Hidden Costs of Nursing Homes

Nursing homes are fast becoming a common choice to provide the elderly with readily available healthcare and assisted-living services. But there may be hidden costs that the uninitiated may not be familiar with. 

It is expected that between 2016 and 2030, Singapore’s population aged 65 years and over will increase from about 12% to about 20% by 2030. Population ageing is driven by a combination of increase in life expectancy and a rapid decline in the fertility rate.  With Singapore’s aging population on the rise, nursing homes have fast become a popular choice for providing seniors with readily available healthcare and assisted-living services. As caregivers, deciding to send our loved ones to a nursing home is not an easy or small decision to make. Indeed, there are many considerations that we may want to take into account before making our choice. Chief among these concerns are our financial situation and whether we can afford the costs of a nursing home. 

Here at Homage, we understand the anxiety that you may face in making such an important decision. We’ve thus prepared a handy guide for you to understand the hidden costs of nursing homes. Read on to find out more about the type of care nursing homes provide, how much nursing homes cost in Singapore, their hidden costs, and the different types of nursing homes in Singapore. 

What is a Nursing Home?

Nursing homes are facilities that provide long-term residential care and help to individuals who need assistance with most of their daily activities or have daily nursing needs. Nursing homes are an avenue for providing reliable and high quality care for our loved ones, when our home environments are not conducive to their nursing needs, or when we lack the capacity to do so adequately ourselves. Depending on each family’s specific needs and concerns, residents could either stay in a nursing home permanently, or temporarily in order for their nursing needs to be adequately satisfied.

Nursing homes are suitable for satisfying general healthcare needs that a resident may have. There are also specialised nursing homes with dedicated dementia and psychiatric facilities that cater to residents who need specific care and support. 

You can also tap on nursing homes for respite care if you require short-term care options for several days to a few weeks for your loved ones. This may include situations such as when your Foreign Domestic Worker returns home for  vacation, or for optimal recovery of a loved one’s temporary injury. 

Nursing homes can also provide night respite care for loved ones who exhibit sundowning behaviour, or a state of confusion that starts in the late afternoon and spans into the night. 

What Type of Care is Provided at Nursing Homes? 

Nursing homes in Singapore provide several types of care to residents. 

They include the following services: 

Help with Activities of Daily Living

Daily acts of living include using the toilet, showering, eating, or strolling.

Dementia and Psychiatric Facilities

Programmes and activities designed for cognitive stimulation are organised to help slow down the deterioration of mental faculties of residents. 

Night Respite

Night respite is an overnight respite option for caregivers of those who live with dementia and exhibit sundowning behaviour. This allows caregivers some time-off from night-time caregiving duties and provides relief to them. 

Nursing Care

This includes the management of wound care, nasogastric tube, urine catheters and other medical needs of residents.

Physical and Social Activities

This includes the organisation of group exercises, outings, games and other activities to provide residents with physical and social stimulation for healthy living alongside each other.

How Much Do Nursing Homes in Singapore Cost?

For the uninitiated, the cost of accomodation in a nursing home could seem deceptively low. After all, you’re just paying for a room, lodging, and medical care; surely that shouldn’t cost too much right?

Accommodation in a nursing home, however, just isn’t the same as simply renting a room or paying for a hotel stay.

Generally, the basic cost of nursing homes in Singapore can range from $S2000 to $3600 a month depending on the level of care required. This is before government subsidy which can itself range from 10% to 75%.  That’s already comparable to rent for an entire apartment in Singapore!

Hidden Costs to Consider

Beyond general cost, however, there are often other hidden costs that may catch the uninitiated unaware. Factors that determine such hidden cost can include:

Number of People per Bedroom

Depending on the level of privacy that your loved one wants or needs, you may consider getting a bedroom with less people. You may also feel that a smaller number of people per bedroom may allow for a higher level of dedicated care, or a higher staff-to-resident ratio. Depending on your preferences, this could lead to a higher cost than usual as you may have to opt for a more premium accommodation choice to satisfy your preferences.

Do take this into account as you make your decision. 

Level of Care Required

If your loved one requires dedicated care services, like wound care management, there may be extra costs incurred if additional care news to be provided outside of standard work hours. If your loved one has specialised care needs that require expert care services, that could also incur additional costs as well.

Amenities and Consumables

The facilities and amenities made available for residents to enjoy will also incur additional costs, these could include the costs of companionship, residential social and physical programmes. The needs of your loved one for consumables such as wound dressing may also be charged separately and result in additional costs.

Special or Emergency Needs

Special or emergency needs can also result in additional costs. These can include the cost of ambulance rides in the event of an injury such as a fall, or extra cost of medical equipment and resources for medical emergencies that occur.

One-Time Refundable Deposit

There may also be a one-time refundable deposit that you may find yourself having to fork out in securing nursing home accommodation for your loved one. While it is refundable, It can still be a significant sum to pay upfront and should be considered carefully as well.

Administrative Charges

Securing accommodation in a nursing home for your loved one can sometimes be a lengthy process due to processing, paperwork and approval seeking even when you find a suitable nursing home. You may find that administrative charges could be levied that add up significantly over time. 

Different Types of Nursing Homes in Singapore

Generally, there are two types of  nursing homes in Singapore: Private Nursing Homes and Voluntary Welfare Organisations (VWO) nursing homes.

As their names suggest, private nursing homes are run by accredited private companies on a profit model, while VWO nursing homes are run by non-profit organisations. The average cost of private nursing homes may thus be costlier than that of VWO nursing homes. 

Private and VWO nursing homes can be further differentiated according to whether they receive subsidies from the Ministry of Health (MOH). 

