NEIGHBOURHOOD LINKS
In 1999, the Inter-Ministerial Committee on Ageing Population recommended that our senior citizens should remain an integral part of a society in which they are valued as active and contributing members. The IMC recommended that more resources be devoted to the promotion of developmental programmes for older people at the community level. Objectives of Neighbourhood Link 2 Neighbourhood Links are amongst the range of services set up to promote seniors’ development. The objectives of a Neighbourhood Link are: To promote volunteerism in the community, so that the elderly residents and other residents will remain active and engaged; To promote inter-generational interaction among residents in the neighbourhood; To moblise community resources in building a local support network for the needy residents To assist vulnerable residents (e.g the frail older persons, the dysfunctional families and the disabled) in obtaining appropriate services to meet their needs. Implementation Timeframe 3 20 Neighbourhood Links were slated to be develop in various parts of Singapore within FY2001-FY2005. Currently, there are 11 full fledged Neighbourhood Links operating in various parts of Singapore, namely Tampines, Bukit Merah View, Bedok, Toa Payoh, Yishun, Jurong East, Chai Chee Avenue, North Bridge Road, Telok Blangah Crescent Bukit Batok Central and Mei Ling Street. 3 Neighbourhood Links operating at a smaller scale are expected to commence full fledged operation by early next year. The remaining 6 Neighbourhood Links will be set up in the next two years. Target Audience 4 The target group of the Neighbourhood Link is residents within its vicinity in the neighbourhood. They include: a) Residents, who can be enlisted as volunteers; b) Residents, who can participate in the programmes run by the Neighbourhood Link; and c) Residents, who needs information and referral services.
Outcome of the Initiatives 5 The progress made has been encouraging. With effect from January 2004, there are 11 full-fledged Links in full operation and 3 NLs operating in a smaller scale. These NLs had recruited approximately 1000 volunteers, including 93 elderly volunteers. It had been a challenge to change senior’s mindset of their retirement as a time only leisure and recreation and it takes much encouragement and persuasion to get them to participate in developmental programmes such as volunteering. As the NLs take deeper root in the community, we anticipate better success amongst service providers in engaging seniors to contribute. Contact Persons 6 Please contact Ms Ngo Lee Yian, Senior Assistant Director (Developmental Programmes) at Tel: 6354 8171 or Ms Chew Shwu Mihn, Senior Elderly Services Executive at Tel: 6354 8397 should you require any further information.
Active Seniors Programme (ASP)
Background 1 The Inter-ministerial Committee on the Ageing Population has recommended that more resources be devoted to the promotion of developmental programmes for older people as they represent a valuable resource to both families and the community. The Active Seniors Programme is one of the many developmental programmes developed under the Eldercare Masterplan (FY 2001 to FY 2005) to enable older persons to stay active and contribute their talents. About the Active Seniors Programme (ASP) 2 The Active Seniors Programme is an avenue for older persons to contribute to the community by sharing their talents, experiences and wisdom with others. MCDS welcomes any locally based organisations to come up with innovative projects that promote the active participation of older persons in the community. They can submit the proposals to seek for funding on a cost sharing basis. 3 The objectives of the Active Seniors Programme are:-
a) to provide opportunities for older persons to be engaged and have meaningful and fulfilling roles in society; b) to create avenues for older persons to share their talents, knowledge and skills and to develop their potential; and c) to promote a positive mindset towards ageing and older persons. Implementation 4 The Active Seniors Programme was launched in September 2001,
Target Audience 5 Since its launch, the ASP has benefited some 20, 000 people consisting of both seniors and children. Details of the Initiatives 6 As at December 2003, there were 11 projects costing about $1,036,500 under the Active Seniors Programme involving 2,600 seniors.
