COS Speech By Minister of State for Health, Dr Amy Khor - Better Care for Our Seniors, Progress in Community Mental Health & Women’s Health, 12 March 2013

I will first address Members’ questions on ageing and mental health before updating Members on the issue of women’s health.

Introduction

2.            Let me start with ageing. Our population is ageing rapidly. We need to make sure that Singapore is ready to support our ageing population in every way.

3.            Our goal is simple: for our seniors to live happy and fulfilling lives, and to age gracefully. Last year, the Government introduced a suite of initiatives to make Singapore “ageing ready”. We raised the subsidies for intermediate and long term care (ILTC) substantially; and we announced that we will build more than 100 aged care facilities over the next five years to meet both the social and healthcare needs of our seniors.

4.            To support the expanding aged care sector, we project a need to increase manpower from 4,000 in 2010 to 15,000 in 2020. Dr Chia Shi-Lu asked about our manpower efforts. Last year, we provided additional funding to support the sector to raise salaries and to enhance staffing ratios. With these initiatives, we grew the workforce in the aged care sector by about 30% over the last two years to about 5,600 in 2012. As mentioned by Deputy Prime Minister and Minister for Finance in his Budget Speech, even as we expand our local supply of healthcare manpower, we will still need a significant pool of foreign healthcare staff. We will therefore continue to ensure flexibility in terms of our foreign worker policy so that healthcare institutions are able to fulfil their staffing needs.

5.            Separately, Dr Chia also asked for an update on the Healthcare Professional Conversion Programme. In 2012, we enhanced training allowances to encourage mid-career professionals to make the switch to nursing and allied health professions under WDA’s Healthcare Professional Conversion and Place-and-Train Programmes. This has led to an increase in enrolment from about 30 in 2011 to more than 50 this year. 

6.            This year, we will place emphasis in two more areas: one, enhancing the quality of aged care; and two, developing more options for seniors to be cared for at home and in the community.

7.            Let me start with enhancing the quality of care, an issue raised by Dr Chia.

Remaking Nursing Homes

8.            First, we want to remake our nursing homes. We are actively engaging Singaporeans and tapping on the creativity of architects to build nursing homes that are not just clinical care facilities, but welcoming, serene and modern homes for our seniors to recuperate.

9.            For the new nursing homes that we are planning, we give careful thought to the design to make them aesthetically pleasing yet functional.  An example is the future nursing home in Jurong East. Instead of a squarish residential block, the architect “breaks up” the massing to create a more interesting form. Green balconies are injected in between the towers, making the whole development more visually pleasing to the surrounding community. This will not look out of place within a residential area.

10.          Another example is the new Lions Home in Bishan East. As you can see, lush greenery features prominently to enhance natural cooling and to be aesthetically pleasing. From the outside, the effect is one of a waterfall of greenery.

11.          On the inside, there is also a garden and communal spaces on the ground floor where people living in the surrounding estate can enjoy.

12.          Beyond the hardware, we are evolving our nursing homes to be eldercare hubs that can benefit a wider community of seniors and their caregivers. Where space allows, we will expand their suite of services beyond nursing home care to include day care and other services for caregivers.

13.          The Man Fut Tong Nursing Home in Woodlands, for instance, offers day care, day rehab and home therapy services to seniors in the community. 69-year-old Mdm Ahesah Bte Abdullah is one of those who have benefited from Man Fut Tong’s expanded services. In 2011, she suffered a stroke that rendered her wheelchair-bound and she needed to undergo physiotherapy. Because she lives near Man Fut Tong, her caregiver can wheel her to the Home three times a week for her therapy sessions. Mdm Ahesah’s condition has improved vastly and she is now able to walk again.

Standards for Aged Care

14.          Second, we want to set clearer standards for different aged care services. Dr Chia asked about nursing home standards. I am pleased to inform him that MOH intends to introduce an enhanced set of nursing home licensing standards by 2015. Last year, we set up an industry-driven committee, comprising nursing home operators and healthcare professionals, to review our existing licensing standards and identify areas that can be enhanced. The committee has since drafted an enhanced set of standards for the nursing home sector. These enhanced standards differ from the current licensing conditions in a few areas.

