Speech by Dr Amy Khor, Senior Minister of State for Health, in response to motion on support for senior citizens, 6 February 2018

1.     Mr Speaker, the Ministry of Health supports this motion. As the Chinese saying goes, a senior in the family is like a treasure in the family. Or in Chinese, “家有一老，如有一宝。” We agree with Dr Lily Neo that our seniors are assets to our society and our country. Our seniors are key pillars in families, as parents and grandparents. They not only raise us, but also educate and bring up grandchildren with the right values and traditions. Many of our seniors are also leaders in the community, contributing their wisdom to community development. Today, more than 1 in 3 of our Pioneer Generation Ambassadors and around 1 in 2 of the Health Promotion Board’s Health Ambassadors are over 60. At the economic level, many seniors are experienced business owners, while our silver workforce is also emerging as a key driver of our economic development, complementing a younger workforce that is likely to shrink in the future.  

2.     Our vision for Singapore is a Nation for All Ages. The Ministerial Committee on Ageing launched a $3 billion Action Plan for Successful Ageing in 2015 with more than 70 initiatives across 12 areas to achieve this vision. In particular, we want to deepen our efforts to achieve positive ageing at three levels.

Confident Ageing  

3.     First, at the individual level, we want to enable our citizens to continue to develop and grow as individuals regardless of age. This includes enabling them to work for as long as they choose to. I am happy to share with Ms Joan Pereira that the number of nurses working past the retirement age of 62 years has increased. In 2017, over 1,400 retired nurses aged above 62 were working, compared to 1,200 in 2015. MOH will continue to work with our healthcare institutions to support flexible work arrangements for older nurses, so that they can continue to contribute. 

4.     At the same time, other seniors may seek purpose in their silver years not by working but by developing their interests or pursuing their own passion or causes. To support seniors’ interest in learning, we launched the National Silver Academy, which has engaged over 13,000 seniors in learning across more than 900 courses ranging from IT and media courses to art and wellness.

5.     Dr Lily Neo also suggested that the government set up policies and programmes to promote volunteerism amongst seniors. I am happy to share that in 2015, we established a $40 million Silver Volunteer Fund to support programmes that offer volunteer opportunities to seniors. To date, we have funded 22 volunteer programmes. One such programme is the Community Befriending Programme, or CBP, whereby the SVF provides programme funding to recruit, train and deploy active agers as befrienders to older seniors, including covering some out-of-pocket costs for these befrienders. Today, we have more than 850 volunteers befriending 2,500 seniors in 47 constituencies under the CBP. We expect this number to grow.  We note Ms Joan Pereira’s suggestion, and would be happy to explore time banking in future where there is ground up interest. 

6.     Confidence and purpose in our silver years is only possible with good health. We agree with Dr Lily Neo and Mr Gan Thiam Poh that the promotion of health and well-being of seniors is key. We have brought preventive health services to over 44,000 mature workers in 7 sectors, and exercise programmes and health talks to over 400,000 seniors in the community to keep them in good health. We have also enhanced subsidies under Screen for Life (SFL) to encourage more Singaporeans to go for health screening and follow up. Now, eligible Singaporeans will only need to pay no more than $5 for screening and the first post-screening consultation at CHAS GP clinics. Close to 25,000 Singaporeans aged 50 years and above have attended screening under the programme in the last 5 months.

Peace of mind and ageing-in-place

7.     Second, at the family level, we want to empower caregivers to better support seniors to age in place, with peace of mind.  I agree with Ms Cheryl Chan, Mr Kok Heng Leun and Mr Gan Thiam Poh that caregiver support and strong families are critical. Our efforts to enhance home and community care services are aimed at supporting seniors in the day, so that their caregivers can go to work with peace of mind. We have worked to increase the capacity, improve on accessibility and also raise the quality of our services. Between 2011 to 2017, we have increased the number of home and centre care capacity by 120% to 13,000 places. In 2016, we started Integrated Home and Day Care packages, which give seniors flexibility to be cared for either at the centres or at home. We are also building nursing homes in the community to support those who are too frail to be cared for at home. Ms Cheng Li Hui said that she cannot wait. I ask for her patience. I am sure it is worth waiting for. Ms Cheng spoke on improving the design and programming for our eldercare facilities. We agree and have been injecting more common spaces and greenery within our facilities. We are also co-locating eldercare and childcare facilities where possible, to facilitate inter-generational activities, to engage our seniors.