7 More information on the ASP can also be found in the website, www.mcds.gov.sg Outcome of the Initiatives 8 Progress has been good since the inaugural projects were launched in May 2002. Examples include: Lions Befrienders Music & Drama Programme has trained 180 seniors in these arts and staged 13 performances for different audiences. Intergenerational Table Tennis Exchange, spearheaded by the Singapore Action Group for Elders, started out with table tennis matches between senior citizens and students in only 4 schools and has now extended to 17 schools. Crime Prevention Ambassadors Programme by National Crime Prevention Council has organised 90 Crime Prevention Activities comprising chit-chat sessions and crime prevention exhibitions and reached out to more than 150,000 people, 70% of which are seniors and 30% students.
Highlights from the new slate of projects 9 Among the new projects implemented under the Active Seniors Programme are: Home Therapy and Care Programme by the Singapore General Hospital (SGH), where seniors care for patients rehabilitating at home. Active Seniors’ Green Workshop by Kampung Senang Activity Centre, where seniors do eco-recycling and organic farming. They deliver the produce while visiting cancer patients. Singapore Professional and Executives Co-operatives programme taps retired professionals to provide management advice and consultancy to new SMEs and VWOs.
These examples illustrate how seniors can remain actively engaged in society. They are helping to shape positive attitudes towards the elderly. Contact Persons 10 Please contact Ms Ngo Lee Yian, Senior Assistant Director (Developmental Programmes) at Tel: 6354 8171 or Ms Kumutha Krisnan, Elderly Services Executive at Tel: 6478 53914 should you require any further information.
CAREGIVER CENTRE AND KIT Singapore’s population is rapidly ageing: the percentage of population aged 65 and above is expected to rise from 7% today to 18% in year 2030. An implication of an ageing population also denotes a growing number of caregivers who would be required to care for the frail elderly. 2 According to the 1995 National Survey of Senior Citizens, it is found that caregiving is a very demanding role. It greatly impacts the carers physically, psychologically and socially. Caregivers need to be supported in their caring roles. The Inter-Ministerial Committee (IMC) on the Ageing Population has expressed concern over this issue of caregiving and recommended that a broad base of support and services for carers be developed. CAREGIVERS’ KIT 3 In Dec 2000, Tsao Foundation was commissioned by MCDS to develop the contents of a caregivers’ kit. The kit has been made available since January 2002 and 2500 copies have been distributed to date. Objectives of Kit 4 The kit aims to: Provide information to families who are caring for a loved one at home. Help families organise and provide the best possible care to their loved one and in doing so relief the stresses of caregiving an increasing satisfaction. Facilitate a new caregiver’s understanding of the abilities and needs of the person being cared thus enhancing the care provided. Target Audience 5 The kit is given free-of-charge as a form of support for family caregivers who need the information and are placed with agencies which have direct contact with the family caregivers. Distribution Points 6 Agencies include Tsao Foundation, Medical Social Work Departments in Restructured Hospitals with Geriatric departments, Community Hospitals, SAGe Counselling Centre, TOUCH Community Services and the Home Nursing Foundation. Copies of the kit are also available for borrowing at the various libraries under the National Library Board. Details of Initiative
7 The Caregivers’ Kit comprises of 4 manuals & a Caregiver Organiser. The titles of the manuals are: a) Eldercare Essentials b) Helping Your Loved Ones with Activities of Daily Living c) The Mental and Emotional Aspects of Caring for Your Loved Ones d) Caring for Your Loved One with Dementia 8 The organiser serves as a planner for carers to record important information about their loved ones’ conditions and to keep records and contacts of important agencies and appointments for easy reference. It also has a medication schedule to inform and assist other family members in the dispensing of medication. 9 The Caregivers’ Kit project cost is approximately S$100,000.
Contact Person 10 Please contact Ms Mark Fong Eng, Assistant Director (Support Services) at Tel: 63548328 should you require any further information. TOUCH CAREGIVER CENTRE 11 The Caregiver Centre is a community project by TOUCH Community Services and is supported by Ministry of Community Development and Sports (MCDS) and the National Council of Social Service (NCSS). Implementation Timeframe 12 The Caregiver Centre was officially launched on 14 October 2002 and is Singapore's first caregivers' support service. 13 The TOUCH Caregivers’ website (www.caregivers.org.sg) was officially launched in April 2002. Target Audience 14 The initiative will benefit caregivers and people with disabilities.
