Healthcare Services (Nursing Home Service) Regulations 2023

a medical practitioner who satisfies the requirements in paragraph (2); or

a registered nurse who satisfies the requirements in paragraph (3).

must be registered under section 20(1) or (2) of the Medical Registration Act 1997 as a fully registered medical practitioner and hold a valid practising certificate under that Act; and

must have one of the following:

registration under section 22 of the Medical Registration Act 1997 as a specialist in any branch of medicine;

registration under section 22A of the Medical Registration Act 1997 as a family physician in the Register of Family Physicians;

full‑time work experience as a medical practitioner for a continuous period of at least 5 years or an aggregate period of at least 5 years during a continuous period of 10 years, in treating patients —

in the provision of an outpatient medical service, outpatient renal dialysis service, acute hospital service or community hospital service provided in a private hospital, medical clinic or healthcare establishment (as the case may be) licensed under the repealed Act; or

in the provision of an outpatient medical service, outpatient renal dialysis service, acute hospital service or community hospital service licensed under the Act.

must not be subject to any condition imposed on his or her registration by the Singapore Nursing Board under section 17(2) of the Nurses and Midwives Act 1999;

must either —

hold a degree in nursing that is recognised by the Singapore Nursing Board; or

have obtained a qualification in any area of clinical nursing that is conferred by an institute of higher learning approved by the Director‑General, after he or she becomes a registered nurse; and

must have full-time work experience —

in providing nursing care; and

in a nursing supervisory function in respect of the provision of a nursing care,at any inpatient ward of a hospital or nursing home, whether in or outside Singapore, for a continuous period of at least 5 years immediately before the registered nurse’s appointment as a Clinical Governance Officer.

is registered under section 20(1) or (2) of the Medical Registration Act 1997 as a fully registered medical practitioner and holds a valid practising certificate under that Act;

is a palliative medicine specialist; and

has full‑time work experience as a medical practitioner for a continuous period of at least 5 years or an aggregate period of at least 5 years during a continuous period of 10 years, in treating patients —

in a private hospital, medical clinic or healthcare establishment (as the case may be) licensed under the repealed Act; or

in the provision of a healthcare service licensed under the Act,where at least 3 years of the full-time work experience is in treating patients requiring palliative care, as a palliative medicine specialist.

is a registered nurse;

either —

holds a degree in nursing that is recognised by the Singapore Nursing Board; or

has obtained a qualification in any area of clinical nursing that is conferred by an institute of higher learning approved by the Director‑General, after he or she becomes a registered nurse; and

has full-time work experience —

in providing nursing care; and

in a nursing supervisory function in respect of the provision of nursing care,at any inpatient ward of a hospital or nursing home, whether in or outside Singapore, for an aggregate period of at least 5 years.

supervising the provision of a nursing service to patients at the approved permanent premises;

overseeing the induction, training and development of every nursing personnel;

supervising the work processes, conduct and activities of the licensee’s nursing personnel in providing a nursing service;

supervising the deployment of nursing personnel at the approved permanent premises so as to ensure the assignment of a suitable nurse who possesses the appropriate qualifications, experience, competency and skills, to provide nursing care to a patient, taking into account the patient’s medical needs and condition;

assisting the licensee in —

establishing, implementing and regularly reviewing written policies and procedures to provide guidance for the provision of any nursing service;

ensuring that the provision of any nursing service at the approved permanent premises is in accordance with those policies and procedures and the approved standards of nursing practice; and

conducting any audit of the provision of the nursing home service at the approved permanent premises so as to evaluate and monitor the quality of the nursing service provided by the licensee to patients;

ensuring that in providing a nursing service to any patient at the approved permanent premises, the licensee complies with the IPC programme.

the emergency power and lighting are sufficient to ensure —

any procedure that has commenced may be safely completed; and

at all times, the approved permanent premises is sufficiently lit to ensure —

the safe movement of patients into, out of or within the approved permanent premises; and

the timely and safe access to fire‑fighting equipment; and

where any life support equipment is used, the life support equipment is connected to an emergency power supply at all times during its use.

