Friday, 15 February 2019

Caregiver Support Action Plan: Raft of measures to help relieve burden of caregivers announced in Parliament on 13 February 2019

Aid ranging from new grant to respite care services to be rolled out over two years
By Linette Lai, Political Correspondent, The Straits Times, 14 Feb 2019

A slew of measures will be rolled out over two years to help Singaporeans who care for the old, the sick and the disabled.

These include a new $200 grant to offset costs of care, more respite care options and the loosening of restrictions on Medisave funds for people to help pay for their siblings' care.

The announcement was made by Senior Minister of State for Health Edwin Tong at a marathon seven-hour Parliament session yesterday, during which 25 MPs and six office-holders spoke at length about the importance of helping Singaporeans age well and ensuring their caregivers receive adequate support amid a greying nation.

Many shared anecdotes of personal encounters with burnt-out caregivers who sought their help.

The measures in the new Caregiver Support Action Plan come four months after the Health Ministry said it was going to review the caregiver support system.

At least six measures to help ease the burden on caregivers will be launched under the plan, including a means-tested Home Caregiving Grant to be introduced by the end of this year.

The $200 monthly grant will replace the existing $120 Foreign Domestic Worker Grant, and will give caregivers greater flexibility in how to use the money. Anyone with permanent moderate disabilities will be eligible, regardless of age.

By the end of this year, people can also use their Medisave funds to pay for the healthcare expenses of their Singaporean siblings.

The Agency for Integrated Care, which coordinates eldercare schemes, will also launch three pilot schemes to expand respite care options. These include a night service for caregivers of dementia patients and a home-based service for cancer patients receiving palliative care.

It will also try out a pre-enrolment system at certain senior care centres and nursing homes so that respite services can be activated at short notice, if necessary.

The ministry will also set up more caregiver support networks and make it easier for people to access the services they need, said Mr Tong. More details will be given in the coming months.

By 2030, one in four Singapore residents will be 65 and older, and informal caregiving arrangements will grow as the population ages.

Given Singapore's demographic profile, Mr Tong said his speech focused mainly on help for those caring for the elderly "as a start".

But there is a "broad range of caregivers who operate in a variety of different circumstances and a very broad landscape", he added.

"Their needs are diverse, as with their own particular family or caregiving circumstances, so over time we will need to look carefully at what these needs are, and whether further assistance might be needed."

At yesterday's session, the MPs also recounted stories about seniors living their golden years with energy and aplomb as they discussed how to help this group age in good health and with financial stability.

Suggestions they made included providing more work and volunteering opportunities for seniors who want them and assisted living options in both Housing Board and private housing developments.

Speaker of Parliament Tan Chuan-Jin neatly summarised the main thrust of the debate by noting how there has been much talk about the impending multi-billion-dollar Merdeka Generation Package to help Singaporeans born in the 1950s with their healthcare expenses.

"I think it is instructive to remember that merdeka means freedom and independence, and that is an aspiration I think we are all aspiring to, in the way we realise our older years as a nation," he said.

Greater support for caregivers, seniors
The Straits Times, 14 Feb 2019

A Caregiver Support Action Plan will be rolled out to better help those looking after the elderly and infirm as the population ages and Singaporeans live longer. The Ministry of Health (MOH) held 19 focus group discussions involving over 200 people from last September to get a sense of these caregivers' needs and concerns. Yesterday, Senior Minister of State for Health Edwin Tong announced plans that MOH and partner agencies will embark on in five broad areas.



The Agency for Integrated Care (AIC) has eight counters at acute and community hospitals and its Maxwell Road office for people to find out about a range of services for caregivers and those they look after. It will set up four more counters at Silver Generation Office locations in Choa Chu Kang, Nee Soon, Pasir Ris and Toa Payoh by the second half of this year as a start.


