Speech by Mr Gan Kim Yong, Minister for Health, at Home Nursing Foundation’s "Futurescape: Home Healthcare – Local and International Perspectives" Conference, 20 August 2016

Ms Priscylla Shaw, President, Home Nursing Foundation

Professor Peter Lim Ai Chi, HNF Board of Management and Conference Advisor

Ms Karen Lee, Chief Executive Officer, Home Nursing Foundation

Distinguished Speakers and Guests

Ladies and Gentlemen

Good morning 

    I am happy to be here to join you to celebrate the 40^th anniversary of the Home Nursing Foundation (HNF). Let me first, let me congratulate HNF on this significant milestone. I also want to take this opportunity to thank all our nurses that have worked very hard over the past few years for our seniors, keeping them well at home.

Singapore is Ageing Rapidly

2.     The theme of this conference is timely, as many parts of the world are facing rapid population ageing. Globally, one in 10 individuals are aged 60 and above. But by 2050, this figure is expected to double^[1]. Asia in particular is ageing more quickly than the rest of the world. Persons aged 65 and over in the region will double, from 7 per cent to 14 per cent of the total population, in just about 20 years^[2]. With the complexity of challenges posed by greying populations, it is no wonder the world’s attention is increasingly turning to policies and programmes to achieve successful ageing.

Ageing in Place

3.     Singapore is no exception. Singapore will take about 19 years for persons aged 65 and over to rise from 7% to 14%². In comparison, France took 115 years to do the same^[3]. Over the next two decades, we will see rapid demographic shift manifest in a few ways: population ageing, lower labour growth and shrinking family sizes. With an increasing number of seniors and weaker family support, the demand for aged care and institutionalization will grow. Yet, ageing in place and at home remains the preference of our seniors.

Developing Home Care in Singapore

4.     Singapore has gleaned valuable lessons from countries which have aged before us. The key lesson we have learnt is that we need to plan ahead and develop home-based care aggressively if we want to moderate the rate of institutionalization. Japan is a prime example for us – with its comprehensive home and community-based care system to support ageing in place. Although one in four Japanese are now aged 65 and above^[4], the institutionalisation rate remains low at about just 3%^[5].

5.     We have been working hard to ramp up home-based care in Singapore. In the last few years, Singapore has stepped up efforts in the following 5 areas.

6.     First, we are increasing the capacity of home care services to make care more accessible. From 3,800 seniors in 2011, we are now able to provide care to 6,900 seniors in the comfort of their own homes. We will continue to grow this capacity so that we can serve 10,000 seniors by 2020. Service partners like HNF are integral to achieving this goal.

7.     Second, we are expanding the diversity and range of home care services to better serve the needs of seniors and their caregivers. In the past few years, we have established transitional care and team-based home care programmes to manage frail patients with frequent hospital admissions at home. Elderly patients and their caregivers are also supported by interim caregivers during their transitions from hospital to home. We have also expanded the scope of home care by introducing new services such as home therapy. We are pursuing care integration. This year, we introduced new Integrated Home and Day Care packages that allow our seniors to receive a mix of home- and centre-based services according to their needs. We are strengthening the network of community-based care coordination, involving local nurses and care aides, to support frail elders in the community. Under the Care Close to Home (C2H) pilot launched in 2013, care teams now provide care coordination and home-based services from senior activity centres (SACs) to nearby communities in 8 precincts today^[6]. With this experience, we are working to expand C2H to more sites in the future.

8.     Third, we are leveraging on technology to enhance the productivity and effectiveness of home care. For example, Singhealth is piloting a mobile application to match available nurses to patients in need living nearby, to provide more responsive home care services. We are also embarking on telehealth initiatives such as a common vital signs monitoring platform for home-based chronic disease management. Funds such as the Care-at-Home Innovation Grant, Tote Board Community Healthcare Fund (TBCHF) and the Healthcare Productivity Fund (HPF) also help to encourage the adoption of innovative technology in the sector.

9.     Fourth, we are growing and developing our manpower capabilities. MOH has formed a workgroup to map the core competencies for community nursing. This is a first step towards developing future training and career pathways for nurses in home and community-based care as a key track within the profession. We will be engaging key nursing leaders to develop the framework further.

