KEYNOTE ADDRESS BY MR ONG YE KUNG, MINISTER FOR HEALTH, AT THE COMMUNITY CARE WORKPLAN SEMINAR

Health Companion to Seniors, for Life

Dr. Gerard Ee, Chairman, Agency for Integrated Care (AIC)

Friends and Partners in the Community Care Sector

1. I am very happy to join all of you today.

An Eventful Year

2. It has been an eventful year since we last met at this event. Let me start the speech by citing some of our key achievements.

3. We expanded capacity all over, starting with the Active Ageing Centres (AACs), but also Senior Care Centres and nursing homes. Capacity increase has been a quantum leap. I will talk more about that later.

4. What is more important is that we have started to offer more options for seniors to age in the community. Together with the Ministry of National Development, we opened the first Community Care Apartments, all very well subscribed. We will also introduce the Shared Stay-in Senior Care Services as a mainstream service. It was started by Red Crowns Senior Living. In the process, they did not totally follow the procedures. But we have straightened out the procedures, and it will be a mainstream service. A few seniors live together, with support from live-in caregivers hired by the service providers. It makes a lot more sense than every individual senior having a live-in caregiver.

5. We enhanced subsidies and grant schemes for long-term care, quite a significant increase. They will be effective from January next year and this will make long-term care more affordable, especially for lower- and middle-income households.

6. The success of our Health and Community Care sectors ultimately depends on people. Over the past year, we focused a lot of our initiatives on developing and retaining people. Over the past four years, our Community Care workforce has grown from 16,500 to 23,000 today. It is a very significant jump.

7. As our workforce expands, it is equally important to ensure our people are well taken care of. It is only when they are well taken care of that they can take care of others.

8. Over the last five years, we enhanced the competitiveness of remuneration in the sector. The Ministry of Health (MOH) introduced the Community Care Salary Enhancement exercise. Essentially, what this means is MOH supported the Community Care Organisations (CCOs) with funding support, and they can pass on the funding support to their workers as higher remuneration.

9. To better equip staff with relevant skills, we rolled out the Community Care Skills Standards Framework for AACs and this year, AIC expanded its Learning Network to offer 360 new courses by its appointed Learning Institutes.

10. We will also be taking steps to ensure a safe and supportive operating environment for our healthcare workforce. We launched the Tripartite Framework for the Prevention of Abuse and Harassment in Healthcare last year. Now, AIC, MOH and the CCOs have worked together to develop a similar implementation guide for the Community Care sector.

11. We will step up our public education campaign to emphasise our zero-tolerance policy to abuse and harassment of community care workers. The guide will be ready next month, and I encourage all our CCOs to implement the guidelines. I thank you all for your support, to stand alongside our community care workers, and give them the necessary moral and organisation support.

Impetus of Change

12. Now, let us focus our attention on the challenges and the work ahead. There is a lot of work ahead. Our healthcare system is undergoing quite a significant transformation. The impetus for change is our ageing population.

13. The population and proportion of seniors aged 65 and above is rising. It is about around 750,000 now, and will reach about one million in 2030. If half of these seniors have at least one chronic disease – and that is actually a conservative estimate – the number of seniors with chronic diseases will grow from 375,000 now to 500,000 in just five years. It is a 30 percent jump in numbers.

14. As age catches up, the number of seniors who require assistance with at least one activity of daily living (ADL) is expected to almost double within a decade, from 58,000 in 2020 to 100,000 in 2030. This increase is far more than the estimate for chronic illness. Because not only are we ageing, we also have more and more people in the 70 to 80s bracket, above 80 bracket, even in the centenarian bracket, and they are more likely to be frail.

15. More seniors are also expected to be staying alone – from 76,000 in 2023, to 122,000 in 2030. Many of them will need befriending and social support.

16. I gave all these numbers to illustrate that in a very few short years, there is a sharp spike in numbers, both in terms of the population of seniors, those who have chronic illness, those living alone, those who require assistance in one ADL. They will put us in a very different situation in 2030 compared to today. Is our system of community care ready for that? I will say that as of now, not quite. A lot more work needs to be done and we need to evolve the system urgently. It cannot be business as usual, and changes, even significant changes, will need to start now. Actually, it started already, but we need to accelerate the changes.

17. The major change is for the sector to become a lot more proactive, helping those who are healthy to stay healthy, and those with chronic diseases to manage them optimally, so that the disease does not progress and become debilitating. This is what we mean when we say the centre of gravity of healthcare will shift from hospitals to the community.

18. If you ask what is the major change in the healthcare sector for this term of government? I will say it is going to happen in the community care sector. This is where I think the major, the biggest change, will have to happen. What do we need to do to bring about these changes? Last year, at this workplan seminar, I spoke about CHOPE. I hope you all still remember. I didn't come up with an abbreviation for fun. It is actually significant, and we need to follow through. These are the five key areas for the Community Care sector to work on. They are C for Coordination of services; H for Healthcare in the community; O for Outreach to seniors; P for Partnership; and E for Engagement through a bigger range and better activities for seniors.