A beta version of a website will be launched by the end of the year to give Singaporeans and their caregivers information, as well as services related to their end-of-life journey, including advance care planning and going about getting a Lasting Power of Attorney, which involves appointing a person or persons to make decisions on their behalf should they lose their mental capacity.

AIC will also develop a health marketplace e-platform by 2020 for caregivers to browse through feedback and ratings before buying goods or engaging services such as medical transport.

It will also revamp the Singapore Silver Pages



The Ministry of Health will introduce a new Home Caregiving Grant by end-2019 to defray the costs of caring for persons with permanent moderate disabilities, that is, those who need some help with at least three activities of daily living.

These are: washing, dressing, feeding, toileting, walking or moving around and transferring from a bed to chair or wheelchair.

This grant will complement severe disability schemes such as ElderShield and CareShield Life by providing support when care recipients are still able to perform these activities with some assistance.

This grant will be means-tested, and replaces the existing Foreign Domestic Worker Grant of $120 a month, giving caregivers more flexibility to defray caregiving expenses.


By end-2019, CPF members will be able to use their Medisave funds to cover the healthcare expenses of their siblings who are Singaporeans or PRs. Currently, they can do so for spouses, parents, children and grandparents.



The Agency for Integrated Care (AIC) has a network of 34 community outreach teams to identify persons with dementia or mental health conditions, refer them to services and assistance, and provide them with emotional support.

Some of these teams will begin to focus on caregivers who have or are at risk of developing depression, anxiety and burnout due to their roles. They will engage them on stress management, planning, and link them up with support groups and counselling where needed.


AIC will grow caregiver support networks across dementia-friendly communities (DFCs) to provide platforms for caregivers and their loved ones to stay active, and leverage on the social capital among people with common experiences for socio-emotional support. There are two caregiver support networks in Queenstown and MacPherson DFCs, and these will be expanded to five by end-2019. AIC will also work closely with grassroots organisations to strengthen caregiver support.


AIC will work with training providers to train foreign domestic workers early in their employment and to offer caregiver skills courses to better support those they assist by the second half of this year.



The Agency for Integrated Care (AIC) will pilot a new night respite service with selected nursing home providers for caregivers of seniors with dementia who experience behavioural and sleep issues at night.

This will let caregivers, especially those who work or care for the senior in the day, to get some rest. Seniors will be engaged through cognitive activities and tasks to help manage their behavioural and sleep issues. The pilot is expected to start in the second half of 2019.


This service will be piloted for cancer patients receiving palliative care at home from mid-2019, as end-of-life care can be physically and emotionally challenging.

Caregivers will get temporary relief with tasks such as showering, dressing and feeding patients.


AIC will pilot a pre-enrolment system with a number of senior care centres and nursing homes to register them and their caregivers early so that administrative processes such as assessing eligibility for subsidies can be done beforehand.



The Ministry of Manpower (MOM) is exploring increasing the budget for its Work-Life Grant, which was first introduced in 2013 to help companies offer flexible work arrangements to staff.

The grant was extended and enhanced in July last year so that companies can get some funding so long as one or more employees adopt flexible work arrangements.

Working caregivers have expressed the importance of such work arrangements to help them balance their work and caregiving commitments.

Currently, companies can tap the grant and receive up to $105,000 over a two-year period when employees adopt flexible work, such as flexi-load, flexi-place or flexi-time, arrangements.

MOM will share more details during the debate on its budget next month.

MOM and the Ministry of Health will also reach out to caregivers to raise awareness of the Adapt and Grow initiative, which provides employment facilitation and support for job seekers, such as job matching, training and wage subsidies. This will help caregivers return to work, especially if they have not been employed for some time.

What's being done for seniors and people with special needs
4 ministries' officials supplement MOH announcement of schemes
By Linette Lai, Political Correspondent, The Straits Times, 14 Feb 2019

The announcement of various new schemes by the Ministry of Health (MOH) in Parliament yesterday was supplemented by officials from four ministries spelling out what the Government is doing for seniors and those with special needs, and how they can lead healthy, active lives.


