Lotus Eldercare

Lotus Eldercare

A while ago, I was roped into advising and suggesting how Internet of Things can support the flow of healthcare data to achieve a more global access. Here is an attempt to create an open source platform for the technologist to reference on: https://github.com/OpenIoMeT/Iomet-wiki/wiki

It started off as a Mozilla opensource project: https://wiki.mozilla.org/Eir

I am sharing my user story I have written for EIR here. Feel free to have a look at my dream of what IOT can support clinician and patient to achieve a seamless flow of data cross borders. Here is our milestones: https://github.com/OpenIoMeT/Iomet-wiki/milestone/2

The EIR Story 

 

Lotus Eldercare Technologies, as a wannabe Tech set up as well, has been involved in or planning to be involve in some of the currently technology competitions and funding exercises available.  We have participated in a few the the past and current grant calls. Here is a list to share with you!

Ageing Master Plan, about livelong learning and employability
 

In the recently published MOH’s action plan for successful ageing, the first 2 topics are: Employability and Livelong Learning.

Here is a not-so-new but perhaps missed out possibility on supporting both these action plans: 

SeniorPreneurs.

 

Here is a possible action plan and reasoning for such a movement and entity call SeniorPreneurs Sg to happen here in Singapore –

SeniorPreneurs Sg seeks to create awareness in entrepreneurship in seniors, creating an ecosystem for senior entrepreneurs in order to create more employment opportunities and life-long learning opportunities.  It is modelled after SeniorPreneurs Australia, whereby entrepreneurship is encouraged and supported with networking, training and business coaching sessions. As such, we strive to be involved in a growing number global network of SeniorPreneurs for networking opportunities and exchange of ideas or even expansion of businesses.

SeniorPreneurs Sg key population includes:

1.     Seniors who are retired from their lifelong work and wishes to start a new initiate related to their hobbies or calling to either retain economically active or serve a greater good.

2.     Seniors who are retrenched from their work and wishes to start something on their own for continual employment and revenue stream.

3.     Seniors who have not been gainfully employed due to family commitments and now wanting to have a new start after their children have all grown up and financially independent.

4.     Seniors who wishes to take advantage of a business opportunity they identified from their professional background, or from the feedback from other seniors and friends in relation to eldercare and the silver industry.

With an ageing population, forms of employability for seniors need to be relooked and entrepreneurship in seniors can be a new form of employment for the seniors.  They can even be more successful then younger entrepreneurs with more experience, skills and endurance honed from years of employment. On a whole, successful SeniorPreneurs can also give a new dimension to the overall national economy.

Key benefits in running SeniorPreneurs Sg 

·      More seniors are employed and still actively contributing economically in Singapore through us

·      More seniors are more engaged socially due their startup commitment and be more willing to participate in lifelong learning activities though Seniorpreneurs

·      KPI of at least 2 startup yearly by seniors supported by Seniorpreneurs Sg

·      Usage, feedback and survey on Seniorpreneurs Sg activities and services for the entity to be financially sustainable on its own

·       Facilitate Seniors to be involved in competitions and conferences with their products or services

Services include:

1.     Networking sessions other seniorpreneurs with Industry experts.

2.     Co-working space rental as needed basis

3.     Linking up in governmental start-up fundings like CDG grants/competitions/venture capitalist/chartable organizations support

4.     Setting up website and creating e marketing solutions or traditional marketing workflow

5.     Coordinating with governmental organization in the ageing master plans on employability and life long learning segments.

6.     As a research facilities for government organizations for topics regarding to elder worker and entrepreneurs.

7.     As consultants for large governmental or non government cooperation in terms of prolonging working lives for their ageing employees and promoting retention among those post retirement age via company policies or twitches to job scope and profile.

 

We aim to set up an Asian Institute for Experienced Entrepreneurship following the lead in America: GIEE

 

How do we intend to be sustainable then?

