More Affordable Intermediate And Long-term Care Services To Help Singaporeans Age-in-place

1           The Ministry of Health (MOH) will be introducing a series of enhancements to the healthcare sector as part of Budget 2012 to make healthcare more affordable and accessible to Singaporeans, in particular for middle income households with elderly. With a rapidly ageing society, the Government will improve access, affordability and quality of aged care. We will promote ageing-in-place, and home care to make it easier for Singaporeans to care for our elderly, within the community and in our own homes.

2          One of the key initiatives is to enhance the subsidy framework for the intermediate and long-term care (ILTC). Subsidy levels for this sector will be raised, and extended to cover more households in the middle income brackets. With these subsidy changes, around two-thirds of Singaporean households (or about 80% of elderly) will be able to receive some form of financial assistance, with the middle income households seeing the highest increase in subsidy levels.

3          In addition, Goods and Service Tax (GST) chargeable for healthcare services will be absorbed by MOH for all subsidised ILTC patients. 

4          The Ministry of Community Development, Youth and Sports (MCYS) will adopt the same enhanced subsidy framework as well as absorb the GST for the relevant eldercare and adult disability care services under its charge.

5          Other enhancements include the provision of a Foreign Domestic Worker (FDW) grant for households with frail or disabled elderly Singaporeans, and higher cash payouts for elderly under the Interim Disability Assistance Programme for the Elderly (IDAPE) scheme.

6          Taken together, MOH and MCYS will spend $250 million annually, which is about $60 million more towards the care of some 40,000 elderly. This represents an increase of about 30% more in subsidies given out per year, benefiting 30% more elderly, served by around 100 healthcare and eldercare providers. This includes community hospitals, nursing homes, day rehabilitation and day care centres, as well as home-based services like home medical, home nursing or home-help.

7          On the Ministry’s initiatives, Minister of State for Health, Dr Amy Khor said, “The enhancements will not only make aged care more affordable, but also free up charity dollars that have been used to subsidise care, thus allowing more resources for voluntary welfare organisations to scale up their services and enhance the quality of care.”

8          Minister of State for Community Development, Youth and Sports, Mdm Halimah Yacob, who chairs the Home Care and Family Support Sub-Committee under Ministerial Committee on Ageing, said, “With the enhanced subsidies and the absorption of GST, we believe that more families will be encouraged to use community based facilities or care for their frail elderly and adult disabled family members at home.”

Summary of key enhancements:

A.   More support to care for frail elderly at home and in the community

                      I.        Higher subsidies for home and community-based services

                    II.        A monthly FDW grant of $120 for eligible households with frail or disabled elderly Singaporeans

B.   Enhanced subsidies for residential ILTC services

                      I.        Community Hospitals

                    II.        Other Residential Care

C.   Absorption of GST for all ILTC subsidised patients

D.   Higher cash payouts for disabled elderly under the IDAPE scheme

A.        More support to care for frail elderly at home and in the community

(I)         Enhanced subsidies for subsidies for home and community-based care

To encourage ageing-in-place and support more elderly to be cared for at home, the qualifying per capita monthly income for subsidies for home and community-based services will be raised from $1,400 to $2,200, covering two-thirds of households[1]. Subsidies will be raised to as much as 80%, with the middle income seeing the highest increase. See Table 1.

Table 1: Current and Revised Subsidy Framework for

Home and Community-Based Services[2]

Per Capita Household Income

(Per Month)

Subsidy Levels

Non-Residential

Current

Revised

$0

to

$600

50%-75%

80%

$601

To

$900

50%

75%

$901

To

$1,300

25%-50%

60%

$1,301

To

$1,500

0%-25%

50%

$1,501

To

$2,200

0%

30%

$2,201

and above

0%

(II)        A monthly FDW grant of $120 for households with frail or disabled elderly Singaporeans

Households which employ FDWs instead of tapping on home help and personal care services to care for their frail or disabled elderly will receive a grant of $120 per month to help them partially offset the cost of employing a FDW.

This grant is on top of the $95 FDW levy concession that households with elderly receive today. It will apply to households with a per capita monthly income of up to $2,200, and employ a FDW to look after an elderly who cannot perform 3 or more Activities of Daily Living (ADLs) or has severe dementia.

