Monday 10 December 2012

Nursing home crunch means longer wait

Recovering patients needing step-down care continue to occupy hospital beds
By Salma Khalik, The Straits Times, 9 Dec 2012

A shortage of nursing home places is putting a heavy strain on public hospitals by adding to their severe bed crunch.

Although there are more beds now in nursing homes and community hospitals, supply has not kept up with demand and the waiting time can be as long as six months or more.

As a result, about 425 patients who need only nursing home care are staying put in hospital.

The Ministry of Health said close to 100 others waiting to go to nursing homes are living at home for now.

Its spokesman said the average waiting time for a nursing home bed is four months. This is in spite of 130 more nursing home beds being added this year.

Most public hospitals are running at about 90 per cent occupancy, giving them little leeway in terms of offering more non-emergency operations. Private hospitals aim for an occupancy rate of about 70 per cent, saying anything higher is less than ideal.

This is because the available beds include those in intensive care which must be kept free for critical emergencies, and special wards, such as those for psychiatric or paediatric patients.

If the 425 hospital patients waiting for a nursing home bed moved out, it would free up about 6 per cent of the 6,700 public hospital beds. Until that happens, the hospitals which are full end up putting new arrivals in corridors, renting ward space from the private sector, and delaying non-critical surgery to ensure they have some free beds in case of a surge in emergency cases. This means a backlog of patients needing knee or hip replacements, surgery to remove cancer tumours and other necessary but not time-critical treatments.

At the 1,290-bed Tan Tock Seng Hospital (TTSH), about 80 beds at any one time are occupied by patients waiting to move to a step- down facility like a community hospital or nursing home.

The chairman of its medical board, Associate Professor Thomas Lew, said that while only about 300 patients go from TTSH to a nursing home each year, they have to wait longer now. The median waiting time has gone up from 38 days last year to 57 days this year. These are patients who require longer-term rehabilitation, such as after a stroke or following a major fracture.

Prof Lew said there are a handful of patients in the hospital who have been waiting for a nursing home bed for six months or more.

These are usually patients with severe dementia or who have psychotic problems, which makes it more difficult to fit them into most nursing homes.

He said that for such patients, "a wait of one year is potentially possible". They make up one in four of the 80 or so patients waiting to move from hospital.

About 156 patients a day, or more than 90 per cent of patients admitted to TTSH, go through its emergency department. Over the past couple of years, the hospital has been forced to put patients in beds along corridors when demand for beds outpaced supply.

It can devote only about 8 per cent of its beds to patients going through its specialist clinics.

It is not the only public hospital with this problem.

Between 10 and 15 per cent of patients at the 1,560-bed Singapore General Hospital stay an average of three to four weeks.

Said its spokesman: "Most of our long stayers are either medically unfit for discharge or waiting to be transferred to a step-down care facility such as nursing homes and community hospitals after they are medically stabilised. There are also families with caregiver issues who require more time to arrange for appropriate home care."

The National University Hospital has about 20 patients on any given day who have been there for more than two months.

Its spokesman said there are a few who stay on "despite being fit for discharge as their families are unable or unwilling to take them home".

By Salma Khalik, The Straits Times, 9 Dec 2012

Singapore is racing to increase the number of nursing home beds to free up acute hospital beds.

The price tag for a nursing home bed is about a tenth that of an acute hospital bed, which at today's rates comes to more than $1 million each.

This is because an acute hospital requires a lot more equipment, including operating theatres, intensive care units and emergency oxygen supply near every bed.

This year, 130 new nursing beds were added. For the next three years, an average of 560 more beds will be added each year as 10 new nursing homes open.

A Ministry of Health spokesman said it foresees demand for beds increasing as the population ages, which is why it is ramping up the building of more nursing homes.

Singapore has 9,400 nursing home beds - up from 6,300 a decade ago.

Health Minister Gan Kim Yong has announced plans to build between 20 and 25 new nursing homes, to be sited within the community, by 2020. This should double the number of nursing home beds.

The six community hospitals add another 840 beds for patients who do not need acute care but are not stable enough for a nursing home.

At least four more - in Yishun, Jurong, Outram and Sengkang - will be built. Together with the expansion of some existing community hospitals, they will add 1,800 more beds by 2020.

There are also three chronic sick hospitals with a total of 270 beds.

Already on the drawing board are plans for a 500- to 600-bed general hospital to open in Sengkang by 2018.

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