15.          First, there is more specific articulation of standards in various aspects of clinical care, such as oral hygiene, continence management and falls prevention. Currently, these areas are implied but not specifically articulated in the licensing conditions.

16.          Second, the committee has enhanced standards in the social aspects of nursing home care, such as respecting residents’ dignity and caring for their emotional well-being.

17.          Third, the committee has added new standards in organisational excellence, covering the areas of human resource and financial management. This stems from the committee’s belief that good care must be underpinned by good governance.

18.          The set of standards is a first draft for consultation. We will engage the nursing home sector in the months ahead, to discuss these enhanced standards. These standards largely reflect the good practices existing in the sector today, so we do not expect a significant increase in costs. Nevertheless, MOH will continue to invest to develop the capability of the sector and allow ample time for nursing home operators to achieve these enhanced standards.

19.          Mr Patrick Tay also asked about setting standards for day rehab, day care and the upcoming senior care centres. I would like to inform him that we have similarly set up an industry-driven committee to review and set standards for the centre-based care sector. The committee started work in September last year and is expected to complete the standards by the end of this year.

More Options for Seniors

20.          Let me now move on to the second area of focus, which is to develop more options for seniors to be cared for at home and in the community. We are stepping up our efforts to develop home care services, to support caregivers who would like to care for their seniors at home rather than in a nursing home. Last year, we added 750 new home healthcare places, bringing the total capacity to more than 4,500.

21.          Take for example, 94-year-old Mdm Yap Leng Im. Mdm Yap suffered a stroke seven years ago and was wheelchair-bound since. Her family initially considered placing her in a nursing home, but opted to take care of her at home instead. Today, Mdm Yap lives in the comfort of her own home with her daughter-in-law and two grandsons, through the support of home care visits by the Home Nursing Foundation (HNF). HNF also provided training to Mdm Yap’s family members and foreign domestic helper so that they can better care for Mdm Yap at home.

22.          After the subsidy framework was enhanced last year, Mdm Yap now receives an increased subsidy of 80% to help cover the costs of her home care visits. And because her foreign domestic helper has been trained in care-giving, Mdm Yap’s family is eligible to receive an additional cash grant of $120 per month to offset the cost of hiring the helper. They will also receive a concession on their foreign domestic worker levy and have to pay only $120 instead of the normal rate of $265 per month.

23.          MOH will be going a step further. To encourage and facilitate home care, we will be convening an industry-led committee to review and chart new standards and strategies for the development of home care in Singapore. The committee is tasked to recommend a common system to assess the care needs of home care patients, articulate common standards of home care and identify new home care services that can be developed to meet unfulfilled needs today.

Relieving Cost of Caregiving at Home

24.          We are also beefing up support for our senior’s caregivers. Mr Christopher de Souza, during the Budget Debate, suggested giving an allowance to caregivers.  

25.          We do want to give families support in caring for their seniors. But we must not inadvertently monetize family ties and filial piety which come from the heart.

26.          There are practical ways to help caregivers. We can help them relieve the cost of caregiving at home. Deputy Prime Minister and Minister for Finance announced in his Budget Statement that we will expand the Senior’s Mobility Fund into the $50 million “Senior’s Mobility and Enabling Fund”. The SMF will go beyond a fund to promote mobility, to a fund that supports our seniors to live independently in the community. Mr Tay asked how the fund will be enhanced.

27.          First, we will expand subsidies beyond mobility devices to cover other assistive devices. Seniors can receive subsidies for more items such as motorised wheelchairs, commodes, geriatric chairs and pressure-relief mattresses. The fund will also cover spectacles and hearing aids.

28.          In response to feedback from VWOs and social workers, we will also simplify the application process for subsidies. Any senior living in a 3-room HDB flat or smaller will automatically qualify for 90% subsidy for devices that cost less than $350. There is no need for a detailed household income means test.

29.          Second, for seniors receiving government-subsidised home nursing or home medical services, and with per capita monthly household income of $1,500 or less, the enhanced SMF will provide between 50% to 80% subsidy for the cost of consumables such as dressings, diapers and milk feeds.