there is sufficient space at the approved permanent premises to accommodate the bed; and

there is sufficient personnel at the approved permanent premises to provide care and treatment to all the patients at the approved permanent premises after the patient capacity is increased due to the addition of the bed at the approved permanent premises.

employ or engage a pharmacist to perform regular medication reconciliation for every patient, and provide the findings of every medical reconciliation and his or her recommendation (if any) based on the findings of the medical reconciliation to the licensee;

ensure that every recommendation of the pharmacist mentioned in sub-paragraph (a) is implemented or (if a recommendation is not implemented) the licensee’s reason for not implementing the recommendation is recorded; and

ensure the safety, wellbeing and comfort, and protect the privacy, of every patient receiving care or treatment at any approved permanent premises.

every patient (other than a hospice patient) is assigned an attending medical practitioner who has overall responsibility for the patient’s health;

where the licensee is approved to provide a hospice service, every hospice patient is assigned a palliative medicine specialist who has overall responsibility for the patient’s health;

every patient is assigned an attending registered nurse who has overall responsibility for the patient’s nursing needs; and

a registered nurse is on call for the purpose of providing support to any nursing personnel present at the approved permanent premises.

every patient as to whether the patient requires any dental care, treatment or procedure; and

if the patient so requires any dental care, treatment or procedure, the patient’s suitability to receive the dental care, treatment or procedure.

at premises other than any approved permanent premises; or

at any approved permanent premises, if the outpatient dental service licensee is approved under section 11B of the Act to provide an outpatient dental service at any premises other than permanent premises.

obtain from the outpatient dental service licensee the following information in writing:

a description of the dental condition of the patient;

the dental care, treatment or procedure provided to the patient;

any medication that is administered or prescribed for the patient; and

ensure that the information mentioned in sub-paragraph (a) is kept as part of the patient’s patient health record that is kept and maintained by the licensee.

provide the dietetic service to the patient at the licensee’s approved permanent premises; or

make arrangements for a dietitian (who is not the licensee’s personnel) to provide the dietetic service to the patient at premises other than the approved permanent premises.

if the patient suffers from an unintended loss of 5% or more of his or her body weight over a period of 3 months;

if the patient suffers from a poor intake of food; or

where a medical practitioner or registered nurse has recommended for the patient to be so assessed.

provide the psychosocial support to the patient at the licensee’s approved permanent premises; and

ensure that the licensee’s personnel who assists the licensee in providing the psychosocial support to the patient —

satisfies the conditions in paragraph (2); or

is supervised by another personnel of the licensee who satisfies the conditions in paragraph (2).

is an employee of the licensee;

holds a degree or graduate diploma in social work or a degree in clinical psychology; and

has full-time work experience in providing psychosocial support to patients for an aggregate period of at least 3 years —

in a private hospital, medical clinic or healthcare establishment (as the case may be) licensed under the repealed Act; or

in the provision of a licensable healthcare service.

in lieu of complying with paragraph (1), make arrangements for the patient to receive the psychosocial support at premises other than the licensee’s approved permanent premises from an individual (not being the licensee’s personnel) who —

is trained and qualified to provide the psychosocial support, and holds a degree or graduate diploma in social work or a degree in clinical psychology; or

provides the psychosocial support to the patient under the supervision of another individual who is trained and qualified to provide the psychosocial support, and holds a degree or graduate diploma in social work or a degree in clinical psychology; or

in lieu of complying with paragraph (1)(b), ensure that the licensee’s personnel who assists the licensee in providing the psychosocial support to the patient —

is trained and qualified to provide the psychosocial support, and holds a degree or graduate diploma in social work or a degree in clinical psychology; or

is supervised by another personnel of the licensee who is trained and qualified to provide the psychosocial support, and holds a degree or graduate diploma in social work or a degree in clinical psychology.

