Lotus Eldercare

Lotus Eldercare

Lotus Eldercare was invited as one of the organisation to be interviewed in this Thesis done by Mr Ng Nghee Guan, doing his Masters in Public Health. We hereby thank Mr Ng for allowing us to post his painstaking work online. You can reach the author via his e mail This email address is being protected from spambots. You need JavaScript enabled to view it.

ABSTRACT

Singapore, like any other countries in the world, is facing ageing population. Currently there are about 10% of population who aged 65 years old and above, but this proportion will increase tremendously to 20% by 2020. In fact, the Singapore government have a Healthcare 2020 masterplan to deal with this influx. However, 2 years have passed since the roll out of the masterplan, efforts have being concentrating to build more hospitals, community hospitals and nursing homes to increase the bed count significantly, but will that be good enough?

A study done by US home care service providers, Home Instead Senior Care (2010), showed that seniors and their adult children know little about their care options, are badly misguided about the costs of those options and inadequately informed about the financial resources needed to cover the costs. We would want to ask if Singapore is also facing the same problem.

E mailing group for HomeHealthcare Services

Home Healthcare Services are increasingly becoming sought after with the public system and the charity groups setting up home care programs for aging and dying in place concept.

Home medical includes seeing patients at their own homes or in nursing homes. This group serves to link up private service providers to governmental and charitable organisations. It is set up by Founder and Director of Lotus Eldercare, Dr Tan Jit Seng, as part of the his services to push home medical services forward in Singapore. This service is free of charge and health providers like home nursing and home therapy providers can e mail us to be included into the group as well if interested.

Institutions interested to obtain medical or other health services can e mail to

  This email address is being protected from spambots. You need JavaScript enabled to view it.  

 

Your e mail will be forwarded to all the members and interested care providers will contact you. As this is only another platform to source for care providers, we will not be responsible for any failure of getting service through the group. There will be no link up fees or whatsoever as well since this is an effort to support home based health services.

Regards,

LocumSg

www.locumsg.com

 

Lotus Eldercare was invited as a panel speaker in the annual Asia Business Conference on the 9th of March 2014 in Harvard Business School. http://www.asiabusinessconference.org/2014/

This year's topic under Healthcare section was on Reverse Innovation of Healthcare delivery. The forum focuses on the current healthcare markets throughout Asia, talking about the investments, the supply chain and the manpower needs.

Speakers include Health IT expert from MIT, Health Investment Director from Goldman Sachs, CEO from one of the pharmaceuticals and Microsoft's health and social service division.  

On healthcare demand and investments, a lot of focus in Asia is now in China. With a aging population and growing demand for more healthcare supports especially in the aging population, there is a great demand for health and chronic care services in China.

The use the ITs for the more remote regions and the lack of an army of trained health service personnel are also big challenges. These challenges must be tackled with the support of sound government policies and innovative processes with collaborations from the private service providers to delivery seamless care support to patients and their families.

 

I am not trained in public health or policies, nor am I an accountant or insurer or have any training in business and finances. However, during the course of my work in the long term care setting, and with my past rotations in the restructured hospitals, polyclinics, private GP clinics, community hospitals, nursing homes and long term home care services; I do very much like to share some insights from my past decades as a clinician and as a fellow average HDB dwelling Singaporean. Like some of you, I do have dementing, dying grandparents and parent with malignancy to care for and pay for. It is already not easy for me as an insider to arrange and manage the health services needed and to contain the costs involved. It must be doubly hard or even impossible for the rest of you out there.

 I have summarized most of the health services needed in one’s life and the biggest costs would be both in the tertiary and long term care setting. (See Annex 1) Many studies have shown medical costs at the last year of life is very much more and with good medications, and efficient and effective care services in Singapore, I dare say we will stretch this last year of life to a few more, hence the cost involved will all escalate.

To me as a physician, all our restructured hospitals are providing very good standard of care and subsidized wards are generally quite affordable. However, due to the constant bed crunch attributable to a sudden population increase, aging population and effective medical treatments, we are always in a hurry to discharge patients. Those who can walk out of hospitals are usually fine and everyone is happy with lesser days hospitalised. However, those that cannot walk out of hospitals may be faced with placement problems and recurring admissions when not well supported in the community. With recurrent admissions, it will further strain the system and escalate costs. Unfortunately, the system favours hospital admissions since it is well subsidised, and able to use private insurance, MEDIFUND, MEDISHIELD and even mobilise MEDIFUND!

On the primary care end, although the cost is usually acceptable and attainable, the biggest problem is still the lack of adequate resources and integration. But that is a discussion for another day. Polyclinic will be the last line of defence and it has been holding up, with more in the pipeline in the near future from the current size of 18.

On acute hospital end, average savvy Singaporean can get private insurances, Medishield with Integrated shield plans and other rider programs etc. Those really cannot pay with no insurance etc can get MEDIFUNDed and VWO support.

