Strengthening Regulatory Regime for Nursing Homes

19 Mr Fadli Fawzi asked the Coordinating Minister for Social Policies and Minister for Health (a) whether there are any plans to strengthen the regulatory regime for nursing homes to ensure that systemic lapses similar to those identified at the Windsor Convalescent Home do not recur at any other nursing home; and (b) if not, why not.

The Senior Minister of State for Health (Mr Tan Kiat How) (for the Coordinating Minister for Social Policies and Minister for Health): Sir, as part of the Ministry of Health's (MOH's) regulatory oversight over providers, we conduct regular and periodic audits, special thematic reviews and inspections on nursing homes. This includes off-cycle audits in response to feedback and complaints to ensure residents' safety. Such an approach ensures that shortcomings and lapses in nursing homes are addressed and rectified in a timely way.

The great majority of nursing homes placed on closer monitoring take adequate corrective actions and sustain the improvements. However, if the gaps are serious, repeated and there is a lack of serious effort to rectify them, such as in the case of Windsor Convalescent Home and LC Nursing Home, MOH will have to escalate our measures.

These two cases of licence revocation are therefore an outcome of the regulatory framework working as intended.

In response to previous identified non-compliances, MOH conducted a thematic audit focusing on compliance with infection prevention and control practices, and basic custodial and nursing care for selected higher-risk operators. After the gaps were first identified, operators were given an opportunity to rectify the lapses, during which we intensified our monitoring of and engagement with the operators. When we ascertained that the remediation efforts were inadequate or were not sustained for the two operators, we revoked their licences and arranged for Vanguard Healthcare to step in.

MOH and the Agency for Integrated Care will also be sharing the findings of our recent audits, and the various manpower training and grant support available with the nursing home sector. This will help the sector maintain an appropriate standard of care.

In response to Mr Fadli Fawzi, like all regulatory functions, it is impossible to eradicate and prevent recurrences of lapses. But with a robust regime, we can uphold good standards of operations and constructive relationships between the regulator and operator to better serve the residents.

Mr Lee Hong Chuang asked about claims and compensation. MOH's regulatory framework aims at assessing licensees' care delivery practices and protocols in compliance with the Healthcare Services Act to ensure resident safety. When necessary, we will step in and take over the operations or coordinate the relocation of residents to another facility.

However, as the provision of care is a contract between the resident and the nursing home, MOH is unable to coordinate private claims from residents or their families against the nursing home.

Mr Speaker: Mr Fadli Fawzi.

Mr Fadli Fawzi (Aljunied): Thank you, Mr Speaker, I have three supplementary questions. Firstly, are there any other nursing homes that have been found to have significant lapses in an initial audit, similar to Windsor Convalescent Home and LC Nursing Home, but have been given the opportunity to rectify these lapses and are still being monitored by MOH? If so, how many?

My second question is, will MOH consider providing smaller nursing home operators with greater support, for example, through a review of foreign manpower requirements?

My third question is, for the transparency and welfare of residents, will MOH reconsider its stance of not informing residents and their family about audit findings before any regulatory action is confirmed?

Mr Tan Kiat How: Sir, first and foremost, I would like to assure Members and members of public that MOH has a robust regime – audits, thematic audits, off-cycle audits – to make sure that our nursing home operators maintain good standard of care, good clinical procedures, and to make sure that resident safety and welfare are taken care of from the healthcare and medical point of view. This is already in place. The audit findings for these two nursing homes are a feature, not a bug of our regulatory framework.

As mentioned earlier in my reply, a large majority of these nursing homes with identified areas of improvement have taken steps to rectify them and sustain the improvements over time. In cases where we believe that they have not done so after repeated engagements with them, we take the extreme step of revoking licence and making sure that we take care of the residents who are in their care. This is a feature, not a bug.

To his point about supporting nursing homes, we do support our nursing homes through different support from manpower training grants to other support for nursing homes, raising the collective standard of care and professionalism across the whole nursing home sector. So, this is something we have been doing and will continue to do.

Thirdly, on informing the family members, MOH's first priority is to make sure those improvements are done, lapses are rectified and to make sure nothing endangers the residents' safety. That is our first priority. If things really do not improve, then we take the extreme step of engaging licence operators. In these two cases of nursing homes, we had to revoke their licence and make arrangements for residents to be get taken called of in another facility.

These are the primary objectives, but we will continue to see how we can think about meaningful information for family members. I know family members when they put their loved ones in nursing homes, there is a range of factors they consider. First and foremost will be the safety, the health and welfare of the resident in the nursing home, but other factors include affordability, include different kind of considerations like vicinity to their home and so on. There are different and a myriad of variables in terms of consideration. MOH is continually looking at how we can provide meaningful information for caregivers and family members to make a decision.

Mr Speaker: I think I will squeeze in one last Parliamentary Question. Mr Pritam Singh.