Growing old: Should you be worried?

This post came out from The Straits Times (6 November 2016)

By 2030, one in every three people here is projected to need some form of eldercare service. Against the current backdrop of different settings in which to grow old, Insight looks at what is being done to care for the seniors of the future, and whether those moves are fast enough to meet demand.

BEST PLACE TO GROW OLD IN?

Singapore is one of the fastest ageing societies in the world: by 2030, one in four people, or more than 900,000 people, will be aged 65 and above, double the number now. Ageing is the single most important demographic shift that will affect the future of Singapore, Senior Minister of State for Health Amy Khor said earlier this year when launching a $3 billion Action Plan for Successful Ageing. The plan's 70 initiatives to help the elderly lead healthy and active lives include a review of the financing system for long-term care, raising the re-employment age and building more centres where seniors can get physiotherapy or take part in activities.

Health Minister and chairman of the Ministerial Committee on Ageing Gan Kim Yong said when initial details of the national plan were released last year: "We need to plan ahead to ensure that Singaporeans need not worry about getting old, but instead embrace new opportunities that come with longevity. We want Singapore to be the best place for Singaporeans to grow old in, and a model for successful ageing."

Yet a recent survey of 1,000 Singaporeans, commissioned by NTUC Income and the Lien Foundation, found that eight in 10 Singaporeans are worried about growing old. Topping their worries is whether they will be able to look after themselves. Financial concerns such as running out of savings comes next. This is even as the traditional Asian approach of caring for aged parents at home is still the "retirement plan" for most. However, the best-laid plans can fail when the elderly need round-the-clock specialised care for illness. Some people also do not have family members to rely on or cannot afford a maid.

Last month, Mr Gan said Singapore will need to make "deep and fundamental changes" to the way care is delivered to seniors, as the country ages and more of its citizens suffer chronic ailments. The Government's focus has been shifting from hospitals to the community - such as polyclinics, nursing homes and daycare facilities - to let the elderly be cared for at home and in familiar neighbourhoods.

There has been much discussion of ageing issues over the past 20 years, and from the early 2000s, MOH has been investing heavily in expanding home-based care services. But are there adequate community resources to ensure the elderly can keep living at home? Despite the years of discussion, long- term private and public residential care options for the elderly are limited. For many frail elderly people who live with family without the necessary time or nursing expertise, or for those living alone who are unable hire a full-time helper, nursing homes remain their main option.

LONG-TERM CARE: ENOUGH BEDS?

In barely three years, there will be 610,000 people in the above-65 age group, but a projected capacity of only 6,200 centre-based daycare and 10,000 home-based care services. As of last year, Singapore had 26.1 nursing home beds per 1,000 people aged 65 and above - the lowest proportion in 15 years - and well below the OECD average of 45.2 beds. To put that in perspective, though, researcher Radha Basu notes in her 130-page report on the state of nursing homes here: "With fewer beds than many advanced countries and relatively stronger family networks, it is no surprise that Singapore has very few older folks in nursing homes." But she cautions: "As families shrink in size, Singapore will need more long-term care options."

In countries like the US, Australia and Finland, about 5 per cent of the elderly population live in some form of residential aged care facility such as nursing homes or assisted living. Going by this, about 50,000 seniors in Singapore will need such facilities by 2030. But there are only about 12,000 beds in nursing homes. This means that even if 95 per cent of the elderly live and die at home, Singapore may need nearly 50,000 alternative senior living options by 2030, says Ms Basu.

When The Sunday Times asked MOH how it comes up with its planning targets for services and facilities for the elderly and why they were not ramped up more and earlier, a spokesman said the demand for aged care services is projected based on a combination of factors. She explained: "Beyond the population of seniors, we also factor in the incidence of disability, the level of disability and utilisation rate. "As the needs and circumstances of seniors and their caregivers are different, we have to plan for a diverse range of options to meet the needs. "Needs are also not static. In tandem with changing social trends, utilisation of different options will change and so we will conduct regular reviews of our projections and adjust our development plans."

For those who do not need intensive nursing care but are too frail to age in place at home, there is the option of assisted living, which is common in countries such as Australia, Britain and the US. They provide a more home-like environment, such as private rooms, for more independent seniors who need help with personal care. There are few such standalone facilities here, though the Government says the assisted living concept can take the form of people continuing to live in their own HDB flats but having access to aged care services in their neighbourhoods.

NO ONE-SIZE SOLUTION

It is clear that the more than 900,000 seniors by 2030 will have different needs, financial capabilities and expectations which no single player or model can possibly cater to. A wider range of options will be called for.

