Upgrade of home, centre-based services needed as they become main form of long-term care for elderly: Study

Ministry of Health figures showed around 14,000 people used subsidised home- and centre-based services in late 2017, up from 12,000 the year before. In contrast, the number of subsidised nursing home residents has remained stable at around 10,000 ove
Ministry of Health figures showed around 14,000 people used subsidised home- and centre-based services in late 2017, up from 12,000 the year before. In contrast, the number of subsidised nursing home residents has remained stable at around 10,000 over the past two years.ST PHOTO: KELVIN CHNG

SINGAPORE - An upgrade of home and centre-based care services in Singapore is needed as more seniors are being cared for outside of hospitals and nursing homes in fast-ageing Singapore, a Lien Foundation study on long-term care services revealed.

Citing Ministry of Health (MOH) figures, the study said around 14,000 people used subsidised home and centre-based services in late 2017, up from 12,000 the year before.

In contrast, the number of subsidised nursing home residents has remained stable at around 10,000 over the past two years, signalling a shift in the main mode of long-term care for seniors.

As the Singapore population is rapidly greying, more needs to be done to help seniors age in place, the study concluded. It highlighted areas such as funding, capacity, affordability, manpower and regulation as key areas of focus.

The number of people in Singapore aged 65 and above crossed the half a million mark in 2017 and is set to double by 2030.

"This is a study that impacts every one of us... If we want to be sustainable as an ageing society and age healthily and happily, we actually need to put in the steps now rather than wait for the demographic explosion to take place," said National University of Singapore (NUS) associate professor Elaine Ho at a media briefing on Tuesday (Aug 14).

She co-authored the study with NUS associate professor Shirlena Huang. Both are from the Geography Department and Social Service Research Centre.

The study sought feedback from 103 individuals, including interviews with 50 non-profit and private care provider representatives, government representatives, experts in the field of ageing as well as caregivers.

They found that despite the increase in demand for home and centre-based care, only 2.5 per cent of Singapore's $9.8 billion healthcare budget, or $240 million, was spent on such care in 2016 -the latest year for which figures are available.

And despite a substantial rise in long-term care spending by MOH in recent years - $800 million in 2016, up $200 million from 2015 - the spending amounted to only 8 per cent of the healthcare budget and 0.19 per cent of Singapore's Gross Domestic Product for the year.

By comparison, advanced nations from the Organisation for Economic Cooperation and Development (OECD) spent an average of 1.4 per cent of their GDP on long-term care in 2014.

The study acknowledged that home and centre-based capacity has more than doubled in recent years. There were 13,000 places in 2017, up from 5,900 in 2011. Another 3,200 places will be added by 2020.

Yet, the report found some evidence that capacity may still be falling short of need. For instance, the Agency for Integrated Care (AIC), which coordinates Singapore's long-term care services, received 7,800 referrals for day care services in 2015, when only 3,500 day-care places were available.

There were 5,000 places available in 2017, but this still fell short of the 2015 demand, and the need has likely increased since then.

Cost is also a concern. While the vast majority of people want to age and be cared for in the comfort of their own homes rather than in institutions, the costs of community care can be considerable, the report found.

A family looking after a severely disabled senior at home could pay up to $3,100 per month, including transport and consumables before subsidies. This is higher than the median full cost of $2,400 for looking after the same person in a nursing home run by a voluntary welfare organisation.

Ms Radha Basu, director for research and advocacy at Lien Foundation, said even as Singapore works to enable seniors to remain healthy, active and engaged for as long as they can, it must be mindful that more will need care and that quality long-term care can be expensive.

She added that an average of only 13 per cent of seniors use formal long-term care services in the 26 member-states of the Organisation for Economic Cooperation and Development (OECD).

Said Ms Basu: "The important point to note from other advanced ageing economies is that although relatively few people need formal care services, the costs of care - and the years spent needing care - can be high and unpredictable. Thus, there is a compelling need for better social protection, especially as family sizes shrink, domestic workers become more expensive and care needs become more complex because of advanced age."

Despite considerable government efforts in the area, attracting and retaining workers in the sector is also a challenge, the report found.

As of March 2017, there were 8,300 direct staff in the long-term care sector working in nursing homes, day care centres for seniors and in providing professional home care services. This number is expected to grow to 12,000 by 2020, according to Lien Foundation's earlier study on long-term care manpower.

MOH said on Tuesday that it welcomes the study. "The report affirms the importance of taking a whole-of-society approach to uplift long-term care for our seniors. MOH shares this view in the provision of home and community care services for our seniors," said a ministry spokesman.

Ms Peh Kim Choo, chief executive of the Tsao Foundation which has been championing community and homecare since the early 1990s, said the report was both timely and important as the government goes about achieving its recently announced goals of shifting healthcare from hospital to community.

She said: "Beyond asking the government to give more funding to elders and long-term care service providers in the community, what we need is an open and critical examination among stakeholders."

She added that expected outcomes of healthcare delivery, what that means for acceptable standards and how everyone can "together achieve good health, affordably and sustainably" for an ageing population is crucial.


Correction note: This article has been edited for clarity.