HEALTH PROFILE OF OLDER SINGAPOREANS

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HEALTH PROFILE OF OLDER SINGAPOREANS: 12.

Assoc. Prof. Paulin Tay Straughan asked the Minister for Health (a) what is the health profile of Singaporeans aged 85 years and older; (b) what is the proportion of these Singaporeans in institutional care facilities; and (c) what constraints does the Ministry face in providing for the healthcare needs of this segment of the population.

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The Minister for Health (Mr Khaw Boon Wan): Sir, about 28,000 Singaporeans are 85 years or older. Half of them are being treated on an outpatient basis for diabetes, high blood pressure or high blood cholesterol. Sir, I suppose, in due course, I will fall into this group too if I exceed 85 years old. Other significant diseases which afflict this group of seniors are dementia, vision disorders, hearing loss and arthritis.

Each year, about one-third of them would require some sort of hospitalisation. The most common reasons were injuries, especially home injuries resulting from falls, pneumonia, stroke, cancer and heart disease.

About 9% of them are cared for in a nursing home. Among those living at home, two-thirds have no difficulty with basic activities of daily living and self care. But about 6% have difficulties in at least three basic activities of daily living.

Caring for the very old requires more care and assistance. I have spoken at length about the various initiatives and efforts that we are putting in place to cope with the increasing health needs of our ageing population, including a reply to the Member in Parliament last month. I will not repeat the points.

For the current cohort of the very old, we are mindful that they did not have the benefit of accumulating sufficient Medisave for their old-age health needs. Whenever possible, the Government tops up their Medisave accounts proportionally more. MediShield does not currently cover them but we have set aside funds under Medifund Silver as their safety net. And we will continue to top it up whenever Government budget has sufficient surplus to do so.

Assoc. Prof. Paulin Tay Straughan: Sir, I am very sure the Health Minister will

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enjoy many more years of healthy living, way beyond 85 years. My supplementary question is this. With the increase in life expectancy and the increased trend in nuclear families, can the Minister comment on the implications on the existing infrastructure for elder care and what plans MOH has in the next few years for nursing home, retirement facilities, and so forth?

Mr Khaw Boon Wan: Sir, clearly, the rising number of seniors is itself a good outcome because it means with better health and healthcare services, people are living longer. As that population increases, infrastructure has to keep pace. Infrastructure covers a whole range of facilities, part of it is within my Ministry's purview and part of it is outside my Ministry – under the Ministry of Community Development, Youth and Sports (MCYS), for example, for the elderly homes; and under the Ministry of National Development (MND), for more studio apartments.

I will just comment on what is within my purview. Hospitals need to expand and that is why we are expanding them. A new hospital has just opened a few months ago, and a couple more will come about further downstream. There is a need for nursing homes as well. Waiting time has been lengthening, and we have been watching this. Two or three years back, we embarked on a programme to review all existing nursing homes, and we decided on two initiatives which we are now implementing to correct the deficiencies. One is the location of nursing homes. Many of these homes were founded many years ago. Overtime, they find their catchment population disappearing with re-siting of the housing estates.

Secondly, they tend to be smaller and therefore do not have the economy of

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scale to provide many supportive programmes which we now found to be very important, for example, physiotherapy. We need a minimum size to reap certain economy of scale. The conclusion is that we should expand, rebuild and re-site them. We will be doing so, for example, in my constituency in the north, we will be building two brand new nursing homes. They will replace two existing nursing homes which are poorly located. But it is not just my area. I am also expanding some others in the west as well as in the north-east. And we will continue to watch over this. Nursing home construction is simpler because the lead time is short, quite unlike a hospital. Hospital takes seven or eight years to plan. But nursing home takes only two or three years. I am quite sure two or three will come up within the next two or three years. But development is not just for institutional care. It is also for care at the community level. As the Member puts it, with more nuclear families looking after the seniors at home when there is nobody at home other than the seniors, is a big problem.

I was doing my cardiac rehabilitation this morning and was chit-chatting with my physiotherapist. She has an elderly mother. She was sharing with me the challenges. As she is in the same generation as me, she has several siblings to share and take turns. As for the next generation, they will not have that luxury, and it is going to be a big problem. The western world is already experiencing this. Their solution is more institutional care which we, from the Oriental side, are not sure if that is the right decision. The Japanese are experimenting with more neighbourly help. That is why I am fully in support of MND's expansion of studio apartments. We group them together and, at the same time, there are also other non-studio apartments, allowing the young and old to be together. I think that provides a much more interesting lifestyle, with "buzz". And if people are neighbourly, they can help watch out for

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each other. The Japanese do that. Sometime ago, I visited some Japanese old towns and I was struck by how closely bonded the neighbours are. They are not relatives but they watch over each other because today, I help you, next week, you may help me. That is the sort of society and values which we should try to inculcate. At the end of it, prevention is still better. In other words, try to stay well for as long as you can which means keep slim, do not over eat, exercise and eat properly.

Mdm Cynthia Phua (Aljunied): Mr Speaker, Sir, just one supplementary question. I would like to ask the Minister whether he would consider extending home visits for medical care because we are encouraging the elderly to stay within the same residential area. Would the Minister consider asking the community hospitals to develop this arm to support the elderly within the same residential area?

Mr Khaw Boon Wan: The community care to support the elderly at home can come from all sources. Community hospital is one good source where you can base the home care activities. Acute hospitals can play that role too, especially now that I have re-organised our acute hospitals for them to take a much more regional approach to healthcare needs. If I may give the north as an example again, the new Khoo Teck Puat Hospital's mission is not just to look after the services within the four walls of the hospital. My message to them is that they are a hospital without walls. The hospital is just a focal point of activities, perhaps to even provide the thought leadership because they have the specialists who would be able to give authoritative information, for example, on nutrition and physiotherapy. It can help organise these services which are not necessarily based in the hospital but outside it. A major part of their activities is to reach out beyond the four walls. That is the same mandate I

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am giving to the new hospital coming up in Jurong and likewise to the existing hospitals.

Mr Speaker: Mdm Halimah, last question.

Mdm Halimah Yacob: Thank you, Sir. I think for many families, financing home-based care is actually quite a burden, so that affects their ability to keep their elderly sick at home. I would like to ask the Minister whether the Ministry will consider providing more subsidies for home-based care and also allow for more flexible use of Medisave for home-based care.

Mr Khaw Boon Wan: Offhand, I am not too familiar with the details, but Members know they have a very sympathetic Health Minister here. I have always been exploring how to help the seniors more, facilitate them more, whether it is through greater subsidy which needs regular adjustments, anyway, with inflation, or allowing greater use of Medisave or mobilising the community to chip in. My own sense is that money is not the key issue. The healthcare needs of an elderly today are being met, but often in the wrong place. If an elderly could be competently cared for at home, sometimes he may still get stuck in an acute hospital where the cost is very high. If they do not need the sophisticated services in the acute hospitals, their money could have been saved if they are, what we call, "right-sited": whether it is at home, at day care facilities, or being in a lower cost community hospital, or in a nursing home. I think right-siting is definitely the way to go. But I will be the first one to admit that the incentives are sometimes warped so that to a patient, he finds it cheaper to stay or over stay in an expensive Class C ward in an acute hospital when he should be, for example, in a community hospital. Trying to clean up these distortions that have been accumulated over the years has taken me

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quite a few years and would continue to take me many more months. But clean it up, we will.