Eldercare cannot rely only on “having somewhere to live”
Recent news that the Ministry of Health decided to revoke the licences of two nursing homes may look like a regulatory story, but behind it lies a bigger question: how exactly should Singapore’s eldercare sector develop?
When many people think about eldercare, they think of nursing homes. It seems that once an older person becomes old, ill or unable to walk, they should find somewhere to move into.
But eldercare is not that simple.
When children go to preschool, they can at least cry, complain, and go home to say: “The teacher did not give me biscuits today.” When older people have dementia, are bedbound, have declining hearing or weaker ability to express themselves, they often cannot even explain where they feel unwell.
So the central question in eldercare is not only whether there are enough beds, but who ensures that an older person is truly well cared for after being entrusted to an institution.
Tighter regulation shows that the sector is being upgraded
The Ministry of Health took action against LC Nursing Home and Windsor Convalescent Home in the same month, showing that this is not an isolated news story about one institution.
Based on public information, the issues involved multiple areas, including resident safety, clinical care, medication management, infection control, environmental hygiene, food safety, management and oversight.
If such problems happen only once, they may be individual mistakes. But if they recur and continue even after rectification, this is not a case of “a staff member being too busy today”; it is a system failure.
Nursing homes are not hotels.
Their job is not complete simply because older people are placed in rooms, meals are delivered, they are bathed and someone pushes their wheelchairs. Many older people now entering nursing homes are themselves at high risk: diabetes, hypertension, dementia, fall risk, swallowing difficulties, pressure-injury risk and recurrent infections.
For them, one missed dose of medication, one fall or one poorly managed wound can lead to hospitalisation, or even more serious consequences.
So tighter regulation is in fact redefining eldercare institutions: they cannot merely “have beds”; they must also demonstrate that they can provide safe, continuous and traceable care.
An ideal Singapore eldercare model: home as the foundation, community as the framework, institutions as the backstop
In my view, Singapore’s more ideal eldercare model should not be about sending older people into nursing homes on a large scale, but about a tiered system.
If they can live at home, they should do so where possible; if the home cannot cope, community services should come in; only older people with genuinely high needs and high risks should then enter nursing homes.
Healthy or mildly frail older people do not need nursing homes, but chronic-disease management, exercise, social interaction, nutrition and fall prevention. Put simply, the aim is to avoid becoming frail too quickly.
Older people with mild to moderate functional impairment may have difficulty bathing, walk unsteadily, have poorer memory, be prone to taking medication incorrectly, or need simple wound care. If there is a domestic helper, children, a community nurse and support from a family doctor, they do not necessarily have to move into a nursing home.
But “ageing at home” cannot become a warm but burdensome sentence: “The older person wants to stay at home, so family members, you work it out yourselves.”
In reality, many middle-aged people already have to juggle work, child-rearing, rent, car loans, school fees and caring for parents. A little more pressure can throw the whole family system out of balance.
So for ageing at home to work, there must be home nursing, day centres, short-term respite care, caregiver training, urgent referrals and care subsidies.
Nursing homes, meanwhile, should care for older people with severe functional impairment, severe dementia, long-term bedbound status, or those whom families cannot care for safely.
At that point, nursing homes can no longer be merely “residential institutions”; they should be more like long-term medical care institutions.
How are medications managed? How are falls prevented? How are pressure injuries assessed? How are wounds documented? How are infections controlled? How is nutrition tracked? Is there enough staff at night? Who reviews unusual incidents?
These should all be basic competencies.
The value of AI: not replacing people, but making the system a little less chaotic
The eldercare sector may also gain an important future variable: artificial intelligence.
AI is not about having a robot sit beside the bed and say: “Uncle, it is time to take your medication.” The hardest part of eldercare is not the lack of a cool robot, but the many small, repetitive things each day that are easy to miss.