Revenue will come from a few sources:

  1. Sponsorship for events from MNCs/government agencies/Business associations/ Foundations in view of possible project collaborations.
  2. Services provision for members and membership subscriptions
  3. Training (WDA courses/Skills future courses etc)
  4. Consultancy services for large organisations for retaining and retraining retired staff
  5. Research services for governmental organisations for topics on senior workforce
  6. Shares from some of the Seniopreneurs startups (Case by case basis)

 

 

Here is the Australian version: http://seniorpreneurs.org.au/

Here is some feedbacks and ideas on SMEF funding for equipment.

 

I have lots of ideas in the past and many are still hidden in my mailboxes unused and unknown.This idea was first started and suggested by my good self on the 18th November 2014 to the .gov and some business partners. Since it is still just an idea till today, I am putting up in my Ideas page to share.

On the ground I have always been receiving calls when my patient pass on and family wants to donate all the equipment to my service. I have no space, no time and no workflow to manage these bulky items. A kind Medical Social Worker from one of the restructured hospital of the community care department sometimes might arrange these hospital furniture to another needy family. This is however sporadic and not very efficient. 

I am now suggesting to have a policy to “buy back” these used hospital furniture and maintain them until the next family might want them. Some equipment providers have been in this business for more than 15 years and have experience servicing and selling 2nd hand hospital furniture and equipment. 

Let’s suggest a fictitious company RECycMEd Pte Ltd. (I hope nobody has such a name at present!)

Relatives “sell” back the hospital furniture to RECycMEd. RECycMEd cleans, services and maintains them, and when needy patient wants even cheaper hospital furniture, they can use SMEF as well to buy these second hand furniture at an even lower pricing.

For example:

3 Crank Electric Low Hospital Bed $1680 from a vendor,  brought by patient at $168 from SMEF funds living in a 3 room flat.

Unfortunately, patient pass on 2nd day getting the bed before he was even discharged from hospital and before the bed was actually used. Now, family wants to dispose the nearly new hospital bed, calls RECycMEd.  RECycMEd comes in and “buys” the bed from them at perhaps $50or even free , helps the relative the remove the bed from the house to his warehousing area. Perhaps a new patient referred to  any MSW needs the bed, but family is unable or refuses to pay $168 for the bed although it is needed after PT/OT assessment. RECycMEd offers the bed at perhaps half or less of the selling price, like $840, and patient is willing to pay $84 for the bed now after the 90% SMEF subsidy. Bed is recycled successfully and it makes commercial sense for RECycMEd to do this business. RECycMEd may even offer the patient for free if he is able to claim the $840 - $84 = $756 from AIC SMEF for the bed.

It will be a win-win-win-win situation, family can dispose of use furniture for Free or even get something in return, new needy patient gets cheaper hospital furniture and equipment are recycled and not wasted. MSW can have easier access to cheap hospital furniture and the government saves from the discounted furniture.

Kindly help me forward to anyone interested in working out such processes. At least I will know what to do next time patient calls me for all these used hospital furniture.

I am frequently being asked by my technology colleagues on what is needed for aged care, what robots should we be building and how can the robot be helpful in day to day life. 

 

It is actually not very complex (to me at least) and people around the world has been developing robots that can help  elderly go about in their daily lives. I have been involved in robotic developments and one group is actually going overseas for a prestigious robotic competition. 

 So what exactly does robots in aged care do? 

Recently, I have been approached by start-ups, governmental, private agencies, tech coy on this topic of Uberising of health services. 

 

Well, first things first, go for the more traditional source of uber, somebody or anybody please do a Uber for ambulances to transport bed ridden patients or for special vehicles transporting patients in wheelchairs. There, I said it. The last I have heard, there have been discussion on such efforts being planned so it is good.

On to health services: As a active player for home and remote health services, there is definitely a role in uberising emergent health services. Those routine, long term relationship kind of services will need such supplementation for the coverage to be complete and functional. So what are the scope and the forms of these uberising there is? 

