SINGAPORE – About 300 nursing home residents ended up in the emergency department less and reduced their hospital stays as well, after taking part in a pilot programme by Woodlands Hospital (WH).
The secret to its success – having specialist geriatric care within the home so that potential problems can be nipped in the bud.
As a result, unplanned hospitalisations and emergency department visits both decreased by about one-third.
The outcomes have been so positive that the hospital is looking at expanding the programme to other nursing homes in the area to benefit more seniors, beyond those at Ren Ci @ Woodlands.
Under the THRIVE, or Transforming Health and Resilience In Vulnerable Elders, programme, seniors receive specialist geriatric care directly at the nursing home.
Before the home opened in 2024, clinical teams from WH and Ren Ci formed a workgroup with about 12 core members. Weekly meetings were held to discuss the collaboration and, later on, management of individual cases.
Ren Ci’s team would consolidate and present relevant health information of each resident to the WH team for case review and to discuss ways to effectively manage issues and complex health needs.
For instance, some residents could have behavioural issues such as agitation or sleep problems arising from dementia or delirium – a condition in which patients are confused, disoriented and cannot think or remember clearly.
Nursing home staff were educated and trained on how to better manage cases, and are now able to better tease out the reasons behind behavioural issues. They also have better skills to manage a situation by diverting a resident’s focus with different activities, said Ren Ci @ Woodlands assistant nurse clinician Anushiya Rajendran.
Learning to recognise early signs helps avoid issues worsening, said Sharen Lim, WH’s geriatric medicine consultant driving the THRIVE programme.
Ways in which specialist geriatric care can benefit nursing home residents
Other review areas included the medication regime and outpatient appointments, with the goal of reducing unnecessary medication or appointments wherever appropriate.
For instance, a resident might have appointments across different hospitals, but these could either be discontinued after an assessment by the geriatrician, or transferred to WH, which would be much more convenient for the residents because of the shorter travel time, said Lim.
Anushiya pointed out that outpatient appointments for routine blood tests or tests for diabetes can also be conducted directly at the nursing home.
The WH team said nursing home residents may face frequent hospitalisations, especially those with underlying frailty, multiple co-morbidities, cognitive impairment and conditions that require physical assistance.
Such health issues, if not well managed due to insufficient coordination among multiple providers, could lead to complications and result in hospitalisation.
Avoiding hospital visits and transfers means the seniors can receive care in more familiar surroundings, avoiding the confusion, stress and functional decline that frail seniors might experience, said WH.
Family members and caregivers also benefited as fewer trips to hospital meant less time needed off work, lower transport costs and reduced caregiver burden.
Sharen Lim (right) is the geriatric medicine consultant from Woodlands Hospital driving the THRIVE programme, where she partners staff from Ren Ci @ Woodlands nursing home, including assistant nurse clinician Anushiya Rajendran, to provide specialist geriatric care for residents.
ST PHOTO: BRIAN TEO
The pilot was held at Ren Ci from April 2024 to April 2025 and benefited about 300 residents, most of whom were frail and had cognitive difficulties such as dementia.
Unplanned hospitalisations and unplanned emergency department visits both decreased by about a third. More than 60 per cent of them had no unplanned hospitalisation.
For visits to the emergency department, the rate used to be 6.2 visits for every 1,000 days that residents spent in the nursing home’s care. This dropped to 4.4 visits with the THRIVE programme.
For unplanned hospital stays, the rate dropped from 4.3 admissions to 2.9 admissions for every 1,000 days that residents spent in the nursing home’s care.
(From left) Anushiya Rajendran, assistant nurse clinician, Ren Ci @ Woodlands; Sharen Lim, geriatric medicine consultant, Woodlands Hospital; De Sagun Dennis Hernandez, resident physician, Ren Ci @ Woodlands; Neduri Neelima, staff nurse, Ren Ci @ Woodlands; and Aring Abigail Domingo, staff nurse, Ren Ci @ Woodlands at the nursing home on June 24.
ST PHOTO: BRIAN TEO
During the pilot phase, THRIVE was funded by WH and was provided at no cost to Ren Ci.
Ren Ci started paying WH a fixed monthly fee for the service from April 2026, although its residents under the programme continued to receive the service free.
There are currently three standalone nursing homes in Woodlands – Vanguard Healthcare’s Woodlands Care Home, Man Fut Tong Nursing Home, and Orange Valley Nursing Home (Marsiling).
“We have not firmed up the plans, but we are definitely going to expand the programme in the Woodlands area”, said Lim.
