Lotus Eldercare

Lotus Eldercare

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/

 

 

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.

Bringing Technology and Fund to You

 

We would like to invite you to our networking event (below).

 

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 call us at 9800 4828 or E mail the request 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

Handphone: +65 9800 4828 WhatsAPP, Direct Call or SMS available. 

Office line : +65 6808 5664  Fax line: +65 6808 5801