provide the rehabilitative service to the patient at the licensee’s approved permanent premises; or

make arrangements for an allied health professional (who is trained in rehabilitation but is not the licensee’s personnel) to provide that rehabilitative service to the patient at premises other than the licensee’s approved permanent premises.

a rehabilitative plan, that has been approved or endorsed by a duly qualified allied health professional for that service, is proposed and communicated to the patient or (if the patient is a minor or lacks mental capacity) a next‑of‑kin or carer of the patient; and

the rehabilitative service is provided by a personnel who is trained in rehabilitation, and in accordance with the rehabilitative plan.

cause the patient’s rehabilitative needs to be reassessed by an allied health professional who is trained in rehabilitation; or

make arrangements for an allied health professional (who is trained in rehabilitation but is not the licensee’s personnel) to reassess the patient’s rehabilitative needs at premises other than the licensee’s approved permanent premises.

it is a minor surgical procedure;

the minor surgical procedure is ordered by a medical practitioner who is the licensee’s personnel; and

the minor surgical procedure is conducted on the patient by a healthcare professional who is trained and qualified to conduct the minor surgical procedure.

an endoscopic procedure on a patient;

a clinical procedure or an invasive procedure that penetrates beyond the epidermis layer of the patient’s skin that changes or is intended to change the patient’s appearance or anatomy.

ensure that adequate and appropriate facilities, equipment and drugs for the provision of any essential life‑saving measure to a patient are readily available at every approved permanent premises; and

at all times, be capable of providing any specified essential life‑saving measures to any patient who is at risk of death.

that only resuscitation drugs that have not passed their expiry dates and are fit for use and resuscitation equipment that is fit for use are made available for use in the provision of any essential life‑saving measure;

the establishment and implementation of protocols for the rapid and accurate assessment of any patient who is in need of essential life‑saving measures;

that every personnel who provides any essential life‑saving measure to a patient is adequately trained —

to provide the essential life‑saving measure in a proper, effective and safe manner; and

in the use of the equipment that is needed to deliver the essential life‑saving measure.

cardiopulmonary resuscitation;

the use of automated external defibrillator on a patient who is experiencing cardiac arrest;

heimlich maneuver.

establish an infection prevention and control programme (called in these Regulations the IPC programme) that satisfies the conditions mentioned in paragraph (2);

appoint an infection prevention and control committee to assist the licensee in establishing, implementing and regularly reviewing the IPC programme;

ensure that the infection prevention and control committee comprises the appropriate number of personnel with the appropriate qualifications, skills and competencies for the purpose of carrying out the licensee’s functions mentioned in sub‑paragraph (b);

appoint as the lead person of the infection prevention and control committee, an individual who is employed by the licensee;

ensure that the lead person of the infection prevention and control committee completes such course or programme relating to the prevention or control of infection in a nursing home, and within such time period, as may be specified by the Director‑General;

keep proper and accurate records of —

the implementation of the IPC programme; and

every infection prevention and control activity carried out at the approved permanent premises;

ensure that only equipment, material or articles that are reprocessed or sterilised through high‑level disinfection or sterilisation in accordance with the specifications by the manufacturer of the equipment, material or articles (as the case may be) and are not subsequently contaminated, are used in any minor surgical procedure on a patient;

ensure that every equipment, material or article that is used in every minor surgical procedure is —

reprocessed or sterilised through high‑level disinfection or sterilisation in accordance with the specifications by the manufacturer of the equipment, material or article, as the case may be; and

kept and stored under the appropriate conditions to ensure that the equipment, material or article remains fit for use until it is used in the next minor surgical procedure;

ensure that every equipment that is used to reprocess or sterilise any other equipment, material or article is checked regularly and maintained properly in accordance with the specifications by the manufacturer of the equipment, so as to ensure its proper and effective operation; and

establish, implement and regularly review a security system to minimise the risk of an abscondment of a patient who is suffering from an infectious disease specified in the First Schedule to the Infectious Diseases Act 1976.