8.     We also agree with Dr Lily Neo that it is important for seniors to age in place in the community. Hence, we piloted the Care Close to Home programme to support the care and social needs of rental block seniors from Senior Activity Centres. Care Close to Home is an example on how we enable seniors to age-in-place, by effectively turning these precincts into in-situ “care homes” with assisted living support. At the same time, we have started building larger day care centres to serve as “Active Ageing Hubs” for seniors that can provide a range of services - from active ageing programmes for healthy and ambulant seniors to day care and rehab services for frail seniors. One such hub is at Whampoa, which now serves some more than 600 seniors across its active ageing and care services.

9.     Several members also asked about respite for caregivers. We have various options today. For caregivers who need help for a few hours over the weekend, they can leave their elderly at one of ten senior care centres across Singapore, where they will be looked after.  For those who need respite for a longer period, they can have their elderly cared for at nursing homes for several days, up to a month. At least 40 nursing homes are providing this service since it was introduced in May 2013. To date, over 1,600 people have tapped on these respite care services. In addition, the Eldersitter programme provides an eldersitter to look after seniors with dementia at their homes when caregiving arrangements are not available.  In the past 5 years, over 1,200 seniors have been supported through this arrangement.

10.     Today, caregivers also benefit from tax reliefs of up to $14,000 for taking care of an elderly parent with a disability. On top of this, they can also benefit from the lower Foreign Domestic Worker concessionary levy if they hire a FDW. If they are from lower and middle income families and are caring for an elderly person or a person with moderate disability, they can get an additional FDW grant.

11.     We recognise that new cohorts of seniors will have differing aspirations. Our active agers will want to plan ahead for themselves and stay independent for as long as possible.  We are evolving new models of care, and studying new forms of housing that provide seniors with support services as they age. Minister Desmond Lee will touch on this in his speech.

12.     Dr Lily Neo spoke on the importance of mobility and I fully agree.  Over 800,000 seniors have benefitted from the PAssion Silver card since its launch in December 2016, which lets them benefit from cheaper transport and merchant discounts. Our Agency for Integrated Care has also partnered Uber to launch UberAssist. Caregivers and seniors can now use the Uber app to call for a car to take them to their medical appointments. Around 800 drivers have also been trained to date, to help assist our seniors so that they can have a safe journey. More than 96% of our public buses are also wheel-chair accessible, and all will be so by 2020. All MRT stations and bus interchanges, and 97% of bus shelters are barrier-free.  Ms Joan Pereira also suggested that we design the signs and notices in public transport to make them easier to read for seniors. Since 2012, all new MRT stations have directional signage with high-contrast colours and larger font size.  MOT is in the midst of making similar enhancements to the signs at the older MRT stations.

13.     Ms Rahayu Mahzam, Ms Joan Pereira and Ms Cheryl Chan raised suggestions on healthcare affordability.  We share the sentiment of Members that peace of mind is important.

14.     Helping our elderly with their healthcare costs is a joint responsibility with the Government through subsidies, collective risk pooling in our community through insurance, and individual and family support through Medisave and personal savings. This is a hallmark of a caring and inclusive society.

15.     We have enhanced the reach of Government subsidies over the years. Through the Community Health Assist Scheme (CHAS), we have made outpatient care in the community more affordable, including for the management of chronic diseases. To Ms Rahayu Mahzam’s query, we continue to review the CHAS criteria. As with all schemes, there could be some who fall outside the eligibility criteria, but we are open to consider such cases on appeal. With the Pioneer Generation Package, all Pioneers enjoy special CHAS support above the CHAS Blue tier, and an additional 50% off subsidized treatments at polyclinics and public Specialist Outpatient Clinics.

16.     We have also made it easier to utilize Medisave for healthcare needs. The number of conditions covered under the Chronic Disease Management Programme (CDMP) has been progressively expanded over the years, and Singaporeans can now use Medisave to pay for 19 conditions.  Singaporeans aged 65 and above can also utilise an additional $200 of their Medisave through the Flexi-Medisave scheme. We will continue to review our healthcare financing schemes to ensure affordability for Singaporeans, while also ensuring sustainability for our healthcare system.  

17.     We made Medishield Life a universal health insurance scheme in 2015. To ensure affordability, premium subsidies are extended to the lower and middle income. Pioneers receive special PG subsidies. This has been a relief for many older Singaporeans, and valuable assurance that their large hospital bills are covered by insurance.

18.     ElderShield is also currently being reviewed to provide stronger support for disability in old age.  The ElderShield Committee had provided an interim update last week, with recommendations to make the ElderShield scheme universal for all future cohorts, to lower the inclusion age to 30 years old, for the Government to administer the enhanced ElderShield scheme, and for the claims assessment process to be improved. We welcome the recommendations, and will work with the Committee to consider how best to target support for those who may need more help with their premiums.

