Speech by Dr Amy Khor, Senior Minister of State, Ministry of Health, at Tsao Foundation Expert Series 2018, 26 June 2018

Dr Mary Ann Tsao, Chairman of Tsao Foundation

Ms Peh Kim Choo, Chief Executive Officer and Director, Hua Mei Centre for Successful Ageing

Professor Tara Cortes, Executive Director of the Hartford Institute for Geriatric Nursing

Ladies and Gentlemen 

       Good Morning. It is my pleasure to join you here this morning, at the symposium, “Nursing Care for Community-Dwelling Elders – A Professional’s Toolkit”.

2.    The world’s population is rapidly ageing. Globally, the number of seniors aged 60 and above is expected to more than double, from 960 million in 2017 to 2.1 billion in 2050. Singapore is no exception. By 2030, one in four Singaporeans will be aged 65 years and above, and our average life expectancy of about 83 years looks set to increase² in the coming years. With an ageing population, our overall demand for health and social care will inevitably increase. This is a challenge we must address together as a society.

Shifting Care from Hospital to the Community

3.    With a slowing labour force growth and growing demands for aged care, we will need to transform care for our seniors in a sustainable way. Most Singaporeans prefer to age at home and in a familiar environment. Nurses, being at the core of the healthcare workforce, are central to this vision. Community nurses in particular, work closely with families, neighbours, volunteers, and other healthcare professionals. In doing so, they anchor care in the community to better meet the needs of the population and ensure that our seniors are well-cared for.

4.    Today, the role of community nurses is primarily being performed by the many nurses working tirelessly in community care organisations such as the Tsao Foundation. Under its Hua Mei Centre for Successful Ageing and Community for Successful Ageing, the Tsao Foundation provides integrated medical, social and psycho-emotional care to our seniors who wish to continue living in the community. In this ecosystem, the community nurse functions as an integral member of of a multidisciplinary team, working in collaboration with other health services to provide holistic, person-centred care.

5.    Let me give one example. One of the Foundation’s services, the Hua Mei Elder Person-Centred Integrated Comprehensive Care or EPICC, is a day health programme dedicated to serving seniors who have multiple chronic conditions and limited social support and who would otherwise require nursing home care. At 96 years old, Mr Lee KS was first referred to the EPICC team last year. In addition to being frail and wheelchair-bound with multiple chronic conditions, community nurses Chua Yah Li and Sheng Hui Bin observed that Mr Lee had difficulties adjusting to the centre as he was easily agitated in new environments. They took it upon themselves to go beyond just tending to the medical needs of Mr Lee to ensure that he could participate in activities like group drumming, which was popular among the seniors, but would be risky for him without the nurses at hand. I am happy to hear that Mr Lee’s chronic conditions are better managed now through the dedicated and strong efforts of the community nurses under the EPICC team. He is also happier, and looks forward to celebrating his 100th birthday at the centre.

Strengthening Community Nursing

6.    For many seniors like Mr Lee, community nurses can play a big role in fulfilling their aspirations of living well within the community. This is why we have taken up the Future Nursing Career Review Committee’s (FNCRC) recommendations to strengthen our community nursing workforce and invest in training efforts to raise community nursing capabilities. These efforts would not be possible without close collaborations between the sector, training providers and training institutions. I am encouraged to see the Tsao Foundation’s Hua Mei Training Academy and Ngee Ann Polytechnic coming together to jointly develop the Specialist Diploma in Community Gerontology Nursing last year, to equip our nurses with skills in care planning for seniors with complex social and functional needs. Such collaborations in strengthening community nursing can go a long way to nurture our future community nurses with relevant skills.

7.    At the same time, it is important for training efforts to be recognised by the healthcare industry. In line with the FNCRC recommendations, we will be developing a competency framework for community nursing that outlines the skills and competencies needed for current and emerging community nursing roles. Employers and training providers may then refer to this framework to design flexible learning pathways.

