Speech by Ms Rahayu Mahzam, Senior Parliamentary Secretary, Ministry of Health, on Adjournment Motion on Dementia

NOTICE PAPER NO. 1443
NOTICE OF ADJOURNMENT MOTION
FOR THE SITTING OF PARLIAMENT ON 20 OCTOBER 2022

Name and Constituency of Member of Parliament
Ms Poh Li San
MP for Sembawang GRC

PREPARING SINGAPORE FOR DEMENTIA

ANSWER

           Mr. Speaker, I thank Ms Poh Li San for her suggestions to prepare Singapore for dementia. This is an important topic, given our ageing population and rising number of persons with dementia.

2.          MOH adopts a three-pronged approach to address dementia. First, strengthening prevention and early detection. Second, building capacity of care services. Third, enhancing support for caregivers.

3.             Beyond healthcare, I will also share how MOH has collaborated with different agencies, community groups and businesses to build more caring and dementia-inclusive communities.

(1) Strengthening Prevention and Early Detection

Prevention, Awareness

4.             Adopting a healthy lifestyle can reduce the risk of dementia. A 2020 report by the Lancet Commission [1] estimated that 40% of dementia cases can be prevented or delayed by addressing 12 modifiable risk factors, including diabetes, obesity, and hearing loss. Through Healthier SG, we will empower our population to improve their health, such as through regular exercise and healthy eating. In addition, programmes like functional screening also allow us to identify seniors with hearing impairment and fit them with hearing aids. This enables seniors to maintain social engagement with others, which helps to lower the risk of dementia.

5.             Health Promotion Board (HPB) and Agency for Integrated Care (AIC) conduct campaigns and provide resources through portals like HealthHub and DementiaHub.SG, to educate the public on common risk factors and signs of dementia. Through education, we hope to de-stigmatise dementia and encourage early help-seeking. 

Early Detection, Diagnosis

6.             Early detection of dementia is important so that individuals receive timely treatment. Nevertheless, there is no clear evidence internationally, that general dementia screening in persons without recognised signs or symptoms of cognitive impairment, is an effective public health intervention. Hence, our current efforts in early detection continue to be targeted at those at risk.

7.             Within the community, we have outreach teams, known as CREST[2], that proactively identify seniors at risk of dementia and refer them for assessment. As of December 2021, we have 68 CREST Teams. They have reached out to over 510,000 participants through outreach events, and provided assistance to more than 32,000 persons. Active ageing centres (AACs), polyclinics and trained GPs also help to identify seniors with suspected dementia and refer them for assessment.

8.             These cases will be referred to memory clinics in polyclinics and hospitals to confirm the diagnosis and cause of dementia. More than half of our polyclinics currently provide these services, and we are in discussions to bring more polyclinics on-board.

(2) Building Capacity of Dementia Services

9.             Various care services support persons at different stages of dementia.

Community Care

10.          Majority of dementia cases have mild-to-moderate needs and can be supported in the community. Dementia Day Care (DDC) services provide custodial care, cognitive stimulating activities and reminiscence therapy, to improve or maintain the senior’s well-being. We have more than tripled the capacity of DDCs from 1,000 places in 2015 to 4,200 places in 2021. We also have Community Intervention Teams (COMIT) that provide psychosocial interventions like counselling and case management. In FY2021, COMIT teams supported a total of 11,100 clients.

Inpatient Services

11.          A small group of dementia cases may require inpatient care as their condition deteriorates.

12.          Majority of nursing homes can care for persons with dementia. From end-2015, we have added 4,000 nursing home beds to reach a total of over 16,000 beds in end-2020. Upcoming nursing homes developed by MOH are also built with dementia-friendly provisions like therapeutic gardens and closed-loop wandering paths. The Member stated that the current wait time for a nursing home bed is 9 months to a year. To clarify, the median wait time is currently around 1 month, although this may be longer for some seniors who have specialised care needs, or specific preferences.

Clinical Manpower

13.          The Member asked about our pipeline of clinical manpower. Today, all doctors are trained to provide basic management of dementia conditions Specialists like geriatricians and psychiatrists are equipped to manage more severe conditions associated with dementia. As at December 2021, there are 152 geriatricians and 277 psychiatrists registered with the Singapore Medical Council (SMC). This represents a 50% and 15% increase respectively, from 2017. This translates to 2.8 geriatricians and 5.1 psychiatrists per 100k population[3]. There is no international consensus on the optimal ratio of geriatricians and psychiatrists to population.

14.          MOH has also been increasing the number of residency training positions for geriatric medicine and psychiatrists. We will continue to review and adjust the pipeline of medical specialists to support ageing population needs.

Financial Support

15.          We provide multiple layers of financial support to ensure that long-term care costs remain affordable. Firstly, we provide means-tested subsidies of up to 80% for services like DDC. Secondly, if dementia has impacted an individual’s ability to perform activities of daily living, grants like Pioneer Generation Disability Assistance Scheme and CareShield Life insurance payouts would further help to defray the cost of care. Lastly, MediFund will provide support for those who need further help. As announced earlier this year, we will also enhance the Home Caregiving Grant to defray caregiving costs.

