FAMILY AND ELDER CARE

FAMILY AND ELDER CARE

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(Balance between family and state responsibility): **

32.

Mr Laurence Wee Yoke Thong:

Mr Laurence Wee Yoke Thong asked the Prime Minister how does the Government strike a balance between supporting families in caregiving support while at the same time not taking over the family's role and making elderly care the responsibility of the community and state.

Mr Laurence Wee Yoke Thong asked the Prime Minister with the impending flood of older people who will require long-term care in the coming decade and the declining numbers of workers in this field, what is being done presently to prepare for the future and what are the plans and strategies for the scale needed to enhance caregiver support and reduce caregiver stress.

Mr Lim Boon Heng: Mr Laurence Wee has made a very important point. The family must remain the first line of support for the elderly, particularly those who are frail. While the Government and the community should continue to help to support family caregivers, this must not take away the primary responsibility of the family.

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Take Japan, for instance, where caregiving for the elderly has been traditionally viewed to be the family’s responsibility. With the introduction of the national long-term care insurance in 2000, there has been a shift in such a view. This is because the scheme is funded through general taxation and compulsory insurance premiums(1). There is little co-payment from the care recipient or the family when care services are required. Caring for the elderly is now seen more as the state’s responsibility! In developing our long-term care financing, we should take care to avoid this pitfall. However, while the Government will not take over the role of the family, we will ensure that caregivers are given the support they need to carry out their responsibilities.

We are aware of some of the challenges today faced by seniors and their caregivers. First, many people do not know what care options are available and which options best suit their needs. Most would not actively look out for such information until the need suddenly arises. Second, seniors generally require a holistic suite of care services. More can be done to ensure a more efficient delivery of family- and senior-centric care. Third, many caregivers require caregiver training, support and respite care options.

There was a case where a family brought home their elderly father who had suffered a stroke. Being filial and caring, they acquired the necessary equipment and applied for a foreign domestic worker. However, they were not sufficiently trained to provide care at home, including basic skills such as transferring the elderly father from bed to wheelchair. The family became anxious that their quality of care was not good enough. They were worn out. Their father’s situation was not improving. In the end, they asked for their father to be placed in a nursing home. This is an outcome that could have been avoided.

Mr Laurence Wee asked how we are enhancing caregiver support and reducing caregiver stress. How could we avoid the scenario I have just described?

This is where the Centre for Enabled Living (CEL) comes in. First, CEL acts as a convenient first-stop referral agency, which helps seniors and caregivers access social care support services and schemes. Anyone with care needs or caregiving needs can approach CEL for information, referrals and other assistance. CEL would assess their needs and refer to suitable service providers. CEL works closely with the Agency for Integrated Care (AIC) to help families navigate the continuum of medical-social services more efficiently.

CEL is also working with partner VWOs to develop a case management framework for more complex cases. Some seniors might require care and supportive services from a few providers. CEL will help to better support these seniors and caregivers within the home and the community, and to prevent premature institutionalisation.

Second, we are building the capacity and capability of the eldercare providers and developing more care options in the sector, including respite care. Many eldercare service providers today, for example, home help services and day care centres, are non-profit organisations and voluntary welfare organisations. Many started out serving the vulnerable and lower-income seniors out of compassion and goodwill.

We are building on this foundation and working with key players in the sector to enhance their capability and capacity. We want to scale up existing services. We want more integrated service delivery as frail seniors will require multiple services. And we

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want sustainable funding models as far as possible. As the ageing population grows, we have to ensure that care services are available, affordable and delivered efficiently to all seniors and caregivers.

Finally, CEL is developing more caregiver support and training programmes. By attending a short training course, family caregivers can learn, for example, how to better support seniors in activities of daily living. More importantly, caregivers can also learn to manage one’s own wellbeing. The Caregiver Training Grant from MCYS is available to caregivers. Many families also tap on foreign domestic workers to care for older persons. It will be beneficial if we train these workers to be more proficient in basic eldercare.

In this regard, CEL is working with the Workforce Development Agency, Tsao Foundation, NTUC Eldercare and other training bodies to develop more structured training courses for both informal and formal caregivers. The courses for formal caregivers would be accredited under WDA’s Workforce Skills Qualifications framework.

Caregiving for the elderly is ultimately a decision for the senior and the family caregivers to make. There are different considerations in every circumstance – level of care required, affordability, emotional and social support from family and neighbours or the senior’s own preference to age-in-place. We will continue to grow a range of eldercare options and to support seniors and their caregivers in making informed choices that meet their requirements.

(1) From citizens aged 40 and above.