the flexibility to plan their day, and access social and shared spaces whenever they wish.

Fees are estimated to range between $1,500 and $2,500 a month for day care and $2,000 to $3,500 for residential care, before means testing.

The Jade Circle extension will still house a training centre for medical professionals working in dementia care. It will offer courses, practical attachments, workshops and seminars, in addition to diplomas and degrees through tie-ups with institutions abroad.

Though the project has evolved over time, its original vision remains unchanged, said Lien Foundation chief executive Lee Poh Wah.

"Like before, we hope to improve the autonomy, dignity and well-being of our seniors with dementia, and offer them high-quality services, regardless of their financial status," he said.

"But we have expanded the daycare component of our project to recognise the need to empower as many seniors as possible to age in the community."

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