Details of Initiative 15 The Caregiver Centre provides information, professional advice and support relevant to caregivers. It serves as a one-stop community resource facility for caregivers of persons of all ages and disabilities. The Centre also conducts caregivers training, support groups and offers consultative help on creating disabled/elder-friendly environments.
16 Located at Blk 173 Lorong 1 Toa Payoh, the state-of-the-art centre also showcases a mock-up flat furnished with disabled/elder-friendly fittings, furniture and appliances and offers the following services: Equipment display & consultation on home modification Equipment database and search Mock–up flat Caregiving training to family members, maids, professional staff and volunteers Counseling and caregiver support Organization and facilitation of caregiver support groups 17 The TOUCH Caregivers’ website (www.caregivers.org.sg) offers additional online help, tips for caregivers and product guides. Contact Person 18 Please contact Ms Mark Fong Eng, Assistant Director (Support Services) at Tel: 63548328 should you require any further information.
REVISION OF SUBSIDY & FINANCING IN STEP-DOWN CARE MOH’s new subsidy framework for VWO services, where provision of subsidies is on a sliding scale according to per capita household income, aims to ensure the affordability of those in need of the services. The subsidy framework for nursing home care was revamped from 1 July 2003. Details of the Initiative 2 Since then, means testing has been introduced progressively to all stepdown care services such as care in community hospitals, chronic sick hospitals, day rehabilitation centres, dementia centres and home care services. 3 The means testing and 3-tier subsidy framework aims to provide the bottom 10th percentile of Singaporeans by household income with 75% subsidy, those in the 10th and 30th percentile with 50% subsidy, and 30th to 50th percentile with 25% subsidy.
Proportion of Singaporeans
Means Test Income Cut-Off
Percentage of Subsidy
Bottom 10% – 10th 30th percentile 30th – 50th percentile Top 50%
$300 or less $301-$700 $701-$1,000 Above $1,000
75% 50% 25% O%
4 In addition, to ensure long term financing of eldercare services, an Elderly Care Endowment Fund was set up under the Medical & Elderly Care Endowment Schemes Act 2000, passed by the Parliament on 7 March 2000. 5 Currently, most of the operating subsidies to step-down care are paid directly out of the Government’s annual budget. The aim is to fund the operating subsidies fully from the interest income of ElderCare Fund. With an ageing population and a shrinking tax base due to a proportionately smaller working population, setting aside the funds now will help to avoid having to fall back on tax increases in future. However, the Fund will not displace the responsibilities of the individuals and families, as well as community support for the low income population. The goal is for the ElderCare Fund to reach a capital sum of $2.5
billion by 2010 to generate an interest income of $100 million. The capital contribution from the Government is $1 billion to date.
ELDERSHIELD The idea of establishing a national long-term care insurance to help individuals defray the cost of long-term care was first recommended by the InterMinisterial Committee (IMC) on Health Care for The Elderly. The IMC was of the view that risk pooling is necessary for long-term care because only a relatively small proportion of elderly will require such care at any one time, and that the approach was already adopted in several countries such as Germany and Japan. Subsequently, the IMC on Ageing Population supported the previous IMC’s recommendation to establish an insurance against severe disabilities. Details of the Initiative 2 ElderShield was thus introduced in June 2002, to provide Singaporeans with basic financial protection against expenses required in the event of severe disabilities. Through a competitive bidding process via a tender, the Ministry of Health appointed 2 private insurers to run ElderShield, namely, NTUC Income and Great Eastern. 3 There are 2 Premium Plans: the Regular Premium Plan (where policyholders pay premiums annually until age 65)1, and the Single Premium Plan (where policyholders pay a single lump sum premium). Once a policyholder finishes paying all the premiums (i.e. at age 65, for those under the Regular Premium Plan), he will be covered under ElderShield for the rest of his life. 4 ElderShield pays a monthly cash benefit of $300, up to a maximum of 60 months, to those who are unable to perform 3 or more of the 6 Activities of Daily Living (ADLs), namely, mobility, feeding, transferring, dressing, washing, and toileting. The $300 would be sufficient to cover a substantial portion of a patient’s share of subsidised nursing home charges. The cash benefit gives policyholders the flexibility to decide whether they want to be cared for at home or at healthcare institutions. Target Audience 5 All Singapore citizens and permanent residents who reach age 40 and who have Medisave accounts, will be automatically covered under ElderShield if they do not opt-out. For those who opted-out and who wish to join ElderShield subsequently, the maximum joining age is 69.
