Lotus Eldercare

Lotus Eldercare

 

I received an invitation to join in the Global Consultation on WHO strategy recently. Unfortunately, the event in held in Geneva, in WHO HQ. Fortunately, with modern information technology available, I was able to join in the webinar and listen to the contributions by Eldercare experts all over the world. Many agendas from the Global strategy draft were discussed. I have attached the draft strategy in this article at the bottom of the page as well.

The impression I felt was ageing issues were too broad, and every different countries had slightly different focus, different political climate, different resources and very different cultures. It is rather confusing for most parts and many did not stick to the discussion agenda, but putting forth when their countries or organisations are doing. In fact, the definition of at what age should you define an older person may differ from each region. It is a 2 days long event and I was able to sit through all the sessions. 

Many of the themes regarding healthy ageing or ageing in place is not new, and has been a recurring themes in many of these forums or discussions. Themes like a conducive environment to age in, housing and financial issues, long term care  and palliative services, trained frontline manpower, health literacy and promotion, research in gerontology issues etc has been repeatedly mentioned in such forums all over the world. WHO seeks to consolidate all of these ideas into a clear framework as a guide for every country. 

As a global leader in healthcare policies, WHO will have to power to set down some ground indices for every country to follow, thus, data can be compared and best practices might be share between countries with similar socio-economic factors. Many countries, especially the local income countries, may find more challenges and perhaps impossible to implement the finalised strategies as some of the delegates shared. They can also facilitate cross countries collaborations in implementing some of the strategies. 

Each countries take their turns to speak and comment and many shared their difficulties faced and some solutions done. It is an eye opener for many of us doing gerontology work.

In the past 5 years, there has been an increasing support for home based care for elderly chronic sick, bed bound patients. The Ministry of Health and Agency of Integrated Care has done much to support the dependent elderly patients through various policies. Primary health care and long term care sectors have been in the news often and are getting the support they deserve from the policy makers.

 

MEANS testing has been getting less “mean” and much easier to pass in recent years. Hence, MEANS testing dependent programs such as IDAPE has seen an increase in claims in the past few years.  CHAS is another program in recent years to help subsidised patients to see doctors at private GP clinics rather than at polyclinics. CHAS provides subsidies for medical services and other perks, which traditionally only polyclinic holds. One big advantage for CHAS clinics now is the ability to refer patients to Specialist Outpatient Clinic as a subsidised patient.

It has been a heartening 3 years.  Authorities are giving more support to our group of chronic sick, bed bound patients to get treatment in their own homes. Support for home-based care is now given only to home care programs from charities and known social enterprises such as NTUC Health.

Private providers for long-term care services are unable to ride onto this program. Hence, we are only seeing those patients that either failed MEANS testing or non-Singaporean.  There is a special group of non-Singaporeans patients who have been staying in Singapore for the past 50 years but never converted to a Singaporean citizenship or even permanent residency.   For the group of patient who are unable to pass MEANS testing, many of them are actually also HDB dwellers and stays with their unmarried daughter or son with a stable income. Ironically, to pass MEANS testing, it is better for the elderly NOT to stay with their children in order to get maximal subsidies since usually the elderly will not have any active income as they are retired.

In the past, the difference between private and VWO services may not be too great, apart from subsidised consultations. But now, with subsidised medications and Pioneer Generation subsidies, my group of patients are losing out quite a bit. They will not be able to get their prescription subsidized like those in polyclinic or hospital SOCs as PG card holders.  As I do not have a physical clinic, my service is unable to be included in CHAS program.  All my referrals back to hospital SOCs will be treated as private referrals.  It would often be more cost effective to just go to the Emergency department for services such as subsidised referrals! Most of my patients are severely bed bound, hence requiring home based service.  It is very difficult or almost impossible for them to go to a CHAS GP clinics or polyclinic to see doctor or to get referrals.  I see this as huge disadvantage for my patients.  Perhaps, it would be timely for the authorities to come out with new policies to bridge such a gap for this group of patients.

I had been running subsidised home care services with various institutions for the past 7 years. I had witnessed first-hand at the many good subsidized schemes that benefitted patients.  As I had recently stop working for a VWO, some of the patients from the VWO wanted me to follow-up with them, but the difference of cost and benefits between subsidised and private service is too great.  There are also other patients whom I see along the course of my work who would like to continue to be followed up by me.  But as I know they would lose out a lot in terms of subsidized benefits, I had to advise them or refer them to be followed up by VWOs.  It seems that being a good doctor to the patient, thinking for the welfare of the patient will result in a losing situation for my own company.

