Seminar And Minister's Dialogue Session With Providers Of Step Down Care

04 Jul 2001

By Mr Lim Hng Kiang

Theme: Enhancements for step-down health care for the elderly

Ladies and gentlemen,

Introduction

It gives me great pleasure to welcome you to this seminar and dialogue session.

In July last year, I announced the Framework for Integrated Health Services for the Elderly at a dialogue session with you. Today, the purpose of the seminar and dialogue is for us to give you an update on the Framework and other developments related to step-down health care for the elderly, and share our experiences in the last year with you. We will also set out the priorities for the next stage of development of step-down care for the elderly. This seminar is also an opportunity for us to get your feedback and suggestions for new ideas to improve the care and services.

Update on developments in health care for the elderly

Our objectives for health care for the elderly, are first, to keep our elderly healthy and active; second, to provide accessible and appropriate health services to those who require the services; and third, to ensure that the services are affordable for both the short and long term. In working towards these objectives, my Ministry has, in the last one year, introduced and implemented a number of programmes and financing schemes. Some of the programmes include the Community Health Screening Programme, Comprehensive Chronic Care Programme and Primary Care Partnership Scheme. We have provided a write-up which we hope will give you a comprehensive picture of what we are doing to provide health services for the elderly. I shall leave you to read it at your leisure. (see Annex)

Update on Framework for Integrated Health Services for the Elderly

Step down care is a key component of health care for the elderly. We discussed about the Framework last year and the key features of the Framework were rolled out progressively. So far, 3 community hospitals and 4 nursing homes have been approved by the Ministry of Health and given additional funding to provide their services under the Framework. The increase in funding is in the region of an additional 10% of the norm cost for community hospitals and 8% for nursing homes.

The handout will also give an update on the implementation of the Framework. We will have three presentations later on to provide the regional hospital, community hospital and nursing home perspectives of the provision of step-down care and services for the elderly. The presentations will give us a sense of the progress, the types of problems faced and how we can improve the services as we go along.

Priorities for next stage

Besides getting an update on the implementation of the Framework, I would like to spend some time talking about our priorities for the next stage of development of step-down care for the elderly. We have identified four areas that we should work on.

Professional development for home health care

First, community care and home care. These are important components of step-down care. My sense is that institutional step-down care has developed a momentum of its own. This is because in the past 5-6 years, my Ministry has been placing significant emphasis on standards and funding of institutional care. We need to similarly direct our energies to community and home care. I believe our capacity for community and home care needs to be built up. Community and home care can play a bigger role and can help delay the institutionalisation of our elderly.

Community-based services like day rehabilitation centres and home care services like home medical and home nursing care are available but can be made more extensive. Take home medical care as an example. Today, it is provided by several Voluntary Welfare Organisations (VWOs). However, because of limited resources, the service availability is patchy and is generally confined to the lowest 10^th percentile income group of the population. We need to address how we can improve the service provision to say, the lower 50% income group of the population. We also need to ensure uniform standards of provision and care. If community and home care services can be improved and made readily available, we can then discharge the elderly who are sufficiently recovered or rehabilitated in the nursing homes back to their own homes.

Operational management of step-down services

Second, operational management of step-down services. We want ideas on how operational management and service delivery can be improved. A centralised agency, the Integrated Care Service (or ICS) was set up in May this year so that the placement of patients in the hospitals to VWO nursing homes can be better co-ordinated. This is a joint project undertaken by the National Healthcare Group and Singapore Health Services. The ICS liaises with nursing homes for appropriate placement of the patients. I urge all operators of step-down facilities to give their support and co-operation to ICS so that the placement of patients can be optimised. In the longer term, ICS's role should not be limited to placement of hospital patients in nursing homes. We will discuss how its role can be expanded -- for example, it can accept applications for nursing homes from members of the public directly and co-ordinate their placement in step-down facilities.

Financing schemes

Third, financing schemes. At present, subsidised health care is provided to the elderly at the hospitals, polyclinics and step-down facilities. The service is very heavily subsidised - 75% subsidy at the polyclinics, 50% subsidy at the Specialist Outpatient Clinics and up to 80% subsidy for inpatient care. For step-down care, those from the lower income group can receive as much as 75% subsidy.

(a) Means test and 3-tier subsidy framework for VWO nursing homes

In July last year, we implemented means testing and the 3-tier subsidy framework for VWO nursing homes. We would like feedback from the VWO nursing home operators on the means test and subsidy framework. We understand that some aspects of the means testing scheme give operational problems to your staff. I am pleased to announce that we will modify the means testing scheme to make it simpler. Ministry of Health will no longer require you to assess whether there are spare rooms to moderate the subsidy given. In other words, there is no moderation for property for all elderly who own or co-own HDB property. However, elderly who own or co-own private property do not qualify for subsidy. I am sure you will agree that this is fair. We will continue to review the parameters for the means test so that more elderly will benefit from the subsidies that we provide.

(b) Medifund

My Ministry has also extended Medifund support to residential step-down facilities in April this year to assist the elderly poor who cannot afford to pay subsidised fees. This measure should help reduce the amount of funds which VWOs need to raise and enable VWOs to focus more on providing good quality care. The Medifund interest income budget allocated to the VWOs is doubled from $1.7m to $3.4m this financial year. We encourage VWOs to apply for Medifund accreditation so that funds can be allocated to them to help the needy patients.

(c) Severe Disability Insurance

Another avenue to make health care affordable for the elderly is to introduce a severe disability insurance scheme to help defray out-of-pocket expenses in the event of severe disability. It is estimated that up to 8% of Singaporeans above the age of 65 years suffer from severe disability and require long term care. As only a relatively small proportion of elderly would require such care, we feel that risk pooling through insurance, as compared to individual savings, is a more pragmatic approach. We are working out the key features of such a severe disability insurance scheme. Our thinking is to set it up as an actuarial insurance scheme, just like Medishied. This scheme should be self-sustaining, with premiums set at a level which is commensurate with the underlying risk of the insured and the insurance benefits.

The Activities of Daily Living or ADLs will be used for the assessment of disability. Any elderly person who is unable to perform 3 or more ADLs will be eligible for the insurance payouts. The pay-outs from this scheme will cover institutional care as well as care of the disabled at home with community-based services. In other words, the insurance payout will be in the form of a cash benefit and not tied to the re-imbursement of institutional care. This is in line with our philosophy of promoting family support and community-based services for the care of the elderly.

We are still sorting out the other key features of the severe disability insurance scheme. We are confident that such a scheme would make step-down care for the elderly more affordable.

Communication plan

The fourth priority is communication with the public. Although we have many programmes, services and financial schemes in place for the elderly, we believe that many elderly may not be aware of what is available. We would like more elderly to make use of the various programmes and schemes that we have set up. Over the next few months, we will try and reach out to the elderly in the community through the grass roots organisations and other means to increase their awareness of the availability of the various programmes and services that I have mentioned. These face-to-face sessions will allow residents to ask questions and clarify doubts or uncertainties. In this way, we hope our senior citizens can be confident that their healthcare needs are catered for in an affordable way.

Conclusion

Let me conclude by saying that your views, ideas and feedback are important to us in our plans to improve step-down services for the elderly. I look forward to your active participation at the dialogue session later this morning.

• Annex (21 KB)