1
For ElderShield members who choose the Regular Premium Plan where premiums are paid annually, the premiums are based on the age at which the member joins the scheme and would not increase as one grows older. For example, a male who joins ElderShield at age 40 pays $148.84 (based on 5% GST) in the first year. When he turns age 41 in the second policy year, he still pays $148.84.
6 When ElderShield was launched in June 2002, a special once-off opt-out exercise was conducted for those aged 40 to 69, so that this group would not miss out on the opportunity to be automatically covered. To help older policyholders in this initial group pay for their premiums, there was a special arrangement to allow those aged 56 to 69 to pay their premiums over 10 years, and to provide them with premium subsidies. Outcome of the Initiative 7 38.3% of the 1.18M persons in the initial group opted out. The opt-out rates for the subsequent group (i.e. those who turn age 40 after ElderShield was launched and who are being auto-covered on a monthly basis) are notably lower at an aggregate rate of 24.3%. Currently, some 675,000 persons are insured under ElderShield. The premium subsidies provided to policyholders aged 56 to 69 amounted to $35m in the first policy year. A total of 782 claims have been processed, out of which 75.7% were approved, 15.5% failed the disability assessment, while 4.5% were not eligible for ElderShield cover due to preexisting disability, and the rest were due to other reasons such as exclusions, policies not-in-force, and void.
INTERIM DISABILITY ASSISTANCE PROGRAMME FOR THE ELDERLY (IDAPE)
8 IDAPE was introduced to help Singaporeans who are not eligible to join ElderShield when ElderShield was launched. Two groups of people are eligible for IDAPE coverage: (a) Singaporeans aged 70 and above (age as at 30 Sep 02), and (b) Singaporeans aged between 40 and 69 (age as at 30 Sep 02) who already suffered from pre-existing disabilities during the launch of ElderShield. 9 As IDAPE is fully funded by the Government, eligible Singaporeans need not pay any premiums to join IDAPE. The Ministry of Health appointed NTUC Income to administer IDAPE, i.e. to process the claims and make the IDAPE payouts on behalf of the Government. Target Audience 10 Under IDAPE, eligible Singaporeans will qualify for the disability payouts if they cannot perform 3 or more ADLs. The payouts are set at $150 per month (up to 60 months) for those whose per capita monthly household income is $700 and below, and $100 per month (up to 60 months) for those whose per capita monthly household income is between $701 and $1,000. The means testing is administered by the Citizens’ Consultative Committees.
Outcome of the Initiative 11 Currently, some 4,780 Singaporeans have benefited from IDAPE. We have continued with promotion activities on IDAPE by working with the VWOs, and hope that more who quality for the scheme would come forward to apply so that they can benefit from the scheme. The total amount of IDAPE payments made to the claimants is $7.3m as at end Dec 03.