The authorities acknowledge the challenges that lie ahead. "We agree that we should seek to enhance the diversity of aged care options and we welcome more ideas to help our seniors age well in place," says the MOH spokesman. "We hope we can see new and exciting models emerging to meet our seniors' needs, that are uniquely Singapore."

Thoughts anyone?

Yours,

Something Small Thinking Big

First private firm to join govt care scheme

This post came out from The Straits Times (9 December 2016)

The first private sector firm has come on board a government scheme to help seniors make an easier transition between hospital and home. Active Global Specialised Caregivers, a 31/2-year-old local company, will start caring for people under the Health Ministry's interim caregiver service from next month.

Its rates, said founder Yorelle Kalika, will be comparable to those charged by the existing providers, which are either voluntary welfare organisations or social enterprises. For instance, Ms Kalika said, Active Global will charge subsidised patients $110 per caregiving shift. In comparison, social enterprise NTUC Health is charging $675 per six days, which works out to $112.50 per shift.

Interim caregivers usually work in 12-hour shifts to provide basic care, such as doing simple exercises or helping their clients with eating or bathing. Fees quoted are typically before applying other government subsidises, which can be as much as 80 per cent, depending on a person's income level.

The interim caregiver scheme was set up in 2013 to cater to the growing group of people who were well enough to be discharged from hospital, but were unable to cope on their own at home. This is where caregivers - who are usually not professional nurses but have undergone simple training - step in until more permanent arrangements can be made. People are generally referred to the programme by hospitals, with about six in 10 families eventually hiring a foreign domestic worker to take over the caregiving of the family member.

Three in 10 do not require any additional care, while the remaining one in 10 will either arrange for home care, engage senior daycare services, or move the patient into a nursing home. The interim programme, which is managed by the Agency for Integrated Care, has helped more than 3,000 patients between 2013 and this year.

In addition, Ms Kalika said, her company will be offering subsidised home personal care services at about $22 per hour. These services, which tend to cost between $22 and $30 an hour, are for people who need help with tasks such as eating or bathing - and reduce the need for a live-in maid. Ms Kalika said Active Global, which started out providing permanent live-in caregiver services, is well equipped to fulfil its new responsibilities.

Thoughts anyone?

Yours,

Something Small Thinking Big

Pioneers received over $700m in benefits

This post came out from The Straits Times (13 August 2016)

More than 400,000 pioneers have received over $700 million in benefits from the Pioneer Generation Package to help them with healthcare costs. Speaking to the media, Dr Amy Khor, Senior Minister of State for health, said about 300,000 pioneers have benefited from the Community Health Assist Scheme, which allows them to enjoy subsidies at participating general practice and dental clinics.

Meanwhile, between 250,000 and 300,000 pioneers enjoyed subsidies at subsidised specialist outpatient clinics, and the same number at polyclinics. The $8 billion Pioneer Generation Package was rolled out two years ago to help citizens who were aged 65 and above in 2014, among other criteria. There are about 450,000 pioneers. It was designed to help with healthcare costs.

Dr Khor, who is also Senior Minister of State for the Environment and Water Resources, and Mrs Josephine Teo, Senior Minister of State for Foreign Affairs and Transport, had led a task force to spread the word to senior citizens about how they could benefit. Yesterday, they hosted an appreciation dinner for the task force's 22 members at the conclusion of its work.

The task force comprised civil servants, grassroots leaders, public relations experts and those from the non-profit sector. Mrs Teo said getting the message across to pioneers effectively required the information to be tailored specially to each individual depending on his healthcare needs and existing circumstances.

It helped to say it over and over. She said: "When it comes to communicating with seniors, repetition is important especially when things can get a bit more complex. Repetition helps pioneers to absorb and understand." To broadcast the word as widely as possible, the task force created a Pioneer Generation Ambassador programme, sending 3,000 ambassadors across the island to visit more than 300,000 pioneers to tell them about the package.

Thoughts anyone?

Yours,

Something Small Thinking Big

Pioneers to get medical subsidies

This post came out from The Straits Times (18 May 2014)

Singapore's oldest citizens will pay less when they visit the doctor or dentist from September. Their Pioneer Generation card will entitle them to significant subsidies when they need treatment for the common cold or chronic ailments, as well as selected dental treatments and health screening.

Everyone 65 or older this year will qualify, regardless of what they earn or where they live, and will get these subsidies at 1,000 clinics across Singapore. Health Minister Gan Kim Yong revealed last night that the subsidies under the Government's Community Health Assist Scheme (CHAS), will be more generous for pioneers than for poor and middle income families already receiving this help.