Several MPs called for more diverse housing options for seniors, including group homes, assisted living services and developments that integrate both housing and care facilities.

While the Government is looking at building more integrated developments, many seniors prefer to age in familiar surroundings, noted Senior Parliamentary Secretary for National Development Sun Xueling.

Hence, another prong in the Government's strategy is to retrofit existing Housing Board estates to make them senior-friendly.

Already, all common areas in newer HDB estates have features such as ramps and barrier-free routes to make it easier for seniors to move around.

Her ministry is also studying how to ensure that private retirement housing properly caters to the intended demographic, and will give more details in due course.


More will be done to help those with special needs live independently, said Minister of State for Social and Family Development Sam Tan.

His ministry is aware that many caregivers of special needs students worry about what will happen after their children complete their studies in special needs schools.

"Parents know that they will not always be able to take care of their children, and they hope that their children will be able to find and hold on to good jobs, and live independently despite their special needs," Mr Tan said.

His ministry is studying these issues and will elaborate on its plans in the upcoming parliamentary debate on its budget, he said.

It will also disclose details of plans to provide better social assistance in cases of complex needs.


Senior volunteerism rates have gone up, and seniors have a wealth of experience that they can tap to give back to society.

This includes providing advisory services to voluntary welfare organisations, said Senior Minister of State for Culture, Community and Youth Sim Ann.

She gave the example of the Centre for Non-Profit Leadership's Board Match programme, which reaches out to professionals across various industries to identify people who can be leaders in non-profit organisations.

The Government is also working with the arts and sports communities to develop activities that help seniors build social bonds and stay healthy as they age, Ms Sim said.


Companies can retain talent by adopting flexible work arrangements that let valuable employees take time off when needed for family commitments, said Senior Parliamentary Secretary for Manpower Low Yen Ling.

Her ministry will continue to encourage companies to adopt such flexible arrangements, she said.

Mr Henry Kwek, an MP for Nee Soon GRC, suggested: Why not legislate such arrangements?

Ms Low replied that the Government will first have to study the potential impact of passing such a law.

Parliament: Suggestions from MPs to help seniors, caregivers in debate on ageing
By Adrian Lim, Political Correspondent and Linette Lai, Political Correspondent, The Straits Times, 14 Feb 2019

Twenty-five MPs yesterday gave suggestions and urged the Government to do more for seniors and caregivers, as the House debated two motions on helping Singaporeans age with purpose and expanding support for caregivers.

One group, led by Mr Henry Kwek (Nee Soon GRC), advocated a "whole of Singapore effort" to ensure that Singaporeans age with purpose, in good health and with financial stability.

The other group, led by Dr Chia Shi-Lu (Tanjong Pagar GRC), underscored the important role that caregivers play in helping seniors age well and called for more support for this group of people.

Mr Kwek is the vice-chairman of the People's Action Party's Seniors Group, while Dr Chia chairs the Government Parliamentary Committee for Health.

Here are some suggestions made by the MPs.

For seniors


Opening the debate on ageing well, Mr Kwek said that many seniors find purpose in work and more opportunities must be created for them to work for as long as they want or are able to.

Ms Lee Bee Wah (Nee Soon GRC) similarly said many elderly people "want to feel useful to society, in a way that is manageable for them".

Ms Tin Pei Ling (MacPherson) called for ageism to be stamped out. The Government can take the lead in testing how the work environment, workflows, job role designs and even compensation and health benefits can be optimised for senior workers, she said.


Ms Joan Pereira (Tanjong Pagar GRC) suggested providing more assisted living options in both Housing Board and private housing developments. "We can either utilise available void-deck space or transform several combined HDB flats into a senior group home with assisted living facilities," she said.

Ms Rahayu Mahzam (Jurong GRC) urged the National Development and Health ministries to look into revising guidelines to enable and promote the setting up of group homes or retirement homes with assisted living facilities in the private sector.