30.          Third, the enhanced SMF can also be used to subsidise transport costs for more seniors who are community ambulant to attend day rehab, dementia day care and renal dialysis centres. Mr Patrick Tay, Dr Chia Shi-Lu and Mr Muhamad Faisal Abdul Manap asked about transport subsidies to and from hospitals for medical appointments. There are already schemes for this. For instance, our Community Development Councils (CDCs) also work with a non-profit organisation, Caring Fleet Services, to provide dedicated transportation services to people with mobility difficulties by giving them vouchers to pay for transportation to hospitals, polyclinics and Specialist Outpatient Centres (SOCs). In fact, they use retrofitted vehicles that can accommodate these wheelchair-bound patients so that they do not need to use ambulances, which are for emergency purposes. In addition, through the “SMRT Gift of Mobility Programme”, our CDCs give out taxi vouchers to needy seniors to travel to hospitals and polyclinics.

31.          Under the enhanced SMF, we will also expand our support to help seniors accessing day services. We will provide transport subsidies for wheelchair-ambulant seniors receiving treatment at day rehabilitation centres and renal dialysis centres funded by MOH, as well as seniors receiving care at MOH-funded dementia day care centers (DDCCs). 

32.          I thank Members for your positive feedback on the enhanced SMF. When the changes take effect from the third quarter of this year, we believe that the enhanced SMF can benefit caregivers like Ms Masni Bte Jaafar. Ms Masni and her husband not only have to support their six children, but also need to care for her elderly parents. Her father suffered a stroke a few years back and is now bed-bound; while her mother suffers from diabetes and kidney failure. Both her parents are receiving home nursing services from TOUCH Home Care and require consumables such as diapers, milk feed and dressings. With the enhanced SMF, they will receive 80% subsidies on the cost of consumables, saving up to $4,000 a year.

Enhancing Respite Care

33.          Several Members also pointed out that caregiving can be tiring. Indeed, we recognise that caregivers cannot do it for 24 hours a day, 365 days a year. At some point, the caregiver may fall ill or simply need a break, and will need someone else to take over the caregiving temporarily.

34.          To relieve the stress of caregiving, MOH is working to make respite services more accessible and affordable. We are starting a pilot project by working with a few nursing homes to set aside some beds that can cater to respite services. Caregivers who need a temporary reprieve can place their elderly to be cared for in the nursing homes for a short period and enjoy up to 75% subsidy subject to means testing.

35.          This pilot will support caregivers like 63-year-old Mr Koh Kok Heng. Mr Koh has been taking care of his 60-year-old wife, Mdm Choo Ngee Neo, after she suffered a head injury that rendered her bed-bound. Recently, due to a toilet leakage, their flat will need to undergo a week of renovation work next month. The noise and dust from the renovation will make it not conducive for Mdm Choo to be cared for at home.

36.          With this new pilot, Mr Koh can admit Mdm Choo into a nursing home for seven days of respite care at a subsidy rate of 75%, while the renovation works are being carried out. The seven-day respite will also give Mr Koh a chance to rest and replenish, so that he can take even better care of Mdm Choo when she returns home.

Capacity of ILTC Sector for Seniors with Dementia

37.          Mr Sitoh and Mr Patrick Tay asked about the capacity and capability of our long-term care facilities to cater for seniors with dementia. I would like to inform them that our new nursing homes will include wards for dementia patients. Today, we have about 515 nursing home beds dedicated for seniors with dementia. By 2016, we will increase this by more than 400 beds. We will also increase our support to help nursing homes develop the right capabilities to manage these seniors. For instance, CGH and IMH have been providing training to staff from eldercare organisations, including nursing homes, on dementia care and behavioural management.

38.          Besides nursing homes, we also have 12 dementia day care centres which can serve more than 300 seniors per day. In addition, we will be developing more senior care centres by 2016 which will have the capability to provide dementia day care services.

Community Mental Health

39.          Ms Tin Pei Ling also asked about the capacity of our public mental health sector. Today, the IMH has about 2,000 hospital beds for patients who require inpatient care, with an average occupancy of 84% over the past three years. So far, this is sufficient but we will continue to monitor the situation.

40.          Our objective is, as far as possible, to have persons with mental illness reintegrated with society. But as Ms Tin pointed out, some with more severe illness may need longer-term care. Today, there are three psychiatric nursing homes with a capacity of about 650 beds. We will be expanding the capacity to 1,200 beds by 2020. We also have two psychiatric rehabilitation homes with 280 beds for those who need temporary residential care to help them reintegrate into the community. We will be increasing this to about 400 beds by 2016.