16.          Social Services Agencies (SSAs) play a key role in providing long-term care services and support for caregivers. Besides direct funding for programmes and services, the Government also provides dollar-for-dollar matching grants for donations to SSAs through the Community Silver Trust.

(3) Enhancing Caregiver Support

17.          Caregiving is an important responsibility.

18.          The Member asked about support for (a) caregivers of newly-diagnosed individuals; (b) caregiver training; and (c) working caregivers. Let me address these questions.

Post-Diagnosis Support

19.          Upon diagnosis, the caregiver may not fully understand the condition, or know where to seek help.  We have therefore started the CREST-Post Diagnostic Support (PDS) pilot, to proactively reach out to families upon diagnosis, link them up with resources, and equip caregivers with coping strategies. As of December 2021, there are two CREST-PDS teams, and we plan to expand the number in 2023.

Caregiver Training

20.          The Caregivers Training Grant (CTG) provides a $200 annual subsidy for attending courses, including on dementia care where caregivers can learn to better manage their own stress and well-being. We will continue to review how to better support caregiver training.

Working Caregivers

21.          For working caregivers, MOM has worked with tripartite partners to encourage adoption of flexible work arrangements (FWAs). Today, a vast majority of employees have access to FWAs. A new set of Tripartite Guidelines on FWAs will be further introduced by 2024 that will require employers to put in place a proper process to fairly consider and respond to employees’ request for FWAs.

22.          Caregivers can also tap on various community care options for their loved ones.  These include DDCs and the Night Respite Care pilot for those experiencing sundowning.

(4) Multi-Agency Collaboration to create a Dementia-Friendly Society

23.          As the Member pointed out, persons with dementia face complex challenges such as safety and mental capacity. We must take a whole-of-society approach to address these issues.

Dementia-Friendly Communities, Private Sector Involvement

24.          In 2016, AIC launched the Dementia-Friendly Singapore (DFSG) initiative to establish more dementia-friendly communities (DFCs). Within a DFC, networks are created where residents, businesses and grassroots leaders are trained to look out for persons with dementia. Go-to-Points (GTPs) are also created to serve as “safe return” points for those who might be lost. The initiative was well-received, and we have since established 15 DFCs across Singapore.

25.          AIC will be launching a dementia campaign next month to rally more community and corporate partners to join us in making Singapore more dementia-friendly. We will expand our efforts to five sectors that regularly serve seniors, namely: (a) Transport; (b) Building; (c) Arts & Leisure; (d) Banking; and (e) Retail.

26.          The Member highlighted our collaboration with SMRT. Besides Transport, venues for the Arts have also started catering programmes for persons with dementia. In 2016, Esplanade launched the ‘Sing Out Loud!’ programme, to help persons with dementia deepen engagements with their caregivers through singing. Last year, Esplanade also became the first Arts venue to become a dementia Go-To-Point (GTP), and their staff also received basic training to assist visitors with dementia.

Infrastructure and Built Environment

27.          Creating a dementia-friendly physical environment is important for persons with dementia to move around safely and participate in social activities.

28.          For instance, Nee Soon Town Council worked with stakeholders to paint HDB blocks with large block numbers and contrasting colours to help residents with wayfinding.

29.          AIC is also working with Centre of Livable Cities (CLC) and Singapore University of Technology and Design (SUTD) to study Dementia-Friendly Neighbourhoods. The learnings gathered will be developed into a set of design guidelines to make the built environment safer and easier to navigate. HDB will continue to explore incorporating such dementia-friendly features into new developments, and in existing estates through upgrading programmes.

Employment

30.          The Member also asked about micro-jobs for persons with dementia. MOH and MOM will work with tripartite partners like SNEF and NTUC to enhance the understanding of dementia at the workplace through educational materials and encourage employers to hire such persons where they are able to meet the operational needs of businesses.

Protecting the Interests of Persons with Dementia

31.          Persons with dementia may find it increasingly difficult to make decisions independently. Seniors with mild dementia, or even those who are well, should plan ahead when they still have mental capacity, to give themselves and their loved ones peace of mind.

32.          MOH, MSF and PSD are working to increase awareness and adoption of instruments such as the Lasting Power of Attorney (LPA) and Advance Care Planning (ACP). We launched the My Legacy portal in 2020 to raise awareness on planning ahead and serve as a one-stop portal for end-of-life related matters. It contains an LPA-ACP tool which allows users to make both documents at one go. This complements communications and engagement efforts such as the annual ACP week campaign led by AIC and involving our health and community care partners.

Conclusion

33.          Planning for dementia is a continuous effort. We have made good progress, and will continue to study further strategies to enhance dementia care.

34.          Let us work together to build a dementia-inclusive Singapore and support persons with dementia to lead purposeful and dignified lives.

[1] Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248):413-446. doi: 10.1016/S0140-6736(20)30367-6

[2] Community Resource, Engagement and Support Team.

[3] Based on a total population of 5.4 million in 2021