Our nursing homes need embedded geriatric care

When families ask why their elderly loved one was sent to the hospital for the third time this month, the answer is often straightforward. The nursing home lacked on-site specialist support to manage complex geriatric conditions.

Hospital transfers are traumatic for frail elderly. They cause deconditioning, infections, and family distress. Yet nursing homes face an impossible choice when dementia crises, recurrent falls, or medication complications arise. With doctors out of the equation, GPs focusing on acute care, and specialists only available episodically, the default becomes "send to hospital."

This isn't the nursing homes' fault. They operate under immense pressure with limited resources and struggle to attract medical expertise. Staff work tirelessly to provide dignified care within tight constraints.

As a geriatrician servicing two nursing homes, I've seen this pattern repeatedly. Patients are sent to hospital not due to lack of care coordination, but lack of specialist intervention. A dementia patient in behavioral crisis that the GP cannot manage. A frail, dying patient whose family chooses hospital transfer despite advance care planning, because no specialist was available to help them truly understand the disease progression and address their medical concerns.

The solution isn't more hospital beds. It's embedding geriatric specialists directly in nursing homes, working alongside GPs to prevent unnecessary transfers.

Our partnerships with Jamiyah Nursing Home and Thye Hua Kwan demonstrate this works. When geriatricians are on-site regularly, nursing staff feel empowered to manage complex cases confidently. Hospital transfers drop significantly. Residents remain stable in familiar surroundings. Families gain peace of mind.

Singapore invests heavily in community care for healthy seniors. Our most vulnerable elderly, those already in nursing homes, deserve the same commitment to keeping them out of hospital.

For families choosing nursing homes, ask: Does this facility have regular access to geriatric specialists? Can the care team manage dementia crises on-site? Will my parent be sent to hospital unnecessarily?

For policymakers and operators, consider geriatric partnership models that provide proactive specialist support, not reactive emergency care.

Our elderly deserve specialist care where they live, not repeated ambulance rides to hospital.