10.     Fifth, we are ensuring that home and community care services remain affordable for seniors. We have enhanced subsidies so that Singaporeans can now receive home care subsidies of up to 80%. Seniors can also tap on the Seniors’ Mobility & Enabling Fund (SMF) for subsidies for home care consumables, assistive devices such as walking sticks and transport to and from eldercare and dialysis centres. The Foreign Domestic Worker Grant provides $120 each month to families with foreign domestic workers caring for seniors at home. We will continue to ensure home-based care remains affordable.

11.     We are optimistic about the future of home care, and our ability to support our ageing population, because we have a passionate sector that champions ageing in place. Home care in Singapore has come a long way, and HNF has played a crucial role in this journey. Over the last 40 years, HNF has grown from just 11 nurses to a team of about 60 nurses now, and allied health professionals. They made 38,000 home visits island-wide the past year. Even as HNF grows its reach, quality care remains its core. HNF is committed to collaborations with other healthcare partners to serve their patients better. We need more partners like HNF who are willing to go the distance, and deliver care not only with professionalism and pride, but also with love. They are key to ensuring that our home and community care services truly meet the needs of our seniors.

An Ecosystem to Support Ageing at Home

12.     To achieve effective ageing in place, it is not enough to develop home care alone. In less than 15 years, we expect nearly 900,000 residents to be over 65 years old^[7]. We need to build a supportive ecosystem in each community that can support seniors to age in place. In several communities, the home care sector is already partnering local non-governmental organisations (NGOs) and grassroots leaders to build this eco-system.

13.     In Kembangan-Chai Chee (KCC), for example, a team of dedicated volunteers equipped with eldercare knowledge would visit the homes of frail seniors to provide basic home safety education as well as to help look out for seniors who may need community care and support. The Singapore Red Cross (SRC) has also partnered the Eastern Health Alliance (EHA) and grassroots leaders to provide befriending services, first response, first aid and eldercare visits to vulnerable seniors at home.

Conclusion

14.     Our vision is to build an inclusive society by 2030 where our seniors can age in place happily and successfully. Conferences such as this one are important, as they facilitate the sharing of knowledge and best practices. We need to draw from the experience of others within and beyond the region to identify impactful, practical solutions to the challenges arising from rapidly ageing populations.

15.     In closing, I thank HNF for your partnership with MOH and for organising this conference. I am confident that this will be an enriching experience for everyone, and wish all of you a very fruitful day ahead.

16.     Thank you very much.

^[1] Source: Report on multisectoral action for a life course approach to healthy ageing: draft global strategy and plan of action on ageing and health, tabled at 138th plenary session of Executive Board, WHO (December 2015), December 2015. http://apps.who.int/gb/ebwha/pdf_files/EB138/B138_16-en.pdf

^[2] Source: World Bank Group (2016). Live Long and Prosper: Ageing in East Asia and Pacific, World Bank East Asia and Pacific Regional Report. Retrieved from https://openknowledge.worldbank.org/bitstream/handle/10986/23133/9781464804694.pdf

^[3] Source: Kinsella, K., & Phillips, D. R. (2005). Global Aging: The Challenge of Success (Population Reference Bureau). Retrieved from http://www.prb.org/pdf05/60.1globalaging.pdf

^[4] Source: 2015 Census released by the Ministry of Internal Affairs and Communications, Japan http://www.stat.go.jp/english/info/news/20160420.htm

^[5] Source: Ministry of Health, Labour and Welfare, Japan (2013). The current situation and the future direction of the Long-term Care Insurance System in Japan ~With a Focus on the Housing for the Elderly~ (page 15).  

^[6] C2H is currently running from AWWA SAC @ Ang Mo Kio, Kreta Ayer SAC (Chin Swee), Goodlife! SAC, Sunlove SAC Marsiling, NTUC Silver Circle SCC @ Henderson, TOUCH SAC (Geylang Bahru), THK SAC @ Ang Mo Kio 257 and THK SAC @ Beo Crescent.

^[7] Source: A sustainable population for a dynamic Singapore: Population White Paper (page 12)