Private Nursing Homes Which Are Under MOH Portable Subsidy Scheme

Private nursing homes participating in the MOH portable subsidy scheme set aside a certain proportion of beds for patients who are eligible for MOH subsidies and are referred by the Agency for Integrated Care (AIC). If your loved one is admitted to an accredited private nursing home and meets the mean test criteria, they may thus have MOH subsidies extended to them. This expands private sector participation in the provision of MOH-subsidised care and allows more nursing home options for caregivers and their loved ones. 

Private Nursing Homes Which Are Not Under the MOH Portable Subsidy Scheme

Private nursing homes which are not under the MOH portable subsidy scheme cater to full-paying patients, with no government subsidies available to them.

VWO Nursing Homes Receiving MOH Subsidies

If your loved one meets means test criteria, they can be referred by AIC to VWO nursing homes which receive MOH subsidies. If you and your loved one require further financial and social assistance, the VWO running the nursing home may also offer additional support. 

VWO Nursing Homes That Do Not Receive MOH Subsidies

Some VWO nursing homes are able to raise enough funds through their own fund-raising efforts and thus do not receive MOH subsidies. If your loved one is admitted to such a VWO nursing home, they will not receive MOH subsidies. The VWOs operating such nursing home are, however,  able to provide necessary financial and social assistance to those who may lack the means to afford the nursing home fees.

Subsidies and Grants Available – Nursing Homes vs Home Care

Given the relatively significant costs of nursing home accommodation and care, you may want to consider alternatives such as home care. To help you make an informed decision, here are some subsidies and grants available for both nursing homes and home care that you may wish to consider.

Subsidies and Grants for Nursing Homes

Government subsidies for nursing homes in Singapore are covered by the subsidy scheme for Government-Funded Intermediate Long-Term Care (ILTC)  Services.

Under the scheme, subsidies for patients in ILTC residential services, which includes nursing homes, can be found in the following table:

Do note that patients with no income will enjoy a full subsidy rate—75% for Singapore Citizens and 50% for Permanent Residents—unless they live in a property with Annual Value exceeding $13000. Such patients will instead receive a subsidy at 20% for Singapore Citizens and 10% for Permanent Residents.

Who is Eligible?

To be eligible for the nursing home subsidy, you must be:

• A Singapore Citizen or Permanent Resident
• Meet admission criteria 
• Already be receiving care from an MOH-funded service provider

Subsidies and Grants for Home Care

Subsidies and Grants for home care come in different forms. Here are some of them.

Enhancement for Active Seniors (EASE)

Introduced in 2012 by the Housing and Development Board, the EASE programme subsidies home modifications so that older residents can live at ease in their own homes, making home care easier. 

Under the scheme, you can install in your home: 

• Slip-resistant treatment to floor tiles in up to 2 bathrooms or toilets
• Grab bars in the flat—8 or 10 grab bars for the first toilet, and 6 grab bars for the second toilet
• Up to five ramps in the flat, and/or at the main entrance – if possible

Who is Eligible? 

To be eligible for EASE, you must be either: 

• A Singaporean flat owner living with a family member who is 65 years and older.
• A Singaporean flat owner with at least one household member aged between 60 and 64 who needs help with one or  more Activities of Daily Living such as washing, dressing, feeding, toileting, mobility, or transferring.

Caregivers Training Grant

The Caregivers Training Grant is a $200 annual subsidy that allows caregivers to attend approved courses to learn to provide better care for their loved ones. The $200 subsidy is provided for each care recipient every financial year, from April to March. Multiple caregivers of the same care recipient need to share the $200. Courses could be conducted in your home, or in a classroom at a training centre. You can also use a computer or other electronic devices to learn, by watching videos and reading training materials.

Foreign Domestic Worker (FDW) Levy Concession for Aged Persons and Persons with Disabilities

The FDW Levy Concession supports households who need to hire a FDW to care for seniors or persons with disabilities. A lower concessionary FDW levy of only  $60 a month is required for eligible households. 

Who is Eligible?

You are eligible for the FDW levy in the following circumstances.

If care recipient is Singapore Citizen (SC):

1.  Care recipient, FDW employer and FDW must reside in the same address; and
2. Care recipient must always require some assistance with at least 1 ADL or Care recipient is at least 67 years old*

*Seniors who meet the age, citizenship, and residential eligibility criteria do not need to apply for FDW Levy Concession as MOM will process the levy concession automatically with the FDW application.

If care recipient is Singapore Permanent Resident (PR):

1. Care recipient is at least 67 years old, and is the parent, parent-in-law, grandparent, or grandparent-in-law of the FDW employer;
2. The FDW employer or FDW employer’s spouse must be SC; and
3. Care recipient, FDW employer and FDW must reside in the same address

You can find out more about subsidies and grants available to caregivers here. 

Home Care Solutions as an Alternative to Nursing Homes

It is natural for some of us to find the costs of nursing homes to be prohibitive given how significant and hidden some of them can be.

You may then want to consider home care solutions as an alternative to nursing homes. Homage offers such home care services at affordable prices on demand, without a need to commit upfront to high costs. Homage home care services include:

• Daily Living Care from $21/hour
• Nursing Care from $24/hour
• Home Therapy from $180/hour

Hopefully with this guide, you’re more ready to make an informed decision about your loved ones’ care needs. If you need further tailored support in choosing a nursing home for your loved one or you would like to explore home care solutions as an alternative, our Homage Care Advisors and Specialists are here to help. 

Fill up the form below for a free consultation with our Care Advisory team.