Websites 12 websites: Information on ElderShield and IDAPE can be found in the following
ElderShield Ministry of Health NTUC Income Great Eastern http://app.moh.gov.sg/pro/pro06.asp http://www.income.com.sg/insurance/ eldershield http://www.Lifeisgreat.com.sg/ElderS hield
IDAPE http://app.moh.gov.sg/pro/pro0 7.asp http://www.income.com.sg/faq/i dape.asp
PRIMARY CARE PARTNERSHIP SCHEME (PCPS)
Under the Primary Care Partnership Scheme (PCPS), MOH pays private general practitioners (GPs) and dentists to provide simple outpatient medical and dental services to needy elderly at polyclinic rates. The scheme offers needy elderly the convenience of seeing a GP and dentist near their home instead of travelling to a polyclinic. Details of the Initiative 2 PCPS was first implemented on a pilot basis on 1 October 2000 in Jalan Besar, Kreta Ayer, Bukit Panjang and Simei, and subsequently extended to Kampong Glam, Ayer Rajah, Serangoon, Sengkang and Pasir Ris on 1 July 2001. On 1 Mar 2002, the Ministry extended PCPS nationwide and included basic dental services in the scheme as well. Target Audience 3 The Community Development Councils (CDCs) help assess the eligibility of applicants and issue the Community Medical Benefit Cards to those who qualify. To qualify, the Singaporeans must be 65 years or above and have a per capita income of $700 per month or less. Persons who are under the Public Assistance (PA) Scheme, regardless of age, will also be eligible for PCPS and receive treatments for free. Subsidized medical or dental services are available at 570 participating GPs and 210 participating dental clinics in Singapore. To date, we have more than 15,000 needy elderly on the scheme. 4 Under the scheme, GPs are contracted to provide common outpatient medical services for simple acute medical conditions. GPs would refer patients who require more complex treatment and management of chronic illnesses to the polyclinics, specialist outpatient clinics or hospitals. Similarly, private dentists are contracted to provide basic dental services. Dentists will refer patients who require more complex dental treatment cases to the polyclinics or National Dental Centre (NDC) for further management. Websites http://app.moh.gov.sg/pro/pro05.asp Common Illnesses To Be Seen By The Participating GPs Cough, cold and flu Diarrhea Cementation Curettage, Infected Socket Dental Services To Be Seen By The Participating Dentists
Headache Sore eyes Ear infections Abdominal pain/piles Urine infection Simple skin problems e.g. infections, rash, pimples Menstrual problems Muscle, bone, joint pains
Denture Extraction Filling Polishing Scaling Soft Liner Topical Fluoride
MEDISHIELD SCHEME FOR THE ELDERLY (MSE) The MediShield Scheme for the Elderly (MSE) was first announced by the Prime Minister on 20 August 2000 in the National Day 2000 Rally Speech. The aim of the scheme was to improve the participation rate of elderly Singaporeans in catastrophic insurance schemes like MediShield or Medisave-approved insurance schemes. It was also part of the government’s efforts to share the budget surpluses with Singaporeans. Features of the MSE 2 The MSE was launched in October 2000. Under the MSE: (a) Elderly Singaporeans aged between 61 and 692 and not covered by MediShield or Medisave-approved insurance schemes were given 3 months from Oct to Dec 2000 to sign up. The Government paid 2 years of premiums (based on MediShield premiums) for those who successfully signed up for MediShield or Medisave-approved insurance schemes. For those who signed up but could not qualify for coverage (e.g. due to preexisting illnesses), they would receive a Medisave top-up equivalent in amount to the premium. (b) Elderly Singaporeans who were already members of MediShield or Medisave-approved insurance schemes were given a 2-year premium rebate (based MediShield premiums) in recognition of their prudence and personal responsibility in taking up catastrophic insurance coverage. (c) Elderly Singaporeans aged 70 and above3 who were not covered by MediShield or Medisave-approved insurance schemes
2 3
Age as at 31 Dec 2000. This is because the maximum entry age then for most Medisave-approved insurance schemes was 70.
received Medisave top-ups equivalent in amount to 2 years worth of MediShield premiums for their age group.
Outcome of Initiative 3 In 2001, 301,000 elderly Singaporeans benefited under the MSE with the Government paying for $52.4 million of premiums or Medisave top-ups. In 2002, another $51.8 million was paid out to 286,000 elderly. Contact Person Ms Yong Lik Sin Assistant Director (Project Development & Subvention) Elderly & Continuing Care Division Ministry of Health Tel: 6325 9029