41.          I agree with Ms Tin Pei Ling and Ms Ellen Lee about the need to reduce the stigma of mental illness. Because of this stigma, many people who need help do not come forward for treatment. To address this, our strategy is to shift the locus of mental healthcare from institutions into community-based settings that are more accessible, and to integrate mental health services with those for physical health.

42.          We piloted two Assessment and Shared Care Teams, or ASCAT in short, last year to provide mental health treatment in the community. One team is located at Ang Mo Kio polyclinic and the other, which is temporarily sited in Khoo Teck Puat Hospital, will be moving out to a community location later this year. The two teams have helped around 400 patients to date. We intend to set up a total of six ASCAT teams across Singapore by 2016 to support up to 9,500 patients at any point in time. 

43.          GPs, too, play a crucial role in encouraging people to seek treatment for mental health, as they are often the first point of contact. Today, we have about 70 GPs collaborating with IMH to provide mental health care in the community. We hope to recruit a total of 100 GPs by 2016.

44.          To support the GPs, we also worked with VWOs to pilot Community Mental Health Intervention Teams or COMIT teams last year. COMIT teams provide counselling and psychotherapy services to support GPs in managing patients with mental illness. There are two COMIT teams today, in Upper Boon Keng and Yishun, and they have helped over 100 patients to date. By 2016, we intend to set up a total of ten COMIT teams to serve up to 10,000 patients.

45.          To further combat stigmatisation, we are increasing community outreach and education on mental health. Today, AIC works with a few senior activity centres to start up teams of volunteers in the community who can identify seniors with symptoms of dementia and depression, and refer them for early treatment.

46.          HPB is also working with community partners such as Silver Ribbon (Singapore), Singapore Association of Mental Health and grassroots organisations to promote awareness of mental wellbeing. In 2012, over 30 such events were organised, reaching out to about 25,000 people in the community.

Support for Caregivers of Mental Health Patients

47.          Ms Tin asked for more support for caregivers of patients with mental illnesses. The enhanced SMF and the residential respite pilot I described earlier will be able to support these caregivers. In addition, we are working with VWOs to provide support targeted at caregivers of dementia patients.

48.          The Alzheimer’s Disease Association (ADA), for instance, offers elder-sitting services. Seniors can be brought to ADA’s centre or be visited at home, where elder-sitters will befriend and engage them in simple mind-stimulating activities, giving their caregivers a few hours of respite.

49.          Another example is the “Dusk to Dawn” programme in St Joseph’s Home. Some dementia patients have “sundown” syndrome, where they cannot sleep at night, thinking it is day. This is a programme whereby caregivers can leave their loved ones with dementia at the Home at night, so that they can catch up on sleep and bring them home the next morning. There will be staff and volunteers in the Home to engage these dementia patients in meaningful activities through the night.

Building an Inclusive and Caring Environment

50.          Mdm Chairman, MOH hopes to engage the community at large, to build an inclusive and caring Singapore for our people. In the past year, reports of “NIMBYism” have made the news. But I think these isolated incidents are hardly representative of the majority of Singaporeans.

51.          Dr Chia asked about the City for All Ages (CFAA) project. I am pleased to inform him that the project is progressing well in its four pilot sites of Marine Parade, Bedok, Whampoa and Taman Jurong. While the project started with the objective of innovating new solutions to create senior friendly communities, we were pleasantly surprised to see how the project has served as a platform to garner community action for seniors.

52.          The energy I see on the ground is incredible. I see many volunteers, both young and old, walking their towns in the hot sun to identify areas of improvements to the town infrastructure that will make it safer for seniors to move around. In Marine Parade, as a result of volunteers’ efforts, the Town Council and the LTA, improvements to the town hardware are being systematically rolled out, such as levelling of void deck aprons and longer traffic light crossings.

53.          On top of that, over 50 new rest stops will be installed across the town so that our seniors can sit down and rest when they feel tired. This rest stop is a suggestion from Marine Parade residents. Even the design is chosen after a vote among residents!

54.          The software of Marine Parade has also been enhanced. For instance, the local senior activity centre called Goodlife! is now providing one-stop information and referral services for senior-related issues. The centre also links up with the Agency for Integrated Care to provide outreach and public education on dementia and depression, and works with the Changi General Hospital to provide social support for recently-discharged seniors.