Households which qualify for this grant will be required to send their FDWs for relevant training in care giving[3]. The Centre for Enabled Living (CEL) provides an annual grant of $200 for the caregiver training.

B.        Enhanced subsidies for residential ILTC services

(I)            Community Hospitals (CHs)

Currently, Government subsidies are provided to CH patients with per capita monthly income of up to $1,400. Under the enhanced subsidy framework, subsidies will be extended to all CH patients[4].

There will also be an increase in subsidy levels for most CH patients, with the middle income seeing the largest increase of up to 50% points. See Table 2.

Table 2: Current and Revised Subsidy Framework for CHs

Per Capita Household Income

Subsidy Level

Current

Revised

$0

To

$600

60-75%

75%

$601

To

$900

50-60%

60%

$901

To

$1,500

0-50%

50%

$1,501

To

$2,200

0%

45%

$2,201

To

$2,700

0%

40%

$2,701

and

Above

0%

20%

(II) Other Residential Care

Similarly, to make residential long-term care services such as nursing homes and inpatient hospices more affordable for the middle income group, the qualifying per capita income for subsidies for such services will be raised from the current $1,400 to $2,200[5].

Subsidy levels will also increase by up to 40%, with the middle income seeing the largest increase. See Table 3.

Table 3: Current and Revised Subsidy Framework for residential ILTC Services[6]

Per Capita Household Income

Subsidy Levels

Residential

Current

Revised

$0

to

$600

60%-75%

75%

$601

to

$900

50%-60%

60%

$901

to

$1,300

30%-50%

50%

$1,301

to

$1,500

0%-20%

40%

$1,501

to

$2,200

0%

20%

$2,201

and above

0%

C.        Absorption of output GST for all subsidised patients

MOH will be absorbing the 7% GST charged for healthcare services consumed by subsidised patients in MOH-funded ILTC institutions. MCYS will be doing likewise for subsidised clients in eldercare and adult day care services under its charge.  This will lead to cost-savings for all subsidised patients and clients.

D.        Higher cash payouts for the disabled elderly under the IDAPE scheme

IDAPE[7] is a scheme that provides Government assistance in the form of a cash payout to disabled elderly who were unable to join ElderShield at its inception, because they were either already severely disabled[8] or had exceeded the maximum entry age.

To further assist these elderly, the qualifying per capita household income for the scheme will be raised from the current $1,000 to $2,200, in line with the revised subsidy framework for ILTC services[9].

Payouts under this scheme will also be increased from the current $100 and $150 per month up to $150 and $250 per month. See Table 4.

Table 4: Current and Revised IDAPE benefit payout

Per Capita Household Income

Current IDAPE benefit payout

(per month)

Revised IDAPE benefit payout

(per month)

$0

to

$700

$150

$701

to

$1,000

$100

$250

$1,001

to

$1,500

Not eligible

$1,501

to

$2,200

$150

All the above changes will be implemented by the third quarter of 2012.

MINISTRY OF HEALTH

20 February 2012


[1] Households with no income will be given maximum subsidies if the annual value of their place of residence is $13,000 or lower.

[2] Non-residential institutions include home care, home help services, day care centres, day rehabilitation centres, dementia day care centres, ex mentally ill day rehabilitation and hospice home care.

[3] The list of pre-approved training programmes can be found on the CEL website: (http://www.cel.sg/Schemes__Caregivers-Training-Grant.aspx).

[4] This applies to patients staying in subsidised CH wards (i.e. six to eight bedded wards) only. Households with no income will be given maximum subsidies if their annual value of their place of residence is $13,000 or lower.

[5] Households with no income will be given maximum subsidies if their annual value of their place of residence is $13,000 or lower.

[6] Long-term care residential institutions include sheltered homes, nursing homes, chronic sick hospitals, inpatient hospices, ex mentally ill rehabilitation homes and ex mentally ill sheltered homes.

[7] More information on IDAPE can be found on MOH website:

(http://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Interim_Disability_Assistance_Programme_For_The_Elderly.html)

[8] This means that the elderly are unable to perform three or more Activities of Daily Living (ADLs). ADLs include washing, feeding, dressing, toileting, mobility and transferring.

[9] IDAPE applicants from households with no income will be given $250 per month if the annual value of their place of residence is $13,000 or lower.

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