I do home based services and uberising of emergent care is possible, but the services should be properly scoped and clients should have an agreement and understanding of the limitations for such services. Funding will definitely be of issue such these form of services are probably all private right now and will not be covered under any insurance. It will be out of pocket expenses. For a MEANS tested and MEDIFUNDED patient, it will be free for them to go back to acute hospital for any emergent situation, even for just a emergency NGT change!

So who will use this form of health services and why?

Let us start with the most basic care giver services. Most commonly, (in fact just today), one of my patient’s family was asking me where to find a nanny service for the grandma, just for perhaps 2 to 3 hours to allow the usual caregiver (domestic helper) to go off duty. Care for this patient is really simple, just transferring her, routine hygiene care and perhaps companionship. She is eating orally with mince diet, which can be prepared before hand.  There are such services known as senior home help, run by charities, social enterprise and private provider. Right now, I would ask family to go to the private providers to ask for help, but as demand for this sort of services are high and such private services are really being handicapped by MOM restrictions, the request for urgent elder sitting might not be successful frequently. Uberisation of such services can help, either pool in all the providers to see who have spare capacity that day and that hour, or engage another group of caregivers totally out of this pool which sign up with this Uber App.  My patient’s daughter can then receive the services promptly.

The issue of getting Uberised care giver is perhaps 2 fold. On the provider or Uber side, how are they proposing to justify the standards for their care workers? Are they properly trained and by who, for example tube feeding techniques, transfer procedures and hygiene management. On the other site, can Uberised care giver service protect their own caregivers? Who are these clients, are they dangerous for a petite lady carer to go into the home? Is the client violent from psychotic depression or having paranoial symptoms of dementia?

Then we come to the charges, is it standardised for the entire services or each caregiver signing up charges differently based on their skills and experiences?

There are such caregiving courses, run by various charity organisations in Singapore. Perhaps, that can be the certification ground and also the source of manpower for this kind of app. Unfortunately, Lotus Eldercare Academy graduate will not be directly available here in Singapore.

Going higher up, nursing and therapy services. Therapy services are not likely to be required urgently so the market for Uberisation of therapist might not be practical. But for the completeness of the APP, there is no harm perhaps including such services.

Urgent nursing services are plainly procedure based and can be scoped rather easily. Why would family require an urgent nurse visit? Either one of the tubes (nasogastric, urinary catheter, PEG) dislodge or gotten pulled out by agitated patients; to review newly onset wounds or do wound dressings; and perhaps other more specialised procedures not being mentioned.  The certification part is easy, but skill level and comfort zone of each nurse differs. I was suggesting a refresher course for nurses doing home care for procedures to perhaps boost their confident and competency levels before they are being hired if they have not been keeping current with some of the procedures.

Similarly, to enlarge the pool, the Uber app should engage all the charity organisations, social enterprises and private nursing agencies providing such services to increase the total numbers if possible. Dangers are same as for caregivers; work place safety is still a question mark when nurse visits the family. I did have an agitated caregiver once going psychotic and took out a knife to try and stab my nurse many years back.

Lastly, urgent medical support. To me, there are only 2 things for anyone to need urgent home care consults. Urgent home care and Housecall is slightly different. Housecalls can be made to ambulant and rich persons who just want the services of GP coming to the home for treatment instead of going to the nearby GP for treatment. Issues which with a MC rest will solve usually. Urgent home medical visit involves bed or house bound patients with are very dependent and frail. Most of the time it either involves

1.     Signing of Certificate of Cause of Death

2.     Urgent medical consult for infections (which may or may not be life threatening), delirium like agitation or food refusal, worsening of organ failures like congestive cardiac failures or hepatic encephalopathies, emergent medical conditions like ischemic foot with gangrene, myocardial infarctions, strokes and seizures.