Who needs a dressing change today? Whose weight has recently fallen? Whose fall risk rose last night? Which older person has just had their medication adjusted and needs blood-pressure observation? Which bed area lacks enough staff today? Which care worker has been on night shifts for several consecutive days?
Trying to remember these things mentally, relying on reminders in WhatsApp groups, and manually updating Excel spreadsheets will sooner or later become chaotic.
Where AI can truly play a role is in matching human resources, medical resources and care needs more appropriately.
This may sound a little like Uber and Grab allocating drivers and passengers, but eldercare is far more complex. Ride-hailing platforms mainly consider who is near you, who is free and what traffic conditions are like. Eldercare must consider an older person’s level of functional impairment, fall risk, pressure-injury risk, medication complexity, infection risk, care workers’ skills, nurses’ qualifications, night-shift fatigue, doctor resources and family support.
This is not simple job dispatching, but a system for allocating human and medical resources with high risk and little room for error.
If the purpose of the design is clear, oversight is strict and data quality is good enough, AI can certainly allocate limited manpower, nurses, doctors and beds to where they are more needed.
For example, it can use an older person’s risk level to flag who needs more care time today; use nurses’ and care workers’ rosters, skills and fatigue levels to help institutions allocate staff more appropriately; and use data such as blood pressure, blood glucose, weight, wound photographs and activity levels to identify earlier that an older person may deteriorate, rather than only realising this after fever, infection or hospitalisation.
For the government, AI can also help regulation shift from “after-the-fact inspections” to “continuous monitoring”, enabling earlier identification of institutions with persistent understaffing, older people with repeated emergency attendances, and care indicators that are worsening.
Of course, AI must not become a cold “cost-cutting machine”.
The goal of AI in eldercare should be to direct limited resources to those who need them most, not to squeeze already stretched manpower even further. Human oversight must also remain over final decisions.
Put plainly, AI’s most important value in eldercare is not replacing care staff, but helping them miss fewer things, helping managers rely less on hunches, and helping regulators see problems earlier.
It is not about making care colder, but about ensuring that human warmth is not drained away by chaotic processes.
The government must hold the line while avoiding system collapse
From the government’s perspective, eldercare policy must balance at least three things.
First, hospitals must not be filled long term by older people. If community care is inadequate, older people’s repeated falls, infections, medication errors and worsening pressure injuries will all eventually end up in hospitals.
Second, families must not be crushed by care pressures. If middle-aged people leave the workforce to care for older people, or experience excessive long-term psychological stress, that too is a social cost.
Third, the eldercare sector must not grow in an unregulated way. Eldercare serves one of the most vulnerable groups; once older people’s ability to express themselves declines, regulation cannot rely only on family complaints.
So the government’s ideal role is not to do everything itself, but to get the rules, subsidies and regulation right.
The market provides services, families provide companionship, communities provide support, the healthcare system provides professional judgement, and the government holds the line.
If any one of these pieces is missing, older people can easily fall through the gaps.
The eldercare sector’s real asset is trust
The most valuable asset in the eldercare sector is not buildings or beds, but trust.
But trust cannot rest only on the phrase, “We are very caring.”
Compassion is certainly important, but it cannot replace processes.
Was the medication given? Was the wound reviewed? Was the fall documented? Was the infection managed? Was the family informed? Who is responsible?
These are the individual bricks that build trust.
The more ideal future of eldercare in Singapore should not simply be “more older people living in nursing homes”.
It should be this: healthy older people do not become frail too quickly; older people with mild functional impairment can live safely at home; family caregivers are not overwhelmed; nursing homes take in only those who truly need them; government regulation can identify risks early; and families can see transparent information.
Even if an older person cannot explain themselves clearly, someone will still protect the bottom line for them.
In the end, eldercare is not about making the system look good.
It is about ensuring that one day, when we are old and frail and no one can hear us clearly, we still do not have to live entirely by luck.
That is what a truly mature social eldercare system looks like.
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