19. CHOPE continues to be a relevant framework to guide us in our transformation efforts. In terms of partnership and engagement, I will not talk too much about them today. I think the sector has stepped up and lots of work is ongoing. Today. I want to focus on the first three elements, where I think bigger changes and mindset shifts need to happen, which is C-H-O. We still have some way to go, and we still need to achieve breakthroughs quickly.

Stronger Co-ordination

20. Let me start with the first C, which is coordination. Community Care is varied and diverse, catering to seniors who have varying needs.

21. Take AACs for example, which cater mainly to the well seniors. We have expanded the network significantly. Our 225th AAC will open soon. Each AAC is making an effort to further extend its services and activities to be nearer to residents. They are using void decks, parks and Residents’ Network centres under the People’s Association, and even coffee shops.

22. We are now encouraging AACs to extend their activities to private estates, most of which have gardens and parks where activities can be held. Our Resident’s Hub at Jalan Mas Kuning, which Minister Desmond Lee and I opened last month, is one example. AIC has told me that more AACs are now interested in this initiative and will be coming on board.

23. Within the AACs, facilities have improved, supported by our $140 million Centre Expansion and Centre Refresh programmes. Some AACs have become very chic, very cool, almost like a resort. Let me show you some examples on screen. It is very nice.

24. Because of these expansion and improvement efforts, more seniors are participating in AAC activities. Over the past year, the number of seniors who participated has increased from close to 80,000 to now, 100,000. There is a long way more to go.

25. Senior Care Centres (SCCs) offer rehabilitation and day care. This is another key component of Community Care. We have expanded from about 140 centres five years ago to 170 today.

26. We have also enhanced the scope of Home Personal Care (HPC) so that it can more flexibly meet seniors’ needs as their conditions change. We call this the Enhanced HPC service and we are in the process of appointing providers.

27. We have also invested to expand nursing homes capacity very significantly over the past five years, from about 16,000 nursing home beds to 20,000 today.

28. The major change ahead, however, goes beyond expanding these individual community care services. We have been doing a lot of that. But what is more important is how we integrate them to better serve our seniors.

29. When families were bigger and there was more help, and the senior population smaller, it was logical for us to grow these individual services in a silo manner. Families could share the caregiving responsibilities and use the service only when they needed it. But now, the converse is happening, families are getting smaller and the number of seniors is getting more and more.

30. As seniors age, they will move from one service to another; and sometimes to and fro. They may need a combination of services as their needs become more complex. The Community Care system must therefore be able to help seniors access and move across services seamlessly.

31. That is why we need to bring together the four commonly used services together and integrate them. They are the AAC, SCC, Enhanced HPC and Home Therapy, and they form the Integrated Community Care Provider (ICCP). As a sector, together in this room, we know they are four separate services, with different providers providing each. Some providers provide a couple. But to a family, to a senior, they should see it as just one service – community care service for seniors, with one contact and one coordination point. In the community, all they see is one service when I need them.

32. For example, when a senior falls ill and you need rehabilitation or support services, ICCP may help him put together the relevant services to restore him back to health. What can this involve? Say, if his condition progress, becomes worse, ICCP can provide the Enhanced HPC and pull in other care services that he may need. When he recovers, he can return to the AAC to lead a more active lifestyle.

33. To bring about this, MOH and AIC have re-organised Community Care into smaller sub-regions and we encourage service providers in each sub-region to come together and form the ICCP.

34. I do not underestimate the complexity and intensity of this effort and how emotionally draining it can potentially be. But I am encouraged that providers in 56 out of 80 sub-regions have indicated your willingness to come onboard ICCP. I thank you for the support. I think we need to do this in order to transform the sector. It is the right thing to do. We have got to put Singapore and the welfare of seniors well above our individual organisations and together, we can make ICCP work.

35. I understand the concerns of small providers, who may worry about being crowded out by bigger ones within the ICCP of a sub-region. Let me assure you, given the numbers I have cited and the rate the population growth of seniors and the rate of growth of the demand for community care, no one will be irrelevant. To meet our growing needs, every organisation every CCO, will play a useful role, we need all hands on deck, and all your capabilities and resources.

Stronger Health Presence

36. Now let me move on to the second letter of CHOPE, which is H, and that is Health. We need the community to have a stronger presence of health services, so that they are more accessible. Here, I look to our clusters for all your resources and all your help to make this possible.

37. Woodlands Health Campus was open about a year ago. I visited it a few times. At my last visit there, doctors told me that they have encountered patients who are relatively young – in their 40s or 50s – with diabetes that was already at a very advanced stage. Some already have gangrene, sadly.

38. When you end up in A&E, you discover for the first time, there is this resident living near the hospital, with advanced diabetes and some with gangrene. Early actions, with a combination of lifestyle adjustments and medication, could have prevented the progression of their diseases. However, these patients either did not know they are sick, or even if they have enrolled in Healthier SG, gone for health screening, and know that they are sick, they did not follow up with their health plan. They thought it is okay, I still feel alright. But that is the danger of chronic illness. You always feel alright until you fall. This is a significant gap which Community Care can help close.

