To free up acute beds in hospitals, Singapore is activating more Transitional Care Facilities (TCFs), which admit medically stable patients from the public hospitals while they wait for a transfer to intermediate, long-term care facilities, or for their discharge plans to be finalised.
In response to CNA’s queries, MOH highlighted how public hospitals facilitate the timely discharge of medically stable patients to appropriate care settings. These include TCFs, as well as community hospitals, nursing homes and patients’ homes.
Currently, there are three TCFs that are operated by private providers at wards in Sengkang Community Hospital, Expo Hall 10, and Crawfurd Hospital. Together, they have a capacity of about 400 beds.
At Sengkang TCF, which has a total of 164 beds and is run by Thomson Medical in collaboration with Sengkang General Hospital (SKH), about 20 to 30 patients are transferred to the facility each week, with most of them coming from SKH.
These are primarily elderly patients in their 70s and 80s, who require extensive nursing care such as regular turning, assisted feeding and toileting but cannot be discharged as they do not have a full-time caregiver at home. MOH said that older patients generally stay longer in hospitals because it takes more time for their condition to stabilise and for them to be eligible for discharge.
Together, teams from SKH and Thomson Medical work closely and share resources to provide continued care for these patients.
For instance, the TCF can leverage SKH for back-end support like catering, cleaning as well as supply of medications and consumables. It can also tap on specialists from SKH to get advice and support, enabling them to care for patients with a wider range of underlying conditions.
According to Dr Shang Lei, medical director of Thomson Medical, less than 10 per cent of patients sent to the TCF are re-admitted to an acute hospital due to a deterioration of their condition.
However, the TCF is currently seeing an “overwhelming demand” for its beds, with the facility almost reaching full capacity. The average waiting time for a transfer to Sengkang TCF is about five days, said Dr Shang.
In addition, the average duration of stay in the Sengkang TCF is about one month but may be longer for some patients due to their family’s preferences on care arrangements.
MOH said that while TCFs have been effective in alleviating the tight capacity at hospitals, they are an interim measure and not intended to be a permanent fixture in Singapore’s healthcare landscape. The ministry said it will work on increasing care capacity in places such as nursing homes, transitional and community-based home outreach services and community-based aged care facilities.
Collectively, these will allow the majority of patients to recover in the community without needing a prolonged stay in hospital, said MOH.
While pairing more hospitals with TCFs can help to free up more hospital beds, it will take time to set this up and may not fully eradicate the problem of bed crunches, said experts.
“Think of the healthcare system as a sausage. In order to create more capacity in the hospital, you squeeze part of the sausage, pushing the meat – or patients – to the nursing home or community hospital part, and that will fill up rapidly,” said Assoc Prof Lim.
“But if the end of the sausage is still tied up – which means you cannot flow the patients out into a home setting – there’s no additional capacity, you just keep moving patients back and forth,” he added.
“Ultimately, the only resource that is infinite is the home setting and so we need figure out what needs to be done to enable people to go home,” he said, adding that this is a function of operational and technical support, as well as financing.
Sharing his experience as a house call doctor, Dr Lim said: “Having a good caregiver really makes a difference because I’ve seen those who are able to take care of the patient so well – whether it’s chronic wounds, diabetes management, medication or exercise or diet – such that the individual is so stable that they hardly get re-admitted to the hospital.
“Conversely, for the less-informed or trained caregivers, patients under their care often move in and out of the hospital because they don’t take their medication regularly or develop infections from their bed sores because their caregiver does not turn them regularly,” he added.
“If we can keep them in their home, we can also relieve the need for nursing homes. Because if the family cannot take care of them at home, the next step is to admit them into nursing homes, which are also facing bed crunches.”
CHANGING MINDSETS
Beyond improving home and community care, experts said addressing the perennial issue of hospital bed shortages also requires a mindset change.
Recent figures shared by Health Minister Ong revealed that non-urgent cases still make up about 40 per cent of emergency department attendances.
With the private sector accounting for the bulk of primary care providers, Dr Lim said many patients tend to rely on acute hospitals and emergency departments as their go-to for their ailments.
“Actually a lot of them could be treated at the primary care level,” said Dr Lim, estimating that 10 to 20 per cent of cases can be adequately managed by a primary care provider.
“If we have a much stronger primary care, it means they don’t need to go to the A&E and they can go to the 24-hour GP clinic and 24-hour urgent care clinics.”
With more than a dozen public acute and community hospitals located across the island, access to emergency departments has also greatly improved, he added.
“We are a small country which means some people might live very near to a hospital emergency department and it might be so convenient that if they aren’t well, they might just go to the A&E because it might actually be harder for them to find a 24-hour GP,” he said.
Ultimately, experts said everyone including the public needs to play their part in order to alleviate bed crunches in hospital.
“We still do not have that sense of solidarity where if the hospitals are full, we should step up,” said Assoc Prof Lim. “I have not come across many people who consider that someone else might need the hospital bed more than their family member and decide to take a week of leave to take care of them, instead of leaving them in the care of the hospital.
“It’s not that Singaporeans are selfish but we need to think about how to make it easier for people to see that hospital beds are a common resource and a public good for all of us.”