Point 1 is commonly the cause requiring urgent medical review. Point 2 can be a simple flu virus to life-threatening conditions.  Depending on the medical services provided, it is often a decision for end of life care at home or more active treatment back in acute hospital for more serious conditions. It also depends on how much resource the doctor can provide, from labs service to intravenous antibiotics to hospital-like services to the home. It is very difficult to scope as different doctors have different capacity and resources.  It will be difficult for any organisation to anticipate the requirements and scope for the services. A medical director should be in place to scope out all the medical service if such an uberisation of urgent medical care is to be done. There is no end for medical service and perhaps even an ICU level of care can be provided at home if there are such resources from the willing family. In fact, a tele-medical services should be inline with such uberisation of medical service to screen and advise. That will be more cost effective and for the very near future!

IFA 2016 held in Brisbane, Australia was indeed an eye opening experience for me in all things ageing. Being a doctor and frequently attending conference, it is refreshing to be in a conference with minimal medically inclined topics, rather, more on the overall social-economical-controversial-overall topics for the seniors. All the keynote speakers were fantastic, giving the insight of ageing policies and on-goings in various countries and the ground issues encountered. Taking a look at the conference program and you will be impressed with the scope and the fascinating number of topics being discussed! Some of the more controversial ones might never make it to Singaporean shores I say!

 

I presented a simple papers on my findings on the causes of disabilities in our seniors. I have met old friends and many more new friends in this conference, and heard interesting sharings from many different countries, including one from Jamaica! There are far too many lectures I heard throughout the 3 day event but it really expose me to many new ideas and practices. I would be very much interested to attend the next one in Toronto, Canada in 2 years time!

This page is a bookmark more for myself than for you, my readers. I have recently been involved or invited to one too many health related or technology themed conferences or competitions that I am in danger of missing some of them out, and a few with me as a speaker as well! 

Perhaps starting in May 2016, I shall start to update a list to remind myself of the events coming up and perhaps to remember to attend!

Here is the link for my close collaborator and his list of events in Europe on Healthcare Technology:

http://www.davidwortley.com/conferences.html 

Here is the link for product exhibition on healthcare and aged care all around the world: 

http://fmhmedical.com/Exhibition.aspx 

In the past weeks and for the next few weeks, I have been tasked by a few governmental agencies to talk about the topics on Caregivers. In all these seminars and conferences that I have the privilege to be involved, I will share some of my thoughts and things learnt from other experts.

 

We are all either being the carer at one stage of our lives or have been cared for, when we are young, when we are sick, and when we grow old and frail one day.

Caregiver can be formal (paid and as a full time work) or informal (spouses, children, relatives, friends and even neighbours). The work of caregiving has been increasingly important and perhaps I would say it should be of National Issue! But why?

With ageing population, number of chronic sick patients is ever raising in the current modern healthcare era. Singapore's efficient and fast tertiary healthcare support system have been ever so effective in saving and prolonging life. With the number of dependent patient raising, families are stressed to have the responsibility of caring for their dependent loved ones. Without properly trained and empowered caregivers, these group of dependent elderly may have repeated admissions into the hospital, stressing our already sardine packed restructured hospitals and increasing healthcare expenditure from a mere SGD $4 Billion just a few years back to $13 Billion on 2016. Not only the governmental health care system is stressed, the families are also being stretched, both emotionally and financially. If every and each of us stay home and care for us dependent family members, with smaller family units now and even so in future, we might not be contributing in Singapore economy! The country might fail as such!

I have been called upon to talk about various topic in caregiving; namely, Role and Skills a caregiver should acquire, Perspective of a Singaporean Caregiver, and Future possibilities of caregiver. To me, the simplest topic will be the role and skills of a caregiver. Caregiver training and care plans are part of my daily work and I can rattle off lots of details anytime. Having written a book on skills for caregiver (which NUS press deemed it was too difficult for a normal reader), I feel that caregiver skills are not too difficult to learn and master (That is for me to say of course!). I am currently giving an outline of the caregiver skills for public audience as a MSF Family 365 programme: Families for Life. https://www.familiesforlife.sg/unite-at-an-event/Pages/FamilyTimePreciousTimeEV.aspx

Experiences from each and every caregiver differs greatly. Depending on the culture, religious belief, financial status, patient's profile on physical and mental disability, care giver's profile, solutions for each and every family differs, as well as the needs and support. The challenges every caregiver faces is very different, some stresses on patient's care, for example, a demented and agitated elderly refusing to bath or to dress even, to external stress from relatives telling caregiver to give up and "let go" of the chronic sick, bed bound, tube fed elderly. As a supporting crew, I see many and supported many in these caregiving journeys. 