Mr Gan said subsidies for the pioneers will be "better than orange and blue" and easy to use once their Pioneer Generation cards are activated on Sept 1. About 450,000 seniors will qualify.

Like those with the blue and orange cards, pioneers who need specialist treatment will qualify to be referred directly to a public hospital specialist at subsidised rates, without needing a polyclinic referral.

Thoughts anyone?

Yours,

Something Small Thinking Big

Eldercare agencies in talks to set up national dementia registry

This post came out from The Straits Times (24 January 2016)

Patients with dementia could have their details logged in a national database to help the authorities identify them more easily. The move would help police to find out if a disoriented people has dementia and, if so, which next of kin to contact.

Family members could also rely on the registry if they need cooperation from the private sector, such as getting telcos to track phone signals of missing patients or getting banks to look out for big withdrawals.

Mr Jason Foo, chief executive of the Alzheimer's Disease Association (ADA), has suggested such a registry to the Agency for Integrated Care (AIC) after attempts to locate missing dementia patients were hampered by red tape, such as needing to file a missing person report before telcos can track phone signals.

"There were also one or two cases of our elderly clients who went into a shop and took something," he said. "The shopkeeper said they didn't pay, but they thought they did because they could not remember. The police came in, didn't recognise dementia and handcuffed the client." The Sunday Times understands that discussions are going on between ADA, AIC and police.

"If we have a registry, it would be most useful if it has photos that can be searched. What happens now is that the police picks them up, then take them to the hospital. But it is hard to identify them, as their names are unknown," said Associate Professor Philip Yap, senior consultant at the department of geriatric medicine, Khoo Teck Puat Hospital.

Such a registry could also help with planning aged care services in Singapore, according to Dr Ng Wai Chong, chief of clinical affairs at the Tsao Foundation, a non-profit group which specialises in ageing issues. "We can see where the dementia patients are and if the number of day care centres there are enough. It will help us understand the complete needs of the population."

In Singapore, dementia affects an estimated one in 10 people aged over 60. There were approximately 40,000 dementia patients in the Republic as of last year and that number is projected to reach 92,000 by 2030.

Currently, the Ministry of Health knows who has been diagnosed with dementia and the ADA maintains a database of those who have come to it for help, but there is no national registry. Only Sweden and France currently have one in place.

A dementia database will require the support of sufferers and their families, who might not want their loved ones to be registered due to the stigma attached.

Thoughts:

1. Working with big data across agencies can lessen the stress that the dementia elderly and family members experience should any incident happen. It also facilitates planning and raising of awareness so that we can build an inclusive community!

Thoughts anyone?

Yours,

Something Small Thinking Big

Medifund disbursed $160m for needy in FY2014

This post came out from The Straits Times (26 November 2015)

Close to $160 million was given out through Medifund to help needy patients in the last financial yest, a 23 per cent increase on the previous one. About a third of the money, $52.4 million, went to people aged 65 and older.

Overall, there was a 30 per cent increase in Medifund use, such as for hospital admissions, outpatient clinic visits, and stays in long term care facilities, including nursing homes.

The Ministry of Health (MOH) said the higher amount of assistance in FY2014 comes from extending Medifund and Medifund Silver (reserved for Singaporeans aged 65 years and older) to more healthcare facilities.

Medifund is a social safety net set by the Government in 1993 to help poorer Singaporeans pay for medical treatment - specifically those unable to pay their bills, even after subsidies, insurance, Medisave and cash payments.

They can apply for Medifund aid in public and charitable hospitals at public specialist clinics and polyclinics, at nursing and aged homes, and hospices. For FY 2014 which ended in March this year, 92 per cent of recipients received the full amount applied for.

Patients in C-class wards received the highest amount, averaging $1,750. The close to 900,000 visits to outpatient clinics saw patients receive an average of $95 each. Medifund can also be used for dental care, antenatal care and delivery of babies.

The money comes from income earned from the capital sum of $2.78 billion in Medifund and $1.22 billion in Medifund silver. This is distributed to the 43 Medifund Committees that oversee the distribution of funds to patients of 108 institutions.

The MOH said the Government is "committed to ensure that Singaporeans have access to good and affordable healthcare".


Thoughts:

1. Is there a high level of awareness of Medifund? Or does Medifund has coverage that do not fill the gap? Why do we hear about people talk about healthcare costs are becoming affordable and do not want to seek help for it? 

Thoughts anyone?

Yours,

Something Small Thinking Big