It was reported a few days ago that a project for dementia patients has been aborted after it failed in its attempt to secure government funding for its clients. The project which envisioned a different model for dementia care by providing single or twin rooms with en-suite toilets was markedly different from the more common model of care for dementia patients here, which adopts a hospital-ward layout of six to eight beds per ward.
The Ministry of Health (MOH) refused to provide ongoing subsidies for the project because it felt that the project will be hard to scale or to be financially sustainable if applied to the rest of the aged care sector.
An Associate Professor in Saw Swee Hock School of Public Health of the National University of Singapore, Gerald Koh, and a Senior Consultant Geriatrician in a public hospital, Philip Yap, have jointly-written an opinion piece for The Straits Times, criticising the regimented model of care for dementia patients which is supported by MOH, and proposing that a patient-centered care should be adopted instead.
“Imagine waking up one day and, for the rest of your life, not knowing what the date or time of day is, and not recognising your closest relations or your own bedroom.
“Imagine that your bedroom has eight identical beds and you struggle to tell which is yours, and there are seven other strangers laying claim to the one bed you are convinced is yours.
“Welcome to the world of a person with dementia, living in a dormitory-like, long-term care facility – the nursing home”, the doctors begin their article to ask if lower patient-to-bed ratio residential facilities are medically justifiable or a luxury.
The doctors also cited evidence that “residents with dementia in nursing homes with individual rooms and more opportunities for personalisation of their living space exhibited less anxiety, irritability and aggression, and had better sleeping patterns”.
“Conducive living spaces may reduce the need for potentially harmful anti-psychotic medications and form part of what is considered appropriate care of residents with dementia,” the doctors argued.
The doctors suggested that general public here had to decide what kind of nursing or retirement homes would older Singaporeans admit themselves to, or place their loved-ones in.
Saying that the “current institutional model of nursing home care can threaten the autonomy and personhood of seniors”, the doctors asked, “how many Singaporeans will choose to stay in the nursing homes of today, where dormitory living and regimented routines are the norm?”
The doctors urged a re-think of the current regimented aged care model, to the type of care which centres on valuing a person’s experiences and making the person the focus of care delivery.
One of Singapore’s most prominent theatre practitioners and the founder and artistic director of W!LD RICE, Ivan Heng commented on the doctors’ op-ed by recounting his own experience with a dementia patient, his grandmother, and asked how we should treat our old people.
“I remember my poor grandmother suffering from dementia in her final days, drugged up to her eyeballs and strapped down to a bed in a room full of old folks.

“Whilst the doctors and nurses seemed to be trying their best, it was altogether regimented, humiliating and inhumane. How should we be treating our old folks? How do you imagine your final days?
“This is a powerful article and essential reading that concerns us all. It is an urgent conversation we need to be having now.
“And no, sending old people to JB is not an alternative.”
– Ivan Heng

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