There are too many permutations and I find it easier to share experiences with the families, often than not, reassure the family of their decisions and others had similar decisions made and the outcome. We are not alone in this world and fortunately, these problems are not solely being "bestowed" to certain families, others had faced similar or worse! Some caregivers are truly commendable in every sense, inspiring and brave in the face of many adversities imaginable in a caregiver journey. These are the people that actually are the most pleasant, down-to-earth and practical. I myself have learnt much from all the carers I come to know and respect.

The future of caregivers will depend a whole lot on governmental policies, sometimes, not only ours, but also policies of our neighbouring countries providing us with the caregiver workforce. I was requested in one of these caregiver sharing sessions to talk about some of my recommendations on the future of caregivers. Here are some of which I can think of:

1. A national caregiver organisation offering "membership" - liken a country club membership with perks like cheaper diapers from bulk purchases, and depending on the length of caregiving, we can then separate it into Silver, Gold, Platinum, and even Diamond Members (esp. one of my previous client with 2 cerebral palsy children who are severely disabled and brought both of them up into their thirties and going.) Plus perhaps transportation perks and even cafes for caregivers only to share and support each other. (Idea from Japan). 

2. A means of remuneration perhaps for Singaporeans quitting their jobs to care for their dependent elderly instead of institutionalisation.  This will be very difficult to achieve from the government point of view and how to fund the caregivers instead of funding the institutions (which is definitely more costly) and how to fund the informal caregivers. Formal caregivers current has both FDG and FDWG to offset some of the costs for families. But if they choose to care for their elders themselves, I don't see any form of financial support at present.

3. Starting a module on caregiving skills in Secondary schools or perhaps have a CCA on caregiving liken Red Cross/Girl's guide/Scout etc. The students can then have the skills and help out in respite care if needed. They will be a good source of support for families.

4. A more consolidated help portal for caregivers based on patient's conditions rather than listing them by services. For example, see my article on listing services based on the condition of the patient: http://www.lotuseldercare.com.sg/index.php/ideas/item/90-ideas-from-pre-mit-hacking-medicine-sg-workshop 

5. Certifying caregivers as a healthcare worker with courses, so that the FDW can upgrade their skills and knowledge and can use Singapore as a training ground. For local caregivers, once their family work is completed, they can be rehired as caregivers in other families to help guide and support. I have many FDW whom are such wonderful carers and often I felt it is very wasted for them to return home after patients has pass on. Their skills and local healthcare knowledge will be invaluable.

With such intense interest in the recent years on caregivers, I am sure there will be more initiatives in future on caregivers. Globally, it is a bigger issue and the topic was discussed in international conferences as well. But, that is for another time!

Upraising of Eldercare Industry – A Vibrant Year 2015

 

This is certainly been an exciting year for the eldercare sector, in terms of the many opportunities and grant calls.

I am privileged to be intimately involved in this sector, from manpower development, research, to cutting edge technology developments.

Here are some of the events that I was involved in Singapore 2015.

 

Care-at-Home Innovation Grant

 

Everyone was excited about this very first grant call on the research thrust “Ageing in Place” under the National Innovation Challenge (NIC) on Active and Confident Ageing. MOH organized a few events to update providers and tech companies alike with networking and matching sessions.

 

Cognitive Grant

 

Following the Care-at-Home Grant call, the 2nd grant call of the series came and we are still in the midst of writing out the proposals. The Grant Call on Cognition is the second of the grant calls under the National Innovation Challenge (NIC) on Active and Confident Ageing. This grant call under the research thrust on “lengthening health span” has two objectives. First, the innovation aims to improve cognitive functioning and delay the onset of dementia in older adults. Second, the innovation aims to provide quality and cost-effective care for seniors with dementia in the community.

