Monday, 9 July 2018

What care and subsidies are available for seniors in Singapore?

By Salma Khalik, Senior Health Correspondent, The Straits Times, 7 Jul 2018


NURSING HOME

The number of nursing home beds has gone up from 9,600 in 2011 to 14,900 last year. More are in the works and there should be 17,000 beds by 2020.

Apart from having more beds, newer nursing homes are designed to be more soothing. Ren Ci's home at Ang Mo Kio, for example, places four people to a room, with shared living and dining areas.

Some high-rise homes have mini gardens or mid-level greenery so residents do not need to leave the homes to enjoy nature.

CARE CLOSE TO HOME (C2H)

Seniors in rental flats in 15 precincts can be cared for while continuing to live in their own homes. People from nearby Senior Activity Centres provide help for daily activities such as bathing and housekeeping, while monitoring the seniors' medical conditions.

HOSPITAL TO HOME (H2H)

Frail patients who have been discharged from hospital are provided with multi-disciplinary care for a short period. This includes caregiver training so family members or helpers know the best way to aid the senior.

Run by the three regional health systems under which all public hospitals are clustered, they also provide phone support as well as medicine reconciliation if the senior is being attended to by different doctors who might prescribe different, and possibly conflicting, medicines. So far, more than 14,000 patients have used this service.

PALLIATIVE CARE

This provides care for people who are dying and in pain, and is especially helpful for terminally-ill patients. The aim is to improve their quality of life.

HOME PALLIATIVE CARE

For patients in the last stages of life, home palliative care supports them till the end of their lives in their own home, instead of in a centre, while offering medical, nursing and psychosocial care.

The number of patients who can receive such care at home has gone up from 3,800 a year in 2011 to 5,900 a year last year. Most charity organisations do not charge for this service. For providers that do charge, the fees are around $1,000 a month. Those who qualify can get subsidies of about $800 a month.



DAY CARE

When caregivers have to work, they worry about leaving the elderly alone at home. Some may even have to give up working to care for the senior.

Day care services give them peace of mind as the senior can be cared for and given proper meals, while still living at home. The centres also give the senior a chance to socialise and engage in activities such as exercise, handicraft and karaoke.

There were 5,000 day care places last year, with at least another 1,200 to be added by 2020. The plan is for 90 per cent of seniors to have such a centre within 1km of their home.

DEMENTIA CARE

These centres try to slow down the progression of dementia by providing cognitive stimulation. They provide activities that try to preserve physical and mental functions. Patients live at home and are taken to the centres daily.

COMMUNITY REHAB CARE

These centres provide physiotherapy and occupational therapy services for people recovering from debilitating medical conditions such as stroke, a fracture or amputation.

The exercises help them regain their ability to do things most people take for granted, such as walking or moving from bed to chair, so they can continue living independently in the community.

HOME CARE

This is a range of services - from medical and nursing to personal care such as assisted showering, housekeeping and medication reminders - to help frail or disabled seniors living alone at home.

A visit by a doctor costs about $250, but subsidies cover up to $200. Similarly, subsidies can pay for up to $90 of the $110 fee for a visit by a nurse.

The number of people who can be looked after by home care has gone up from 3,800 in 2011 to 8,000 last year, and is expected to increase to 10,000 by 2020.

INTEGRATED HOME AND DAY CARE

This is a pilot scheme that offers a package of both day care and home care, depending on the senior's needs. The senior can opt for a combination, such as going to a centre three days a week and getting home care on other days.

ACTIVE-AGEING HUBS

These are larger centres that provide a range of services - from active-ageing programmes for healthy seniors to rehabilitation care for those who are more frail. Seniors are able to transition from being active and independent to needing help when they are older and frail, while remaining at the same centre.

There are now two such hubs in Whampoa and Kampung Admiralty. Eight more are being planned in towns like Toa Payoh, Ghim Moh and Telok Blangah.

MEDICAL ESCORT AND TRANSPORT

This is to help seniors who have no caregivers and are unable to travel independently to get to their medical appointments. The escort will also help the senior register and navigate the hospital system.

As part of this move, the Agency for Integrated Care (AIC) has been training some Grab and Comfort drivers to assist disabled or frail seniors in getting into or out of their vehicle.

Subsidised regular transportation is also provided for those who need to get to day care and dialysis centres.

FOREIGN DOMESTIC WORKERS

To help seniors continue living at home, the Government allows Singaporeans aged 65 and older to pay a concessionary foreign domestic worker (FDW) levy of $60 a month instead of the normal $265.

If the senior needs help with at least three activities of daily living and comes from a household with a per capita income of no more than $2,600, the Government also gives him $120 a month to defray the cost of hiring an FDW.

Families with no income can get the grant if their property has an annual value of less than $13,000.

There is also a training programme for FDWs to learn the proper way to care for frail elderly, such as how to move them from bed to chair and provide good hygiene care. About 300 FDWs have gone for such training.