"This could mean creating a new strata title category and legislation that could ring-fence non-seniors from purchasing such properties and deal with the conversion or transfer of ownership upon demise of the owners," she said.


Mr Zainal Sapari (Pasir Ris-Punggol GRC) called for building owners to set aside rest spaces for elderly workers, especially for outsourced cleaners, security officers and landscape workers.

This gives them a greater sense of dignity and self-worth "knowing that their basic needs are provided for at their work sites", added the assistant secretary-general of the National Trades Union Congress.


Citing studies that show that attending or taking part in arts-related events benefits the mental and physical health of the elderly, Nominated MP Terence Ho called for more support and resources from the Government, companies, enterprises and the public to make the arts more accessible for senior citizens.


Home-grown technology companies could work with the Government to produce basic smartphones or similar devices with functional features such as electronic payment, said Mr Darryl David (Ang Mo Kio GRC).

These could be made available at a nominal rate for senior citizens and help them stay connected even if they cannot afford a smart device.

For caregivers


Workers' Party MP Chen Show Mao (Aljunied GRC) wants more financial assistance to be given to caregivers, especially those who give up their jobs to take care of their family members. This could include Central Provident Fund top-ups for those in low-income households, he said.

Mr Christopher de Souza (Holland-Bukit Timah GRC) also suggested that the Government consider a caregiver allowance, particularly for full-time caregivers taking care of an elderly person with disabilities or mental health problems.


Having caregiver leave and flexible work arrangements can help caregivers better deal with situations when an elderly parent falls ill suddenly, said Dr Chia.

He also called on the Manpower Ministry to examine potential roadblocks to companies implementing flexible work arrangements and work with them to overcome the obstacles.


Recounting the experience of a burnt-out caregiver whose father was often active at night because of dementia, Ms Tin called for the provision of respite care beyond the conventional working hours.


Take a look at how younger Singaporeans can be encouraged to pursue careers in fields such as gerontology and geriatrics, said Dr Intan Azura Mokhtar (Ang Mo Kio GRC).

These could include putting in place professional conversion programmes for people who want to make a mid-career switch.

Seniors to get more help to stay healthy
More efforts to strengthen communities of care and evolve new models of ageing in place
By Adrian Lim, Political Correspondent, The Straits Times, 14 Feb 2019

Seniors will continue to get more help and programmes to age in place, stay in good health and receive support from care networks, said Senior Minister of State for Health Amy Khor.

Dr Khor said the Ministry of Health (MOH) is strengthening efforts in three areas: Empowering seniors to stay healthy and active, enabling communities of care, and evolving new models of ageing in place.

Singapore has made good progress on initiatives under the $3 billion Action Plan for Successful Ageing that was launched in 2015, she told the House yesterday.

There is a need to plan ahead for successive generations of seniors who have different needs and aspirations, Dr Khor said.

"The Merdeka Generation seniors, for example, are living longer and healthier, and are more educated, skilled and IT savvy, compared to our pioneers."

Dr Khor was responding to one of the two motions put forth by MPs, on ageing with purpose and on support for caregivers. A total of 25 MPs spoke on both motions, which were taken concurrently.

Besides empowering seniors, Dr Khor said the Government wants to provide them with opportunities for personal development and community participation.

She also spoke of expanding the reach of preventive health services to seniors in the community.

Dr Khor cited a nationwide screening programme by MOH and Temasek Foundation Cares that was launched last year, which helps seniors get screening for hearing, eyesight and oral health at a low cost, or for free. Project Silver Screen has benefited about 45,000 seniors since January last year, she said.

Since 2014, a group of about 3,000 volunteers have made more than a million home visits and engaged about 450,000 seniors aged 65 years and above, Dr Khor added.

During the home visits, these Silver Generation Ambassadors assess the seniors' health and encourage them to participate in preventive health and active ageing programmes in their neighbourhoods.