39. We have already rolled out Healthier SG. I think it is a very successful preventive care strategy, but for it to be truly successful, we have got to go beyond the GPs. The GPs needs to be supported and reinforced by effective Community Care services. While the resident may visit a public healthcare institution or see the Healthier SG GP a few times a year, he interacts much more frequently, daily or weekly, with the care providers in the community.

40. It is like occasionally going to Orchard Road to shop but on a daily, weekly basis, you go to the neighbourhood shops to shop. So they are not substituting each other. They complement each other in order for us to buy our necessities or daily activities.

41. Realising this, our three healthcare clusters have set up Community Health Posts (CHPs) throughout Singapore. Today, about nine out of ten AACs have a CHP at or near their centres. At the CHPs, nurses from the clusters attend to patients of the clusters that require follow ups, or walk-in residents from the community. From the many visits I made to AACs and CHPs, I would say most of the time, patients or residents who go to the CHPs tend to be existing patients of the clusters, as opposed to walk-ins.

42. It is a good start, but we can certainly do more, especially in catering to walk-ins. CHPs can help do a lot of things. You can help enrol seniors who have not signed up for Healthier SG, provided they walk in. You can ensure those who already know that they have chronic diseases but are not doing much about it, you can ensure that they take their medication and follow up with their appointments, also provided they walk in. You can provide lifestyle coaching and health advice so that seniors follow through their health plans, provided they walk in. You can offer to link them up with the hospitals and health services offered by the clusters, provided they walk in.

43. CHPs can be the nexus between Healthcare and Community Care, between medical care and preventive care. This is a strategic role. With an effective CHP model, AACs are more than places for senior social activities. It is where seniors can get support to achieve their health goals.

Comprehensive Outreach

44. The third area of change is in the way we conduct outreach.

45. From time to time, we hear about unfortunate instances where a senior living alone had passed away alone in the flat, and were not discovered for weeks, until you can smell the decomposing body, and you call in the Police and then you discover. It is always very sad when something like that happens. One of the reasons is that no one in the community knows the senior, or is regularly checking on him or her, even though he or she is living alone.

46. For my constituency, I have set myself a goal. I do not want this to happen ever again. Today, if and when such an instance happens, it will most likely be a senior whom we know, have regularly engaged and befriended, and are able to discover his or her passing at home very soon after it happens. This is thanks to the comprehensive effort by volunteers to conduct very extensive outreach, knock on every door to try to know every senior, especially those living alone, in the constituency.

47. We might wonder – why haven’t Silver Generation Ambassadors done that? After all, we have several thousands of them. They have outreached to almost 600,000 seniors. But these are seniors known to us based on official records of their registered addresses. We know that many seniors live with their children and grandchildren, not necessarily at their registered addresses.

48. The only way to find out, and I have come to the conclusion, is that there is no shortcut. You knock on every door until you discover that. When you have a database, over time, share with all the partners and update them. Who are the partners? Silver Generation Ambassadors, People Association, and other corporate organisational volunteers. They have to work together to visit every household in the community, and share data across, so that collectively, we know every senior in the community.

49. Knowing every senior is the first and basic step to identify those who may be at risk, so that we can befriend them and invite them to social events, to the AACs, benefit from CHPs, and participate as volunteers or even take on jobs in the community. We need to do this across every region in Singapore.

Health Companion to Seniors, for Life

50. Let me end by saying that we now have a refreshed team of political officeholders in MOH after the Cabinet reshuffle. They will assist me in overseeing and supporting the changes we just talked about.

51. We have Minister of State Rahayu who will continue her role in the Ministry. We have Senior Minister of State Koh Poh Koon, who had left MOH and now returned, and we welcome Senior Minister of State Tan Kiat How as a new member of our team. I have assigned all of them a role in Community Care. You will shortly know what the specific tasks that I have assigned them are. They are in the areas of manpower, coordination, evolving the community health post system and outreach. Each of them will take up one of these areas.

52. What will Community Care of the future look like?

53. It must be a system that every senior can count on, regardless of your health status. When we are well, community care prevents us from falling sick. If we are sick, it supports us to manage the disease and prevent it from progressing. If we become frail, it supports our families to take care of us and organises the different services that we need. If our families are unable to take care of us, the system then steps in, as a last resort.

54. The Community Care of the future is proactive, ubiquitous, and has a large preventive component. It bridges the role of hospitals, polyclinics, GPs, our families and ourselves in healthcare.

55. It is all around us in the community and in our homes – constantly nudging us, reminding us to do the right thing, health screening, take our medication, maintain a good diet, lead active lives, exercise.

56. Community Care of the future is like a caring friend and companion, encouraging us to look out for and take care of each other. It is not a service that we go to. It is a service that is all around us. It is like a Health Companion to Seniors, for Life.

57. We have begun our journey of change, and I thank all of you for your support so far. The changes ahead will be quite significant and can be quite disruptive and uncomfortable. But I believe it will make a huge difference to the lives of Singaporeans and to our seniors, to help us address what I feel is the largest social development in the coming decade, which is the ageing of our society. I invite everyone to come on board this change and co-create this future together. Thank you very much.

As of 29 May 2025, paragraph 4 has been amended for accuracy.