Monday 25 January 2016

Eldercare agencies in talks to set up national dementia registry

Proposed national registry will make it easier to track down missing dementia patients
By Kok Xing Hui and Tan Weizhen, The Sunday Times, 24 Jan 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 person 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 the ADA, AIC and police.

"We started just a few months ago," said Associate Professor Philip Yap, senior consultant at the department of geriatric medicine, Khoo Teck Puat Hospital.

"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 pick them up, then take them to the hospital. But it is hard to identify them, as their names are unknown."

The AIC could not respond by press time.

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.

Experts suggest having government bodies such as the Ministry of Health or the AIC manage the database, letting doctors and the police tap into it and, possibly, voluntary welfare organisations who work with the elderly.

"The database should be held by the Government," said Mr Foo. "Because if ADA were to hold it, it is a huge responsibility for us. If we lose that database, it's a very valuable database. If you know which households have dementia, it's very useful for someone who wants to market their products."

Dr Ng said access to the registry has to be tight to prevent scams and suggested that commercial entities go through the Office of the Public Guardian or the police to check the registry.

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.

Dr Yap added: "Having a registry can be very stigmatising, especially for patients with early dementia. If they are still aware, they must agree to this, but they might not consent."

Dr Chia Shi-Lu, who chairs the health Government Parliamentary Committee, said the authorities need to consider when someone should be included in the database.

"What defines a dementia case?" he asked. "There are early-stage dementia patients, where they are still aware, then mild-stage, where they get more agitated, and then the severe cases. So what qualifies you to be included in the database and who decides? Doctors or relatives? Because dementia isn't so clear-cut, there's no special test."

Mr Foo insisted: "The database needs to be there, all the various people need to know that there is this database, then when people find an elderly person they need to know what to do. It's a long process for us but we think we need to get started."

Singapore should offer first-world care for the elderly: Philip Yap
By Tan Weizhen, The Sunday Times, 24 Jan 2016

When he wrote a commentary published in The Straits Times called "Would you want to grow old in today's nursing homes?", Associate Professor Philip Yap wanted to start a conversation among Singaporeans.

"I wanted this article to get Singaporeans to say what kind of place they wanted to grow old in," said the senior consultant in the department of geriatric medicine at Khoo Teck Puat Hospital (KTPH). "What do they want for themselves?"

Prof Yap was inspired to write the piece in response to news that plans had been put on hold for Jade Circle - a pioneering model of care for dementia patients that proposes to house them in single or twin rooms instead of the usual six- to eight-bed dormitories.

The Ministry of Health told the group developing the Jade Circle home last month that it could not provide subsidies to residents staying in such rooms.

Prof Yap said: "The Jade Circle issue highlighted the issue of whether different kinds of care settings would benefit people with dementia.

"Is it just a luxury, or is it really a medical case for them to be housed in a certain care setting?"

Responses he has received so far are unanimous in calling for better nursing homes here. "We are a developed, first-world country," he added. "We should be first-world in our care of the elderly."

Dutch-style care facilities offer independent living
By Tan Weizhen, The Sunday Times, 24 Jan 2016

Some nursing homes here could soon opt for a more independent style of living for dementia patients, after four voluntary welfare organisations (VWOs) took a study trip to the Netherlands last month to visit facilities that treat patients with the condition.

Key staff from Thye Hua Kwan Moral Charities, Peacehaven Nursing Home, St Joseph's Home and Lions Befrienders visited a dementia village, a farm and an apartment complex for seniors on a trip by ageing consultancy Ageing Asia.

They were won over by the Dutch way, which advocates the philosophy of pursuing your own life as much as possible even if you are old and have dementia.

This style of living helps to slow the rate of decline in the patients, as it discourages dependency.

At dementia village De Hogeweyk in Amsterdam, there are facilities such as a supermarket where patients are encouraged to shop for their daily needs.

The residents are grouped together with about seven to one apartment, each with his or her own room. All have to manage the household with help from staff members.

"Everything is natural and nothing is forced. Each house is given a budget every month, and every day the residents can pick up what they want for their meals," said Ms Janice Chia, founder of Ageing Asia.