 

NUS Enterprise Small Change Festival

 

 

Small Change is a social movement by youths and for youths, to inspire innovative solutions to address social needs in Singapore. FB/Instagram: smallchange.nus 

I was very honored to be invited as a panel speaker on the theme of Ageing. The one thing I learnt is that Silver Tsunami should be termed as Silver Reservoir instead! I learn much from other senior panel speakers and their drive and focus on Elder services are unparalleled.

Here are some photos for the event which include other social issues:

https://www.facebook.com/smallchange.nus/photos_stream?ref=page_internal

 

NUS Enterprise: Modern Ageing Singapore

 

I was invited as a judge in this event in their Semi-Final rounds. Although I have seen and come across most of the innovations, nevertheless, it was a great event to boost tech start-ups in the Eldercare sector!

Here are some news report on this event:

https://www.techinasia.com/modern-aging-winner-startups

http://www.channelnewsasia.com/news/singapore/3-teams-receive-s-125-000/2319006.html?cid=fbsg

 

Asia Pacific ARTT-Network: Active Ageing

 

One of the Eldercare friendly and rehabilitation “toys” where showcased by its founder in the 2nd Edition of SMART NATION Series by Asia Pacific Assistive, Rehabilitation, and Therapeutic Technologies Network .

I am very privilege to be there as Prof Lund explained his concepts and the potential effects in getting our seniors to do exercise through the gaming process.

It was a very fun and interactive session and I got to try out the games myself!


   

Design Singapore Council: Two New Books: Publications on rethinking health and wellness for the elderly

 

I am very fortunate to be invited for the book launching at National Design Center and given 2 very informative books on Eldercare and their needs.

The e books are online now and here are the links!

Design for Aging Gracefully: 

http://www.designsingapore.org/for_enterprises/Design_Research/DesignforAgeingGracefully.aspx

Empathetic Technology for Ageing – Rethinking Health & Wellness for the Elderly:

http://www.designsingapore.org/for_enterprises/Design_Research/EmpatheticTechnologyforAgeing.aspx

 

Design Singapore Council: Designathon 2016

 

ABOUT DESIGNATHON 2016

Designathon 2016 is a 36-hour design challenge that will bring together a diverse group of people to produce design solutions that will enable the elderly in Singapore to live beautifully in

their golden years.

 

THEME: Living Beautifully: Designing for Our Golden Years

How might we design to transform the experience of ageing for the elderly in Singapore and enable them to continue living their lives with dignity, grace, and equality as they age?

I was involved in the Pre-Designathon workshop and will be joining in the Designathon next year.

 

Other developments:

Unaging:  http://unframed.so/unaging/

AIA-Konica Minolta Digital Health Accelerator:  http://www.aia-km-accelerator.com/

 

How We Operate

Our doctor is available from 9.00 am to 5.00 pm. Mondays to Fridays, excluding public holidays, strictly by appointment only.  Please call to arrange for an appointment.

Our charges are fixed at $200 per doctor visit per patient for a routine visit for patients under our long term home care service, including all procedures and reviews. Medications and expendables will be charged separately if required. Our charges for acute visits for patients not under our regular service will be $300 to $500 per review and strictly subjected to availability. We are not a medical clinic service and will not support services such as immunizations or review urgent hyper-acute conditions. We also only sign CCODs for patients under our long term care.

For referrals, kindly right click our Referral button on our top right menu (then choose save link as...) to save our referral form as a pdf file. E mail the referral to us at info@lotuseldercare.com.sg and we will get back to you as soon as possible.

Technology companies please e mail us at technology@lotuseldercare.com.sg  or use this LINK to set up appointments with Dr Tan Jit Seng

Get in touch with us!

Our care coordinator will advise you on the possible options available to cater to your unique needs.

16 Collyer Quay Level 20 Singapore 049318

 

Office line : +65 6818 9512

Fax line: +65 6818 9600