Lotus Eldercare feels like we are falling through the cracks as well in terms of policy, mirroring those patients we serve.

 

I am excited to be involved in this year’s Global Ageing Conference in Perth, both as a speaker in the concurrent program and a delegate. This year’s biannual IAHSA event is co-hosted with Aged & Community Services Australia (ACSA), which is also celebrating its 40th year anniversary. We were treated to many good practices and great innovative ideas from our Australian counterparts. The conference lasted 5 days, from 31st August to 4th September, with main conference from 1st to 3rd September 

There were a series of interesting Plenary speeches given by global experts from North America, Europe and Australia talking about global aging trends, housing issues, technologies, policies and laws relating to aged care. I did not remember any Plenary speakers from Asia and Asia is unfortunately not very represented in this conference. One of the most advance groups in Asia doing aged care services well in my opinion will be the Japanese. However, I did not chance upon any Japanese except for a sales person based in Australia selling Paro seals.

The speakers are exciting and give very good insights in global trends and practices. In summary, my take home point is the world is ageing, in 2030, 1 in 8 of Earth citizens will be above 65.  There are not enough frontline care workers and the more advanced countries are taking in many of these frontline staff from the surrounding developing or still third world countries. There is no global system and checks on these care migrations. There is no prefect funding system for aged care and many are still figuring out what is the best method without bankrupting the coffers. Technology is very much involved in aged care and aged care should try to adopt technology or risk being obsolete.

There are many concurrent sessions by speakers globally sharing their practices and experiences. There were 3 concurrent sessions in the course of the conference, and 9 - 10 groups with 3 presentations in each grouping. In total, perhaps about 90 to 100 presentations. I am one of the presenters in these concurrent sessions.

I have met many new friends in the conference, notably those from Africa and on a scholarship by CommonAge. CommonAge is a Commonweath Association for the Ageing. They aim to build and support relationships in smaller Commonwealth countries. Their website is www.commage.org , twitter @CommonAgeAssoc and fackbook.com/commage.org 

Those interested in this conference may still view all the recordings. Just download from www.evertechnology.com or e mail Ed at This email address is being protected from spambots. You need JavaScript enabled to view it.

MIT and SMART came up with a pre-MIT Hacking Medicine workshop to introduce to us the concept of the Hacking Medicine and what it encompasses. Many people suggested better ways for technologies to help patients navigate the complexities of both the services and the available funding schemes.

 

Chronological age is definitely not a determinant of the services required. A 90-year-old marathon runner and a 55 year old bed bound stoke patient will require totally different set of services. However, a 90-year-old bed bound from advance dementia and on nasogastric tube feeding will likely to be requiring similar services to that of the 55-year-old stroke patient.

As a primary care as well as long term care physician practicing in the community, part of my work is to advise patients and their families with regards to the possible services they would require; how to get maximal benefits out of our complex health system and also perhaps to relieve some of the work in our congested polyclinics.

There are already informative portals such as Agency of Integrated Care (AIC) site which is very useful but still focus on services rather than the client.

As such, I will be proposing a new portal perhaps via AIC or other aging issues related statutory board, to come out with a portal with the patient in mind. To explain further, this portal will be divided into 9 categories in accordance to the clinical fragility scale. Under each category, there will be subdividual into different sections such as health, financial and social support information. For example, the 90-year-old marathoner will be clicking onto Category 1 pages, perhaps telling him on chronic diseases screening and exercise prescription information, socially on the SG 50 sponsored courses etc. The 90-year-old stroke patient will have information on home medical and nursing services, and financially advised on IDAPE, PG-DAS, FDWG and SMEF funding schemes if eligible.

As the Clinical Frailty Scale is easy to understand and categorize, with useful information stack behind these more patient orientated headings, services can be groups and organized in a more functional way for the users.

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Project Yangon June 2015 with medical students from Yong Loo Lin School of Medicine, Singapore:

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IDA, would like to invite you to attend the Pre-MIT HackMed@SG Workshop to be held on 1 July 2015. This is a run-up to the Massachusetts Institute of Technology Hacking Medicine in Singapore (MIT HackMed@SG) event, which will be held on 25-26 July 2015.

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