To get more seniors moving, MOH is also building larger daycare centres that offer a range of active ageing and care services, Dr Khor said. Five such Active Ageing Hubs have been opened so far, with another five more to open by 2020.

Dr Khor also called for suggestions to get more men to take part in active ageing programmes. Only one in five participants is male, according to anecdotal observations from community partners.

On enabling communities of care, Dr Khor said the Community Networks for Seniors initiative has been expanded to 89 neighbourhoods and areas. It involves government bodies, voluntary welfare organisations and volunteers teaming up to visit seniors.

This helps "close the last-mile delivery of active ageing programmes and care services, and provide timely and coordinated care for our seniors when needed", she noted.

Responding to Ms Cheng Li Hui (Tampines GRC) and Workers' Party's Mr Faisal Manap (Aljunied GRC), Dr Khor said that while the number of elderly suicides has increased in recent years in tandem with the ageing population, suicide death rates among Singaporeans aged 60 and above have declined from 22.4 per 100,000 residents in 2007 to 16.4 in 2017.

"Nonetheless, each suicide is one too many," she said, adding that the Government will boost efforts to proactively reach out to those at risk.

Care Line, a 24-hour senior helpline, will be expanded nationwide, she said, noting that the helpline staff call seniors regularly to check whether they are well and provide urgent assistance to distressed seniors.

As for new models of ageing in place, Dr Khor said the Build-Own-Lease (BOL) framework and funding model for nursing homes will continue to be reviewed to ensure residents can access good and appropriate care at affordable fees.

Under the BOL framework, the Government pays for the capital costs of development and tenders out operating rights to both private operators and voluntary welfare organisations so they do not have to bear the upfront capital costs.

Moving forward, Dr Khor said MOH will explore new concepts of ageing in place.

One such programme is Care Close to Home (C2H), which is offered at 15 sites across Singapore, serving more than 3,500 clients.

Under the scheme, seniors in rental flats 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.

Dr Khor said MOH is working closely with the National Development Ministry to develop new assisted living options that include care services, and more details will be announced in the Budget debate.

Wrapping up her speech, she said: "Longevity is not a curse but a blessing and offers us possibilities to live more meaningful and productive lives. As future cohorts of seniors are more educated and skilled, there is no better time to take advantage of our longer life years than now."

NTUC to look at ways to increase employment rates of middle-aged women who are caregivers
Tripartite effort to study ways to boost eldercare community services to help middle-aged women get jobs
By Jev Akshay Jeevan, The Straits Times, 16 Feb 2019

The labour movement will look at ways to increase the employment rates of middle-aged women, many of whom indicated in a survey last year that they do not look for work because of caregiving duties.

In order to do that, the National Trades Union Congress (NTUC) said it will consider the types of eldercare services in the community that need to be provided and how they can be funded.

It said a reform of employment models to include flexible work options is also critical.

"There must be enough quality yet affordable eldercare services in the community for caregivers to entrust their family care recipients to, so that they would not need to quit their work entirely in the first instance, or are able to take on part-time work if they cannot take on full-time jobs," NTUC said in a statement yesterday.

The labour movement said it will collaborate with the Singapore National Employers Federation and the Ministry of Manpower (MOM) to study, recommend and subsequently implement ways to get more middle-aged women to join the workforce.

"It is crucial for all Singaporeans, including caregivers, to have the chance and choice to earn a steady source of income to meet current expenses and more importantly, to strengthen their retirement adequacy," NTUC said.

A 2018 MOM survey showed there were 168,300 unemployed female residents aged 40 to 59 who were not in the 2.3 million-strong labour force. Of these unemployed women, one in five indicated that they did not seek employment because they had to care for family members, other than children.

The announcement of the tripartite effort follows Wednesday's Parliament debate in which MPs called for caregivers to be given more support.

Among other things, they had proposed greater financial assistance in the form of grants, as well as more flexible work arrangements.

