Synchronise efforts to care for the elderly

SINGAPORE - The Singapore Government may have one of the more efficient bureaucracies in the region, but sometimes, there is still a tendency for each ministry and government agency to function independently as if it were in a silo.

Unfortunately, governments cannot be truly effective if they are run in this manner. This is particularly so when it comes to dealing with multi-dimensional challenges such as that presented by an ageing population.

On March 5, Finance Minister Tharman Shanmugaratnam, who is also Deputy Prime Minister, noted in his Budget wrap-up speech that one million Singaporeans will reach retirement age in 10 to 20 years.

The country needs, he said, "a cost-effective way to prevent the total health-care bill from spiralling upwards, because everyone will have to pay for that".

In dealing with this issue, the relevant government departments could learn much from the the National Security Coordination Secretariat (NSCS). It was formed under the Prime Minister's Office in 1999 to address intelligence issues and formulate national security policy. In this way, security agencies under the Ministry of Defence, the Singapore Police Force and the Internal Security Department came together to manage security issues and threats.

The national effort to provide cost-effective health care to an ageing population requires a similarly coordinated approach. The Ministry of Health (MOH) in particular needs to leverage on the infrastructure and organisations that are already set up in the community.

The Ministry of Social and Family Development (MSF) runs 41 family service centres (FSCs) and will have 14 social service offices (SSOs) by the middle of this year, including four new ones in Ang Mo Kio, Sengkang, Bedok and Queenstown. The MSF also plans to set up a new eldercare system for seniors by the end of the year in response to the increasing number of seniors living alone.

Under the eldercare system, the island will be divided into zones, each anchored by an operator appointed by MSF. These anchor operators will run social and recreational activities within the communities, while the main centre in each zone will have case managers to counsel and visit the seniors at home. These FSCs, SSOs and eldercare regional centres already offer medical counselling, dietary advice and caregiver counselling, and provide early interventions such as making the home more elder-friendly during house visits.

However, more coordination is needed between hospital staff and social workers.

The MOH could tap these organisations to extend health-care services deep into the community, thus removing the need for some patients to visit the polyclinics for their health-care needs. The MOH could also identify retired but able health-care professionals - doctors, nurses and pharmacists - as well as para-healthcare assistants who could serve in the centres.

General practitioners (GPs) could also form alliances with these centres, especially for repeat consultations for chronically ill patients, provided health-care subsidies are made portable.

Ideally, each centre should have a multi-disciplinary team of social and health-care experts. Such teams will enable the centres to provide more holistic care to the needy and families at locations closer to their homes.

It is both easier and cheaper to provide assistance before a health situation deteriorates and makes a hospital visit necessary. It is also more convenient for the patient and saves transport costs for the needy (which could be very significant).

The able elderly folk are also invaluable assets to society. They can contribute in areas such as volunteering, childcare, care of other adults and charitable giving.

If we are able to better manage the upstream care demands - that is, local or home-based care - before hospitalisation, we will be in a better position to manage the downstream demands in a more cost-effective manner.

The challenges involved in caring for an ageing population require health-care professionals and social workers, as well as their partners among private and voluntary organisations, to be willing to work together in new ways.

By doing so, Singapore will be better placed to enable the country to cope with the large number of people reaching retirement age in the next 10 to 20 years.

This article was published on May 12 in The Straits Times.

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