On the long term care, it is an issue since not much emphasis has been place in the past and the government has let the charities and private sector take over. Hence, in step down care facilities, just a few years back, there is no government built community hospital or nursing home, rather these facilities survive on its own or services are partially funded by MEANS testing. There is not much insurance when the patient cannot walk out of the hospital for continue care and planning to keep them out of hospitals, hence our readmission rates and heavy workload in the emergency department.

So how much does it cost to maintain a dependent patient in the community? What sort of insurance policies can they tap on at the moment? Apart of the IDAPE/ELDERSHIELD scheme and eSMF which was recently introduced to include consumables, I guess we are on our own. One of the issues is drug cost which is not subsidized when you leave the restructured hospital system but then, there is no so-call hospital system in the long term care setting in the community. We can break down the cost of the patient into a few simple aspects:

1.      Healthcare manpower, including the caregiver, doctors, nurses and therapist

2.      Hospital furniture

3.      Consumables

Let see the cheapest possible cost for a bed bound patient on nasogastric tube feeding (which I can personally do, and which I do for many patients -  for the poorest)

Cost to be cared at home:

90 year old grandmother staying in 3 room HDB, born in 1924, bed bound on nasogastric feeding. This in what I will do usually:

MEANS tested 80% since she lives alone in a 3 room HDB with $0 income, Cost:

1.      Hospital bed at 10% cost (just the single cranking type – new) $690 x 10% = $69,

2.      Air mattress 4 inch $400 x 10% = $40,

3.      Diapers (Tena etc) 5 pieces/day x 30 = $200 to $300

4.      Ensure milk 5 cans/day = $2.00 x 5 x 30 = $300

5.      Care giver – Daughter = Free

6.      Other consumables – NGT set, laxatives, barrier creams, moisturisers, dressing etc = $100

7.      Medications: Dr Tan Jit Seng decided to stop all medications apart from some laxatives

8.      Dr Tan Jit Seng’s review under charity $30 per once in 3 months plus cost of flexiflo $20 = $50. I will include the insertion the NGT and all other possible procedures as well for free.

 

Total for 3 months (maintenance excluding initial hospital furniture =

$200 x 3 + $300 x 3 + $100 x 3 + $30 +$20 = $1850)

One year average = $1850 x 4 = $7400

 

Subsidies eligible:

IDAPE $250 monthly x 12 = $3000

eSMF funding for MEANS tested 80% annually allowed = $2000

 

Total: $7400 - $3000 - $2000 = $2400/12 = $200/monthly.

 

This is the absolute absolute cheapest case scenario and can form the backbone for any further calculations. I see the poorest to the richest and to perhaps maintain a patient from richer family with paid caregiver(s) the cost may be between $1000 to $5000 monthly, inclusive of the medications and without any subsidies or insurance claim.

Cost to be cared in nursing home:

Same patient, nursing category CAT 4:

Nursing home bed norm cost from $1200 to $5000 per month excluding consumables and extra charges/administrative charges depending on the class of stay and before any MEAN tested subsidy. Hence, at maximal 75% subsidy, so the cheapest bed at $1200 will set the family back by $300 before adding the cost of milk feeds/diapers etcs

The cost will only go UP In future.

Hence, I am hopeful that MEDISHIELD Life may be a partial answer for the funding for this group of patient in future. My suggesting would be to either get CPF board or a new government board (even AIC) to run this insurance and for the insurance to include long term care as well in proper accredited nursing homes or home care services. It is stated to be covering all Singaporean citizens and with pooled resources it may be possible. MEANS testing are not as mean as before but can still be quite mean since those middle class who have worked hard for Singapore past 5 decades and achieve a reasonable standard will not get any subsidy and add more liabilities to their younger and growing families. So it depends what are policy makers are leaning towards, it was pretty right in terms of old and frail before but since 2011 GE it has shown to be going towards more left with more mentioning of chronic and eldercare services. 

There are many different healthcare policies in the world, ranging from both extreme ends like universal healthcare in the British NHS, to all private in term of paying out your own pockets for insurances etc. There are countries with state insurance programs, like Taiwan, Switzerland and co-payment programs like 10% of monthly salary for hospitalizations in certain European countries.

Which program is best suited in Singapore? We will see!

So what we can hope to do is to aim for compression of mortality model, where everyone is fit with little healthcare expenditure from year 0 to year 99, get sick and die within 1 year at year 100. This will start from health education from young and change our unhealthy and stressful lifestyle. Possible? Well, I guess we have to continue to fight fire…

Drafted by
Dr Tan Jit Seng
Senior Home Care Physician
Lotus Eldercare Pte Ltd

A New Model of Care: Home Continual Care and Response Service (HCCRS)

 

Target Patient Population:

Activities of Daily Living (ADL) dependent patients

Services:

Ranging from subacute care services to long term nursing services up till palliative care services

Liken step down care services but entirely home based, relying on trained caregivers and remote monitoring technologies and usage of electronic medical recordings.