NTUC deputy secretary-general Heng Chee How said the mindset of employers must also be changed to increase their willingness to hire part-time employees and workers with flexible schedules.

But he said that "unions can only do so much" because jobs and how jobs are structured are determined by employers.

Besides changing mindsets, the labour movement believes strengthening know-how and devising the right incentives are important.

"I am not promoting a switch from full-time to part-time work for the sake of it. I am promoting it so that those who have no work can at least work part time," said Mr Heng.

Caregiver Koh Leh Choo, 61, was employed as a full-time nurse until February 2017, but she was forced to resign to look after her father, who is now 87 years old.

"I can't work full time as my father needs to frequently visit the hospital. I want to be there for him," she said.

After more than a year without work, Ms Koh said, she struggled to keep up with expenses.

She also found it difficult to find another job as many employers were not keen to hire part-time employees, and because of her age.

About three months ago, she secured a job with NTUC Health as a part-time homecare nurse.

"I feel more at peace and I'm comforted that I have a steady income while at the same time, I'm able to care for my father," Ms Koh said.

A significant step up for caregivers
The Straits Times, 18 Feb 2019

Over the years, calls for greater support for caregivers have cropped up periodically, including in Parliament. It is heartening to see that such calls have not fallen on deaf ears. Last week, the Government added a vital piece to the fabric of support, with a new Caregiver Support Action Plan. Measures include a new grant to offset care costs, more options for respite care, and allowing people to use Medisave to help pay for siblings' care, MPs heard in Parliament last week.

The range of caregiver support has been expanding over the years. Grants help caregivers attend training courses. Respite services are available. A network of caregiver support is being built up. Today, government subsidies are available for home-based nursing and medical services to augment family caregiving. Among the new measures, the caregiving grant is noteworthy for representing a small but significant shift in thinking.

In 2007, MP Lam Pin Min, who is now Senior Minister of State for Health and Transport, called for a caregiver allowance in Parliament. He cited the case of a middle-aged woman who gave up her job to care for an elderly parent. Among the points he made: Supporting such decisions enables the frail elderly to be cared for at home and relieves pressure on limited places in nursing homes and eldercare centres; also, countries such as the United Kingdom, Japan, Australia, New Zealand, Norway and Sweden provide a caregiving allowance. Over the years, various MPs have repeated the call. Mr Christopher de Souza did so in 2015, but was turned down with a similar argument as was made in 2007 - namely that introducing a direct caregiver allowance may inadvertently monetise family support and filial piety, which are priceless. Still, Health Minister Gan Kim Yong did promise to continue to study new ways to beef up support for caregivers.

The ministry has kept its promise by putting caregivers high on its agenda over the past year. The new Home Caregiving Grant of $200 will be means-tested and introduced by the end of this year, available for anyone with permanent moderate disabilities, regardless of age. It replaces the existing $120 Foreign Domestic Worker Grant. The new caregiving grant is a well-thought out and apt response to a growing need. It is not positioned as an allowance for the caregiver, thus avoiding any suggestion of monetising family ties. As a grant to offset expenses, it recognises the practical costs of caregiving. It is fungible, and can be used for anything from eldercare centre fees to transport to medical appointments. It is more equitable than the previous grant which benefited only those who hire domestic maids. The conceptual framework is in place for financial support for caregivers. This can be expanded in the future, as the need arises, if the country's Budget permits.



ElderShield to be replaced by CareShield Life with higher, lifetime payouts from 2020; Parliamentary Debate on ElderShield Review Committee Report, 10 July 2018

Government to strengthen long-term care financing for all Singaporeans through CareShield Life, MediSave cash withdrawals and new ElderFund assistance scheme for the lower-income who are severely disabled

HDB to fit ramps for flats with multi-step entrances from 5 December 2018 under the Enhancement for Active Seniors (EASE) programme

What care and subsidies are available for seniors in Singapore?

Caregiver Support

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