8.    A strong community nursing workforce requires not just excellent nurses, but also excellent nursing leaders. This is why we introduced the Community Nursing Scholarship last year, which supports future community nursing leaders in furthering their education either locally or abroad. Thus far, four scholarship recipients were awarded last year and they are now undertaking their nursing degree studies at NUS. The selection process for this year’s scholarship cycle is on-going and will end this month. We welcome anyone who is interested to pursue a rewarding and meaningful career in community nursing to take up this opportunity.

Community Nurses as Bridges between Hospital and Community

9.    Nurses play an important bridging role to ensure smooth transitions of frail and complex patients between hospital and home. The Regional Health Systems (RHSes) are piloting geographically-based community nursing teams to complement existing community care providers in delivering integrated care across care settings. The intent is for each RHS to have a network of community nursing teams that hold a “portfolio” of patients within each region. Supported by trained staff and volunteers, community nurses provide patients with preventive health support such as screening and falls risk assessment. They will also help to keep a closer eye on the management of patients with known chronic conditions, and facilitate smooth transitions of the patients from hospital to home. This includes providing treatment such as the Outpatient Parenteral Antimicrobial Therapy, or OPAT, in the community to patients who require antibiotics injections. For patients requiring end-of-life care, community nurses help to monitor their conditions closely so as to support doctors’ decision-making, and serve as a source of timely advice and support for caregivers.

10.    In the last ten months since the pilot started, it has helped to identify and provide support to seniors who may have otherwise fallen through the cracks.

11.    For example, with the support of the Community Network for Seniors initiative or CNS, volunteers from the Brahm Centre recently brought an elderly lady living alone to the attention of community nurse Eunice Lim from the National Healthcare Group. The resident had been experiencing lower leg pain for years, but had not received any treatment due to her reluctance to seek medical care. To avoid distressing the resident, Eunice and the team first screened and assessed the resident for risk of falls. Having determined that the resident was at high risk for falls, they then contacted her nephew and explained her condition to him. They also provided assurance that he had the continual support of the community nursing team as he watched over her during the weekend to ensure her safety as well as her well-being at home. Eunice and the team then made subsequent visits to monitor her condition while convincing her of the importance of timely treatment. Eunice was not deterred by the slow progress of conversations, and was careful to pay close attention to the concerns of the resident. Through her persistence, patience and tact, Eunice gradually built rapport and trust with the resident, who finally agreed to have her condition reviewed by a doctor.

12.    Further assessments at the clinic revealed that the resident also had dense cataract that clouded her vision. By then, the team had built up sufficient rapport with her to be involved in her care plan, and she actually agreed to the recommendation to see a specialist for assessment accompanied by volunteers. I am happy to share that she is now pain-free and is awaiting a date for her cataract surgery. Through the collaborative efforts and proactive care-planning involving the community nurses, doctors, family members as well as volunteers, the resident is now able to continue living at home comfortably and safely, while getting her health concerns looked into.

13.    Beyond having good clinical acumen and judgement, as well as having the heart and passion for their work, community nurses need to be able to practice independently, think on their feet, be resourceful in non-clinical settings such as the new environment of a patient’s home, and communicate effectively with seniors. We will continue to look into how we can better resource community nursing. With the high demand for nurses to meet growing healthcare needs of Singapore, we will also need to explore how we can use technology and innovation to be productive in our community nursing care model. Indeed, that is also one way to support our community nurses so that they are able to perform more effectively.

Conclusion

14.    At the heart of every transformation of care model is its people. It is only with the concerted efforts of the community care sector, communities and healthcare partners that we can succeed in enabling more seniors to live and age well at home and in the community. The shift from hospital to home will not happen without continued efforts to strengthen community nursing, sustained collaborations across the community care sector, as well as a relentless process of learning from each other. 

15.    I wish you a fruitful morning and a successful conference. Thank you.

¹Source: United Nations, Department of Economic and Social Affairs, Population Division (2017). World Population Prospects: The 2017 Revision. New York: United Nations.
²Source: 2017 World Health Statistics report by the World Health Organisation.