RESPITE CARE

More than 1,600 seniors have taken advantage of this service, where they are looked after temporarily at a nursing home when their caregiver is on a break or when their family is away on a holiday.

There is also weekend respite care where the senior is looked after for a few hours.

This is available at 12 eldercare facilities.

ELDER SITTER PROGRAMME

This temporary service is for seniors with dementia, where sitters look after the seniors in their homes while caregiver support is being arranged. Over the past five years, more than 1,200 seniors have been helped by this programme.

CHANGI GENERAL HOSPITAL'S CARELINE

This is a round-the-clock service provided by Changi General Hospital that proactively checks if seniors have taken their medicine. It also calls them for a status check.

The senior can also call the Careline if he is in distress.

MEALS ON WHEELS

Meals are delivered to home-bound seniors who have difficulty buying or preparing meals and have no caregivers to help them. Meals are usually delivered by volunteers.

Dr Lim Peng Peng, who works part-time at St Luke's ElderCare providing home medical care, is a volunteer at Touch Home Care. For the past three years, she has been delivering dinners once a week to seniors.

Touch has 6,000 volunteers who deliver two meals a day to 500 home-bound elderly. It is one of several charity organisations that offer this service.

Meals cater to different dietary needs, such as soft foods, vegetarian and halal meals.

Dr Lim recalled a senior who once told her that dinner had not been delivered the previous day. As the elderly woman was not able to get her own meal, she had to make do with a meal of biscuits.

"I realised then how important this (meal service) is to them," she said.

SENIORS MOBILITY AND ENABLING FUND

Subsidies are given to Singaporeans who qualify after means testing to help defray the costs of getting devices such as walking frames, wheelchairs, hospital beds and even spectacles and hearing aids.

Subsidies are also given for consumables such as milk supplements, adult diapers and wound dressing.

HDB'S ENHANCEMENT FOR ACTIVE SENIORS (EASE)

Elderly Singaporeans can get up to a 95 per cent subsidy under the Housing Board's EASE package that provides seniors with ramps for wheelchairs, grab bars and non-slip tiles in their flats to reduce their risk of falling at home.

COMMUNITY NETWORKS FOR SENIORS

Silver Generation Ambassadors proactively visit seniors aged 65 and older to see if they have any needs, share ageing programmes that might interest them, and link them up with the relevant people, should they need help.

So far, 70 per cent of those aged 65 and above have had at least one visit by these volunteers.





Services to meet seniors' long-term care needs
Stroke patient can continue living at home, with the help of day care and subsidised transport
By Salma Khalik, Senior Health Correspondent, The Straits Times, 7 Jul 2018

Mr Tan Sue Hoai, 72, cried when his wife, Madam Oei Lian Eng, 65, suffered a stroke which left her paralysed on one side of her body and unable to care for herself.

They had met, fallen in love and married in their 40s and have no children.

She is fairly big-sized, and he could not cope with her disability. Mr Tan thought putting her in a nursing home was the only option. That would leave him living alone at home. He was depressed. He had vowed to take care of her when they got married, and now he felt he could not keep his promise to her.

Then the medical social worker at the hospital put him in touch with The Salvation Army Peacehaven Bedok Multi-Service Centre, one of the services specifically designed to help frail or disabled seniors to continue living at home.

The centre arranged for Madam Oei to be cared for during the day from Monday to Friday - she gets a shower, lunch and snacks, and is made to exercise and do other activities.

Peacehaven also provides weekend care for those who need it, at the Changi centre. It also offers home care, or a combination of home and day care, depending on the senior's needs.

The centre helped arrange daily transport for Madam Oei to commute between her flat in Bedok and the centre, which is a 15-minute walk away.

The subsidy for this comes from the Seniors' Mobility and Enabling Fund (SMF), and pays 80 per cent of the cost. The SMF, run by the Agency for Integrated Care, pays 90 per cent of the cost of equipment, such as the wheelchair that Madam Oei needs.

Mr Tan said when his wife is at day care, he is able to do the housework, go shopping and sometimes have a drink with friends.

Madam Oei said of her husband: "He is the best. He does everything for me. And he is a good cook, too."

When she needs to go to the hospital to see her specialist, she uses the medical escort and transportation service, again subsidised by the Government. She is happy that she is able to continue living at home. She has also made many friends at the day care, she said.

Health Minister Gan Kim Yong told The Straits Times that more will be done to help people like her.

He said: "Many Singaporeans prefer to be cared for in their home and to continue living in a familiar environment among their loved ones. We will do more to support this by growing the range of care and support options."

Mr Gan plans to strengthen support for families caring for seniors, so that more of them can continue living in the community.

Earlier this week, he announced new schemes to help people pay for such care.


CareShield Life will be launched in 2020 to provide the severely disabled with at least $600 a month for as long as they live.

"Taken together, these enhancements will provide better protection and assurance for Singaporeans to age actively and well in the community," Mr Gan said.




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