standard operating procedures relating to the infection prevention and control of any infection at the licensee’s approved permanent premises;

policies and guidelines relating to the prevention, identification, control and management and elimination of any infection that is acquired in or brought into the licensee’s approved permanent premises, including the practice of good hand hygiene and in the use of personal protective equipment;

policies and the appropriate processes for the training and competency assessment of the licensee’s personnel to ensure that the personnel are familiar with and are able to comply with the matters mentioned in sub‑paragraphs (a) and (b);

surveillance plans to monitor every incident at the licensee’s approved permanent premises that involves an epidemiologically important organism or an infection that is acquired at the approved permanent premises;

plans to carry out regular audits on the personnel, patients and environment of the licensee’s approved permanent premises to ensure that the IPC programme is being implemented effectively.

an emergency at every approved permanent premises;

a medical emergency in Singapore.

establish and equip an operationally‑ready emergency response team to manage an emergency mentioned in that paragraph;

establish, implement and annually review processes and procedures to control and manage an emergency, including any radiation emergency or incident;

with respect to a radiation emergency or incident, establish, implement and regularly review processes and procedures to prevent, identify, control and manage any radiation emergency or incident, including strategies to isolate every area or patient who is affected by radiation, setting up isolation facilities for every affected patient, and the use of equipment to prevent, control and manage the spread of radiation;

train every personnel who is deployed to the emergency response team in the processes and procedures mentioned in sub‑paragraph (b); and

participate in any exercise specified by the Director‑General that is for the purpose of evaluating the emergency preparedness and response capabilities of the healthcare system in Singapore.

the qualifications and competencies (including training and competency assessments) of each personnel, that are relevant to the provision of the nursing home service;

every programme, policy, system, measure, protocol or process that the licensee is required to implement under these Regulations, and every activity undertaken under that programme, policy, system, measure, protocol or process;

the installation, maintenance, servicing and repair of all equipment used in the provision of the nursing home service;

the findings of every medication reconciliation performed by a pharmacist for every patient (as mentioned in regulation 16(2)(a)), and the pharmacist’s recommendation (if any) based on the finding of the medication reconciliation;

the licensee’s reasons recorded under regulation 16(2)(b) for not implementing a pharmacist’s recommendation mentioned in regulation 16(2)(a).

represent to any person or give any person the impression that the licensee is an approved institution; or

otherwise mislead any person as to whether the licensee is an approved institution.

an approved medical institution within the meaning of regulation 2(1) of the Central Provident Fund (Medisave Account Withdrawals) Regulations (Rg 17);

an approved medical institution approved by the Minister under the MediShield Life Scheme Act 2015;

an accredited medical institution under any public scheme providing financial assistance that is established by the Government.

the estimated price range of the fees for the care, treatment or procedure;

the fee benchmark for the same or similar care, treatment or procedure that is published on the website of the Ministry of Health at https://www.moh.gov.sg (if available);

whether any part of the fees mentioned in sub‑paragraph (a) may be —

deducted from any medisave account;

reimbursed under the MediShield Life Scheme; or

reduced by any subsidy or grant under a public scheme; and

any other benefit that the MediShield Life Scheme provides to the patient in respect of the care, treatment or procedure, if any.

the fees that is currently charged for the care or treatment and the new fees that will be charged for the care or treatment;

the fee benchmark for the same or similar care or treatment that is published on the website of the Ministry of Health at https://www.moh.gov.sg (if available);

whether any part of the new fees mentioned in sub‑paragraph (a) may be —

deducted from any medisave account;

reimbursed under the MediShield Life Scheme; or

reduced by any subsidy or grant under a public scheme; and

any other benefit that the MediShield Life Scheme provides to the patient in respect of the care or treatment, if any.

to a fine not exceeding $20,000 or to imprisonment for a term not exceeding 12 months or to both; and

in the case of a continuing offence, to a further fine not exceeding $1,000 for every day or part of a day during which the offence continues after conviction.