Improving Care in Nursing Homes in Singapore - Role of the Physician

Abstract

Introduction/Objective: Nursing homes (NH) face many challenges. The frail elderly residents may have potentially treatable conditions like recent decline, medication side-effects, pain, and mood disorders besides acute illness episodes. There is increased expectation from healthcare funders and the public for higher standards of care and more efficient use of resources. Acute hospitals want them to take more complex and sicker patients. Doctors generally are not keen to do NH visits. Those who do provide medical services come from various backgrounds and practices. For several reasons including lack of time and know-how they often focus on acute care. NHs may not be prepared to deal with many of these issues including palliative care for end stage conditions. The author, a community aged care physician with interest in intermediate and long term care has adopted an approach to maximize physician time in NH visits in three nursing homes over the past five years. This paper describes the approach used and its outcomes over the years.