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SINGAPORE : Several MPs have called for better integration between healthcare and community services for the elderly.
Madam Halimah Yacob, MP for Jurong GRC, said the current state of step-down care services for the elderly is not satisfactory. She was speaking on Monday during the debate on the Health Ministry's budget estimates in Parliament.
She said: "Some elderly prefer to stay in hospitals long after they have recovered because they can tap into their Medisave for in-patient stays. Home-care services for the elderly is lacking and, if available, is not affordable to many. There are also not enough people trained in geriatric care at all levels among healthcare providers."
Madam Halimah also raised concern over whether there are adequate places in nursing homes as the population is ageing rapidly.
Acknowledging there are gaps in the current step-down care facilities, Health Minister Khaw Boon Wan announced that from April this year, the Integrated Care Services will be upgraded into an Agency for Integrated Care (AIC).
Starting with Changi General Hospital and NUH, the AIC will equip public hospitals with resources, including additional care coordinators.
These coordinators will help ensure that patients who are fit for discharge, but who have multiple complex care needs, are transferred to appropriate step-down care providers and receive necessary medical and social services.
The agency and its services will cost S$20 million over four years.
Keeping nursing home beds affordable and accessible is another key focus.
While bed occupancy rates in nursing homes run by voluntary welfare organisations are high, Mr Khaw said there are 1,000 vacant beds available in private nursing homes.
So the Health Ministry is tapping on this spare capacity via a portable subsidy scheme that is being refined. A number of nursing home sites will also be released via tender in line with demand.
But even as step-down care facilities are being expanded, Mr Khaw also issued a reality check. He said it is important not to "over-medicalise" care for the elderly.
Explaining, Mr Khaw said high-tech medicine costs a lot of money and often results in a poorer quality of life for elderly patients.
Mr Khaw said: "As we busy ourselves with our work and our family, we should sometimes take a pause and reflect on how people spend their last moment. Death is not a taboo subject to be left unspoken.
"In fact, the more we think seriously about death, the more likely we will know how to live life to the fullest and make each moment and each day the most meaningful possible."
One example Mr Khaw gave of active ageing was in the Japanese village of Ogimi. It has 3,500 residents of whom 17 are more than 100 years old. And the Okinawans lead active, happy and independent lives, with few bed-ridden in nursing homes.
But in Singapore, he said most of those who are in their 90s live in nursing homes and chronic sick hospitals. Mr Khaw said this age group poses the greatest challenge to healthcare systems around the world.
For example in the United States, Medicare which funds the medical care of the elderly takes up 3 percent of the US GDP and one quarter of Medicare is spent supporting the last year of patients' lives.
One reason is that current healthcare systems largely skew the practice of medicine towards high-tech medicine at great financial cost and often with low quality of life for the patients.
So Mr Khaw said a different approach is needed: "Proper chronic care should be carefully designed for the long term, with appropriate level of resources, usually low-tech care, and most critically with strong co-operation by patients and their families.
"Chronic care is a very different care regime from acute care. But when high-tech acute care is mindlessly extrapolated to cover long-term chronic care for the elderly, it is not at all surprising that problems in the US and other countries have arisen." - CNA/ch
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