Windsor, LC closures expose pressures on smaller nursing homes, but experts say lapses go beyond money
The closures have revived calls for greater transparency over nursing home quality, although experts are divided on how much information authorities should publish.
The licence revocations of Windsor Convalescent Home (left) and LC Nursing Home (right) have exposed longstanding challenges facing smaller nursing home operators. (Images: Google Street View, Instagram/LC Nursing Home)
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SINGAPORE: The licence revocations of Windsor Convalescent Home and LC Nursing Home have exposed longstanding pressures facing smaller nursing home operators, from manpower shortages to rising costs, according to experts and operators CNA spoke to.
However, they said these structural challenges cannot excuse the serious lapses in governance and care that led to the two homes being shut down.
Associate Professor Wee Shiou Liang, a gerontologist from the Singapore University of Social Sciences’ (SUSS) S R Nathan School of Human Development, said the two homes’ relatively small size may have left them at a disadvantage.
“These are two small nursing homes that lack the economies of scale larger operators enjoy, and that have struggled to meet basic care standards,” he said.
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Still, he cautioned against viewing the closures as evidence of widespread failings across the sector.
“There is no evidence that the problems are systemic, and I would hope they are isolated,” he said.
Instead, he said the two cases reflected different shortcomings: lapses at LC Nursing Home persisted despite repeated audits and a remediation window, pointing to organisational incapacity, while Windsor Convalescent Home suffered failures in clinical governance and leadership oversight.
The Ministry of Health (MOH) has said it intends to share the findings of its audit with the sector and work with the Agency for Integrated Care to strengthen support, including training to help nursing homes meet required standards.
As of 2024, Singapore had 88 nursing homes, comprising 35 public, 30 private and 23 not-for-profit operators. CNA has contacted MOH for more recent figures and for the number of small nursing homes.
LIMITED RESOURCES, MANPOWER CRUNCH
Those pressures are familiar to smaller operators like Ms Irene Ong, who runs Irene Nursing Home at Jalan Ampas and Serene Nursing Home in Joo Chiat.
Her two homes, with a combined capacity of just over 100 beds, operate from retrofitted buildings rather than purpose-built facilities. Besides overseeing operations, she conducts daily ward rounds, trains staff and personally checks clinical work.
“We don’t have much resources, and don’t have as much manpower so we have to multitask,” she said.
Like many operators, she relies heavily on foreign workers, many of whom leave after completing their contracts, forcing homes to continually recruit and train replacements.
She also spent about S$400,000 upgrading facilities at Serene Nursing Home to meet regulatory requirements.
“I wouldn’t say it’s difficult to comply with regulations, but it can be challenging at times,” she said. “We should try to do it for the safety of the patient.”
Her experience reflects the broader pressures smaller nursing homes face in balancing affordability, staffing and regulatory compliance, said experts CNA spoke to.
“Nursing home care here is funded through a mix of means-tested government subsidy, MediFund and out-of-pocket payment, and the sector has expanded capacity substantially over the past decade,” said Assoc Prof Wee. “But manpower is the largest cost and it continues to rise.”
Unlike larger operators, smaller homes often struggle to spread fixed costs such as clinical governance, staff training and quality management systems across a larger resident base, making the “affordability-quality squeeze” particularly acute, he said.
“But financial pressure is an explanation, not an excuse. The failures at these two homes were about governance and basic capability, which money alone does not fix.”
Associate Professor Kelvin Tan, head of the Minor in Applied Ageing Studies programme at SUSS, said workforce shortages remain one of the sector’s biggest structural challenges.
“Nursing homes in ageing countries face challenges in finding headcounts to run their operations, they are competing within their sector – whether its private or public – as well as with other sectors,” he said, adding that foreign workers also need to be recruited and trained.
He also pointed to financial pressures facing providers, with many non-profit nursing homes relying on donations to supplement government funding, while private operators typically serve residents who can pay higher fees.
Dr Mok Ying Jang, chief executive of Kwong Wai Shiu Hospital, said staffing remains one of the biggest operational challenges for nursing homes, which rely heavily on foreign nurses and care staff who need time to adapt to the local language, culture and clinical practices.
Rising manpower costs have also affected the financial sustainability of operators, while some families continue to struggle with nursing home fees despite means-tested subsidies, he said.
Families whose incomes exceed subsidy thresholds may opt for lower-cost homes instead of larger operators that generally follow MOH and Agency for Integrated Care fee guidelines, he added.
For charitable operators such as Kwong Wai Shiu Hospital, long-term financial sustainability remains a concern as fundraising is needed to cover operating deficits, Dr Mok said.
SHOULD NURSING HOME RATINGS BE PUBLISHED?
The recent enforcement actions have also revived calls for greater transparency over nursing home quality, with experts divided not over whether families deserve more information, but over how it should be presented.
Unlike countries such as the United States and Australia, Singapore does not publicly rate individual nursing homes based on care quality or inspection outcomes.
MOH previously told CNA that audit findings are shared directly with the licensee, which is responsible for implementing the necessary rectifications promptly and effectively to ensure resident safety.
Because audit findings may result in regulatory proceedings governed by statutory procedure, MOH does not inform residents and their families before any regulatory action is confirmed, it added.
However, Assoc Prof Tan believes greater transparency could strengthen governance and encourage improvements across the sector.
“There is no reason for us to be too conservative,” he said, adding that publishing inspection findings could encourage more professionals to contribute to the sector while helping donors identify homes that need support.
In the United States, nursing homes participating in Medicare or Medicaid receive public five-star ratings based on health inspections, staffing and quality measures. Australia similarly publishes star ratings based on residents’ experience, compliance with quality standards, staffing and care indicators.
Assoc Prof Wee agreed that greater transparency could help families make more informed choices, but cautioned that poorly designed rating systems could encourage operators to chase inspection scores rather than improve residents’ well-being.
“A single audit is a snapshot, and homes differ enormously in the acuity and frailty of the residents they take on. Without case-mix adjustment, raw audit results can mislead, and could even penalise homes that do the harder work of caring for sicker residents,” he said.
Publishing routine audit results also risks pushing operators towards caring for the audit rather than the resident, with “defensive, risk-averse practice” and compliance for show rather than genuine improvement, he added.
Instead, he said, any future reporting framework should measure residents’ quality of life and lived experience alongside compliance with regulatory standards.
Source: CNA/vl(cy)
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