Innovation in Eldercare Sector

8 Mr Leon Perera asked the Minister for Health what is the Ministry doing to promote experimentation and innovation in the eldercare sector so as to encourage care models that provide greater privacy for dementia patients in a space-efficient way.

The Senior Minister of State for Health (Dr Amy Khor Lean Suan) (for the Minister for Health): The Ministry of Health (MOH) has been making innovations in care for our elderly, including those with dementia, with our partners. For instance, in some of our new purpose-built nursing homes, we have created closed-loop outdoor gardens next to dementia wards, to enable seniors with dementia to move around independently and enjoy the greenery.

We are also experimenting with a dementia-friendly concept of "cluster living" in Ren Ci's new nursing home in Ang Mo Kio, which is in the midst of construction. The home is designed in the form of small "clusters". Each cluster consists of bedrooms with a smaller number of beds compared to other nursing homes, sharing a common living space, including activity and dining area, as well as bathrooms. This design allows for a smaller-scale and more familiar environment to support residents with dementia and yet promotes interaction among seniors and does not segregate or confine seniors in single rooms which may be more challenging in terms of monitoring and care.

This design is the result of a brainstorming workshop with Ren Ci, facilitated by Dr Emi Kiyota, an environmental gerontologist based in the US, who is most noted for her work in championing the concept of the "Ibasho" or a place where seniors can live in safety, comfort and dignity.

We have also implemented several dementia-friendly initiatives at our acute and community hospitals. The Institute of Mental Health (IMH) has renovated a dementia ward to create a more homely living environment which includes a garden designed to allow dementia patients to move around safely. The ward includes a reminiscence room and a sensory room to provide dementia-specific therapy. Khoo Teck Puat Hospital (KTPH) is also operating a ward which is designed to have minimal distractions from the hospital environment. This is to provide better and more personalised care for dementia patients who may find the unfamiliar environment in a hospital disconcerting and stressful. St Luke's Hospital (SLH) and St Andrew's Community Hospital (SACH) have also introduced dementia-friendly wards which are designed to provide a more private and safer environment for dementia patients to move around, participate in group activities and interact with one another. Staff in these wards received additional training in dementia care to provide care that is tailored to the unique needs and personality of each dementia patient.

Dementia care is evolving in Singapore and we are continually seeking to learn and experiment on better models. Even in land-scarce Singapore, it is possible to design spaces that strike a balance between providing for the privacy and dignity of users and ensuring the cost-effectiveness and sustainability of the care model. We will continue to learn and adopt new thinking into our local efforts in designing dementia care facilities.

But good dementia care goes beyond the physical attributes of the care facility. Good care has to come from quality hardware design, coupled with good care delivery. MOH is also piloting innovative care models within the community for persons with dementia so that they can continue to be cared for and supported at home and in the community, with funding support provided under the Community Mental Health Masterplan. For example, Tsao Foundation offers a dementia home intervention service where they provide advice to caregivers on how to better care for their loved ones at home.

NTUC Health and Thye Hua Kwan also provide elder-sitting services, where care staff accompany persons with dementia at their homes and engage them in activities according to their personal interests. We have also worked with Tote Board to put in place a Community Healthcare Fund to support new pilots in the community, including in dementia care. These include Montfort Care's Happy Kopitiam programme which provides caregivers with education and support, while giving an avenue for caregivers and persons with dementia to participate in activities together and Alzheimer's Disease Association's Family of Wisdom programme where caregivers take part in the day care sessions with their loved ones with dementia and provide mutual support.

The Government also provides funding support to further catalyse new models of care and ideas. Most recently, we set up the National Innovation Challenge on Active and Confident Ageing under the Action Plan for Successful Ageing to catalyse innovative ideas and research to transform the experience of ageing in Singapore. Last year, MOH launched a grant for innovative preventive programme to delay the onset of dementia and new models of dementia care in the community. The grant call attracted close to 40 proposals from multi-disciplinary research teams that comprise clinicians, engineers, sociologists and care providers.

We will continue to enhance the access, quality and affordability of care to seniors. We will partner our aged care providers to innovate and make eldercare better and more resource-effective.

Mr Leon Perera (Non-Constituency Member): Mdm Speaker, I thank the Senior Minister of State for a very comprehensive and helpful reply. I just have two supplementary questions, if I may. Firstly, specifically in the context of the Jade Circle proposal and in the context of dementia patients requiring institutional care, would the Ministry consider creating, as a permanent subvention, a portable subsidy that is associated with dementia patients according to age or income or some other such criteria, as opposed to a subsidy that is associated with the institution?

My second question is: would the Ministry consider initiating a process to develop an integrated national plan to cope with dementia, which will be an increasing problem in Singapore, along the lines of the Australian National Framework for Action on Dementia and the report of the Hong Kong Working Group on Dementia?

Dr Amy Khor Lean Suan: Let me take this opportunity to explain briefly with regard to the Jade Circle project.

First of all, let me say that MOH supports innovation on new models of care that will enhance care outcomes for the patients. But we need to balance this against the need to ensure the long-term sustainability of the care models because our aged care needs will grow and, ultimately, subsidies come from taxes.

Due to the reduced ability of dementia patients to adapt to environmental stresses, smaller scale layouts which provide personal space and privacy would actually help the patients in terms of calming them and ensuring that they are not aggressive and there are no other negative social reactions. But single beds, which is Jade Circle's proposal, do have their downsides. For instance, there will be patients who would feel more isolated if they do not come out of their rooms. And there are issues with safety, surveillance, monitoring because of line of sight by the care staff and, particularly so for patients with functional deficits, leading to limited independence or because of behavioural and psychological problems.

So, there will be challenges not just with space constraints, but also manpower constraints. Single rooms are not necessarily the magic pill to good quality dementia care. As I have pointed out, good quality dementia care does not depend just on the physical attributes of the facility – of which layout of the bedroom is one aspect – but it also depends on the quality of the care delivery.

Having said that, we note that there will be instances where single rooms or twin-bedded rooms are needed for patients, say, with some behavioural issues. These are provided in our purpose-built nursing homes. Our subsidy policies will need to take into account the scalability and the resource sustainability of the care models at the system levels, beyond any single-pilot project.

Let me say at this point that we are not clear that single rooms or twin-bedded room facilities can be cost-effectively implemented across the entire aged care sector. But having said that, as I have said, we do want to support innovative new models of care because we do want to experiment and learn and find better care models. Because of this, actually, we are still in discussion with Peacehaven Nursing Home and the funders to look at how the project can be adjusted so that it can proceed. Then, we can learn lessons from this model and see if we can apply it to the rest of the sector.

With regard to funding, as I have said, we need to ensure that the care models are sustainable because, at the end of the day, we know that ageing needs are going to grow and we do have limited resources, as well as manpower and space constraints, so we need to look at the different models of care and ensure that these are sustainable models and are cost-effective. The subvention will be given to the different care models, depending on the projects, as well as, of course, the programmes. And there are actually subvention or subsidy to the individual patient, which is portable because it depends on which nursing home or which care they take up.

I also want to add that, at the end of the day, if you ask the elderly, their preferred option is to be cared for at home, not in an institution. What we are doing is ramping up home care and community care and we want to encourage and support more home care for as long as the elderly is able to be cared for at home. Nursing home should only be for those with higher care needs, as well as those with very low or no family and social support.