The residents are also allowed to wander around the village, which has facilities such as restaurants - giving them a sense of independence and freedom.

In Singapore, nursing homes have been criticised for being too institutionalised, with patients placed in hospital beds. At some facilities, patients are not allowed to leave their rooms without supervision.

The group also visited a green care farm for dementia patients, where agricultural activities are combined with care services.

Activities include growing vegetables, milking cows or doing household chores.

Around 250 green care farms in the Netherlands care for dementia patients and aim to get them to participate in meaningful activities.

While it is not possible to adopt all these measures in space-constrained Singapore, the VWOs believe some aspects can be tweaked.

Peacehaven executive director Low Mui Lang is even thinking of sacrificing some office space to make room for social activities, for her residents.

Another idea is a shared kitchen, where patients can help themselves with simple tasks, such as getting a drink.

"In Singapore, there is a culture of workers doing everything for patients, just because they pay for the service," she said. "But when they have maids or nurses, they aren't independent anymore. They begin to lose a lot of their physical mobility and social skills.

"What we need to re-think is the model for nursing homes, which is now like a medical institution rather than a place where people stay. They should be more like homes."

Most such facilities in Singapore are around eight storeys high but Madam Low wants them to expand even higher to give patients more space to move around.

"If they have space to hang out and move around, they can help themselves instead of staff helping them all the time. We should be increasing their well-being, rather than making it so medical and routine, like now, " she said.

Madam Low also wants to give volunteers incentives such as meals for helping patients.

"In the Netherlands, their volunteer recruitment is very good, and it's how they handle the manpower crunch. They reimburse transport and meals."

At the national level, VWOs also want to introduce insurance for long-term patients and diplomas for those who care for them.

Mr Norman Tan, divisional director for community outreach services at Lions Befrienders, said: "We should build on MediShield Life or have another insurance scheme. Right now, ElderShield doesn't quite cover long-term care."

In the Netherlands, the payout can be as high as €2,000 (S$3,000) per month for such patients, enough to pay for a home-based carer.

Mr Tan added: "We must start building such jobs and career paths now."

More day care centres to be located in nursing homes
Having more services in one place makes better use of manpower
By Tan Weizhen, The Straits Times, 23 Jan 2016

More day care centres for the elderly could be located in residential nursing homes, as different kinds of services are grouped together to serve patients better in the future.

Speaking at the official opening of nursing home Ren Ci @ Bukit Batok St. 52 yesterday, Health Minister Gan Kim Yong said the Ministry of Health is investing in home and community care services even as it expands nursing home services.

"Through integration of services, we hope to support patients in a more seamless manner," he said.

The 257-bed Ren Ci @ Bukit Batok St. 52 has a senior care centre within its grounds, with services for the elderly who need day and dementia day care, and day rehabilitation services.

The Ministry of Health has been planning for the expansion of aged care capacity to meet the future needs of an ageing...
Posted by Ministry of Health on Friday, January 22, 2016

Run by Ren Ci Hospital, it has been operating for a year now and currently has 238 residents.

It can provide 30 places for general day care, 30 for dementia day care and 20 rehabilitation sessions daily.

Having all these services in one place has benefits, such as moreefficient use of manpower, as staff do not need to be hired separately, said Ren Ci Hospital CEO Loh Shu Ching.

"The therapists do not only run the day care services, they also look after the residents in the nursing home," she said.

There is also a gym in the centre, which Bukit Gombak residents can use in the evenings and on weekends, which makes the home's residents feel less isolated, she noted.

"The residents in the community will start to see our facility as a value-add, and not as an invader. They can also interact with our residents," said Ms Loh, who revealed that 250 residents have used the facilities.

MP Low Yen Ling, adviser to grassroots organisations in Bukit Gombak, noted that the population in the older estate is ageing faster than the national average.

"During my house visits, I do come across residents who need rehabilitation, and we will then introduce them to Ren Ci," said Ms Low.

In his speech, Mr Gan also said MOH would be working on new care models.

Last year, MOH launched two grant calls for new ideas in the delivery of home-based care, as well as programmes to delay the onset of dementia, and new ways that dementia patients could be cared for, he said.

The grant calls attracted close to 100 proposals from care and technology solution providers.

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