19.     There have been some questions on why the Committee recommended lowering the inclusion age to age 30.  The Committee explained that lowering the inclusion age for ElderShield distributes an individual’s own premium payment over a longer period during his working years to pay for his own future needs when he grows old. This will make premiums more affordable. The premiums paid are for their own long-term care needs, and are not intended for the young to subsidise the elderly for their long-term care needs. In fact, the very intent of tapping on insurance is to avoid shifting the financial burden to the young.

20.     I also note Ms Joan Pereira’s suggestion to review our nomenclature for ElderShield. The current name of the scheme reflects its objective, which is to protect Singaporeans from the costs of long term care, in particular during their older years where the risks of severe disabilities are higher.  We acknowledge the feedback however, and the ElderShield Committee will be reviewing the name of the scheme.

21.     We would like to assure everyone that no Singaporean will be denied appropriate healthcare. For those who continue to have difficulties with their healthcare bills, additional support is available through MediFund.

A Caring and Resilient Community 

22.     Third, at the community level, we want to build stronger communities of care to complement families in supporting our seniors.  This is especially important as family size shrinks and increasingly more elderly will live by themselves. 

23.     An area of focus for MOH is to work with both community-based VWOs and our healthcare providers, to integrate health and social support for our seniors. For instance, AIC has worked with VWOs to station care teams within senior activity centres, to do regular checks and support the activities of daily living of seniors living alone in rental precincts.

24.     We agree with Dr Lily Neo that technology can present new opportunities to bolster our community support for seniors. For instance, in the SHINE Seniors project at Marine Parade, sensors are placed in the homes of seniors living alone so that VWO staff or volunteers can respond to calls for help. Another example is Changi General Hospital’s Care Line, which is a 24-7 call centre that can respond to calls for help from seniors living alone in the community. We are also conducting a nationwide pilot of tele-rehabilitation that allows seniors to follow up with their rehab exercises in the comfort of their homes, post discharge from hospitals. Khoo Teck Puat Hospital is also using tele-health consultations to support new nursing homes in better managing residents who are near the end-of-life.

25.     Given the magnitude of population ageing, formal services alone are not enough. I agree with Mr Henry Kwek, Ms Tin Pei Ling, Ms Cheng Li Hui and Ms Rahayu Mahzam that we need to rally the whole community to come together to support our seniors.  We would like to thank our members who have spoken out in support of these initiatives, and helped with bringing our communities together on the ground. The Community Networks for Seniors, or CNS initiative, was introduced in Budget 2016, as a pilot of what would eventually serve as a national community-based support system to help our seniors age well. In essence, it coordinates a strong local network of health and social care partners to support seniors, as a complement to family support, enabling our seniors to age confidently in the community. For well seniors, we want to keep them active and healthy for as long as possible. For those who are lonely, we find them a friend; and for those with multiple needs, our aim is to get them holistic help quickly.

26.     The CNS has been piloted in Tampines, Choa Chu Kang and Marine Parade.  As we have heard from Ms Cheng, it has been well received by all stakeholders.  To date, CNS has activated more than 70 RCs to hold regular preventive health and active ageing activities and engaged more than 70,000 seniors. There are now more than 1,500 senior attendances for these programmes on a weekly basis.  CNS has also matched more than 600 seniors to befrienders and assisted about 800 seniors who have complex social and health needs.

27.     Based on what we have learnt from CNS, we plan to strengthen this effort.  More details will be announced at the Committee of Supply this year. However, our success in building communities of care hinges on support and partnership from the wider community. Therefore, I fully support Mr Kok Heng Leun’s suggestion to step up public education and promote greater awareness of the process of ageing and needs of seniors. Together with community based organisations, we have made efforts to promote awareness of end of life issues and palliative care, and we have also launched an exhibition on ageing, called Dialogue with Time, at Science Centre, which has attracted over 10,000 visitors since its opening last November. We will continue to invest in public education.

Conclusion

28.     Longevity is a blessing and not to be spent in sickness or loneliness.  If we can work together, ageing need not be feared. We can enable seniors to age positively with purpose and grace, empower strong families that can care for seniors, and build a cohesive and resilient community able to thrive in the face of population ageing.  The Ministry of Health and Ministerial Committee on Ageing look forward to working with all members and Singaporeans to realise a Nation for All Ages.

29.     刚才听了郭庆亮先生的演讲，我很感动。我也很认同他的看法。人，总有生老病死。但我们要让年长者的晚年过得精彩，要让他们有尊严地养老。政府会不断努力，打造一个亲乐龄的环境。但最无价的，是亲情和关怀。所谓老吾老，以及人之老，让我们每一个人都拿出爱心，一起携手为我们的年长者建立一个温馨的社会。 谢谢。