55.          A group of volunteers has also been formed to befriend seniors living alone in Marine Parade. And the oldest volunteer you see here is Uncle Wai Chong who is all of 83 years old!

56.          We want to continue this positive momentum. I am pleased to inform the House that MOH plans to expand the CFAA project to another five to 10 more constituencies over the next three years, and will provide an award of up to $80,000 for each constituency which wants to start its own CFAA project.

57.          Mdm Chairman, our seniors have contributed much to Singapore. Now that they are old, we should create an environment that allows them to age happily and with dignity, in our midst. Our aspiration is to create a people movement across the island in every town, to make our city a senior friendly one, and the best place for our seniors to grow old in.

Update on Women’s Health Advisory Committee

58.          Ms Ellen Lee asked about health screening rates among Singaporean women. I agree with Ms Lee that more can be done to improve on our women’s cancer screening rates. According to the National Health Survey conducted in 2010, only about 48% of women aged 25 to 69 undergo regular cervical cancer screening and about 40% of women aged 50 to 69 go for regular breast cancer screening.

59.          The Women’s Health Advisory Committee (WHAC), which I chair, aims to encourage more women to undergo screening and to promote health among our women. In September last year, we introduced a resource kit called “My Journey to Better Health” to provide women with important health information on issues such as starting a family, weight management and breast and cervical cancer. To date, the kit has been distributed to more than 30,000 women. We target to reach 200,000 women by the end of this year.

60.          The Committee and HPB also worked closely with healthcare providers and grassroots organisations to increase public awareness of breast and cervical cancer through regular exhibitions and road shows held in the community during the Breast Cancer Awareness Month (BCAM) and the World Cancer Day (WCD). 

61.          This year, we aim to make cancer screening more affordable for women, particularly those from lower income households. The Committee and HPB will, over the next two years, work with VWOs and the private sector to help cover the cost of breast cancer screening for 15,000 women from low income households. Eligible women will only need to pay up to $2 for a mammogram, compared to the existing subsidised rate of $50 under BreastScreen Singapore. This two-year project will be introduced from 17 Mar 2013. Eligible women will receive an invitation letter to go for screening at a participating polyclinic x-ray centre.

62.          In addition, we are making screening more accessible by expanding the coverage of BreastScreen Singapore’s mobile mammogram screening service, the Mammobus, to more estates.  We will also be organising ferry services at selected estates to bring women to screening centres.

63.          To encourage working women to adopt healthy habits, HPB will expand the existing $15,000 annual Workplace Health Grant by another $5,000 a year for employers to create a supportive work environment to promote health among working women. Employers can use the additional grant to organise health promotion programmes tailored for working women, such as talks on child and maternal health, workshops on managing work and family, and classes on healthy cooking. Of course, men should be welcome to join these programmes if they want to. The grant can also be used to subsidise costs of breast and cervical cancer screening.

Traditional Chinese Medicine

64.          Before I conclude, let me thank Mr Low Thia Khiang for his feedback on the Continuing Traditional Chinese Medicine Education Programme. The objective of the programme is to help TCM practitioners raise their professional standards and acquire new skills to better serve their patients. We believe that continuing education is integral for their professional development, just as it is for doctors, nurses and pharmacists.

65.          Let me clarify that the TCMPB is introducing this in phases beginning with a voluntary system. We are not the first country to introduce CTE for TCM practitioners. Participation in CTE for TCM practitioners is in fact a compulsory requirement for the renewal of TCM practice licence in Taiwan since 1993, Hong Kong since 2005, China 2006 and Australia 2012.

66.          We have received feedback, similar to the ones raised by Mr Low. This is still a fairly new pilot, having only started in January this year. I assure Mr Low that the TCM Practitioners Board will carefully consider all the feedback received during this pilot phase when they review the programme.

Conclusion

67.          Mdm Chairman, every Singaporean wants to live healthily and age gracefully – to add life to our years as we add years to our lives. As a Government, we must help our people to reach this goal. Besides our aged care services, we must also encourage Singaporeans to lead healthier lifestyles. After all, a healthy lifestyle today is critical for healthy ageing tomorrow. Thank you.

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