A letter to the editor of the Journal of the American Geriatrics Society by Li Feng Tan and Santhosh Seetharaman, published on the 26th of March.

Tan and Seetharaman report that, at the time of writing there had not yet been any case of transmission in nursing homes in Singapore. The letter outlines some of the measures taken in Singapore to reduce the risk of infections in all healthcare settings (including nursing homes).

Measures to reduce risk of infections:

• restricting visits to institutions
• pre-screening of all vistors
• reduction in unnecessary transfers of residents

Management of admissions of nursing home residents to hospitals:

• Nursing homes refer all patients with fever and respiratory symptoms to acute hospitals in order to rule out COVID-19.
• All nursing home residents admitted to hospital are isolated in a negative pressure room and tested once for COVID-19 if clinical suspicion is low
• If there is significant concern, they may be subjected to a repeat swab prior to transfer to a general ward.
• Nursing homes request letters from hospitals to certify that returning residents do not have COVID-19.

Impact of isolation on nursing home residents:

• Fall rates in isolation facilities are much higher than in general wards
• Providing suitable care to people who have dementia or are experiencing delirium or distress is challenging in isolation facilities
• The requirement for staff to war full personal protection equipment (PPE) makes responding to residents experiencing distress more challenging.

The article also mentions the use of a robot to minimise patient contact, but recognises the limitations of the use of technology for this purpose.