1.      Present situation consisting of a few scenarios:

 

  1. Acute hospital to Community hospital to Nursing home
  2. Acute hospital to Nursing home
  3. Acute hospital to community hospital – care giver training to home
  4. Acute hospital – care giver training to home

 

2.      Home Care Environment setup:

 

Hospital Bed
Pressure relieving mattress
Nasogastric Feeding Set
Tracheostomy Cleaning Set
Suction Set with catheters
Urinary Catheter Set
Nebulisation Set
Normal/Reclining Wheelchair
Geriatric Chair
Oxygen concentrator
Any extra equipment like electric hoist/bathing trolley etc
Expendables ( Diapers/Sterile sets/ Dressing set and Dressings – various)

 

3.      Workflow:

 

Team consisting of Home Care Physician/Nurse/Physiotherapist/Medical Social worker/Caregivers having family conference in hospital before discharge/at first home review:
Major difference is that care giver is part of the team, and can be provided by the service with interchangeable care givers or provided by the family. They will have more training in monitoring and input into electronic medical records of the patient similar to a hospital service and directly link to the caring team.
 Nurse in charge functions as the case manager and supervises the caregiver and provides timely training for the care givers when needed, for example wound management
Physiotherapy in charge will do rehab planning or maintenance rehab as required
Doctor in charge is the primary physician does chronic medical reviews and managing acute medical conditions to prevent readmissions.
Care of the patient will be sole at home with any forms of admission avoided if possible, palliative and pastoral care services are provided as well when required.

 

4.      Information technology usage:

 

Remote monitoring of vital signs via electronic medical records and tele conferencing with the caregivers
Tele rehab with “live” supervision of physiotherapist via video conferencing provided
Virtual rehab possible as well with computing programs

Advantages:

Able to tap in eSMF for the patient and reuse the hospital furniture for more needy patients
More streamline and cost saving process, no further land/building/maintenance/equipment cost to the government like setting up another community hospital or nursing home
Will tap into National Electronic Health Records to provide monitoring data (functions as a home based virtual hospital/community hospital/nursing home) Both MOH and restructured hospital will have patient’s home monitoring data and most updated clinical records and management plans
Less conflict with family and staff since we now work in tandem rather that the family shifting all the responsibility to the caring institution

 

5.      Business model:

 

MEANS tested subscription model, liken cost of staying in community hospital or nursing home

Private insurance/Medisave/Medishield Life (in future) /Medifund/VWO support for patients

FDWG eligible for the caregivers under the service, or any further grants for the care givers

Can be partially funded out of hospital programs such as transitional care services

Can be linked up with VWO to provide the services e.g. VWO-HCCRS Ang Mo Kio etc

Pooling and bulk buying of resources for more economical pricing

Recycling of hospital furniture or rental equipment

Private entity with government/VWO support plus private patients

 

Drafted by:

 Dr Tan Jit Seng

Senior Home Care Physician

Lotus Eldercare Pte Ltd

Provide home-based assessment for Basic Activities of Daily Living (bADLs)  dependent patients who are unable to physically attend to a clinic. New applications or review visits are both welcomed!

National Disability Scheme includes

1. IDAPE, Eldershield, Elderfund and CareShield Life for severely disabled patients. 

2. Home Caregiver Grant, PG DAS for moderately disabled patients.

3. Foreign Domestic Worker Levy Concession for those needing help in daily care.

Do call us at +65 6808  5664 during working hours, or WhatsAPP us at +65 9800 4828 after office hours to arrange for a home visit to apply for the grants.

  WhatsApp Us today!

There are many policies relating to eldercare funding, Seniors’ Mobility and Enabling Fund (SMF) is one of such. There are also policies like IDAPE / Eldershield, LTC subsidies etc.

With effect from 1 July 2013, the $10 million Senior’s Mobility Fund has been expanded into a $50 million Seniors’ Mobility and Enabling Fund (SMF).  With its expansion, SMF now provides even more holistic and comprehensive support for seniors to remain mobile and to live independently in the community.  It also offers greater support to caregivers in caring for their seniors at home.

Please click the icon below for more information on the various funding policies:

Lotus After Hours Support is presently closed. Kindly download the list of house call doctors below

We recommend you to read the blog from our long term collaborator The HouseCall GP:

 

 

 

Do click the picture below for the full list of acute urgent house call services in Singapore:

 

 

 

interRAI is a collaborative network of researchers in over thirty countries committed to improving care for persons who are disabled or medically complex.

Please visit interRAI's website to find out more!

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 range from about $250 to $300 per doctor visit per patient for a routine visit for patients under our long term home care service, including procedures and reviews. Medications and expendables will be charged separately if required. All visits are strictly appointment based only. 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.

1 Raffles Place #19-61, Tower 2, Singapore 048616

Office line : +65 6808 5664

Fax line: +65 6808 5801