Find out what the alternatives are for such step-down care or what is termed long-term care.

BY: Eddy Cheong

 

At the National Day rally this year, Prime Minister Lee Hsien Loong said that the Government is gearing up to prepare for an ageing population and one of the key initiatives would be the expansion of the step-down care for our elderly. This is a critical area of our healthcare system as more people move out of the acute hospitals but continue to need a certain level of medical care.

Long-term care or LTC is not about short-term rehabilitation or recuperation from surgery, but rather continuous care over an extended period. The way to measure LTC is the Activity of Daily Living (ADL). For instance, one is defined to be disabled in an ADL if he or she requires the help of another person to perform that activity, with either active or standby help. Hence, those who rely on assistive devices only are generally not counted as using LTC services, because they do not require the assistance of another person. In Singapore, one in 12 elderly suffers from disabilities as a result of ageing and illness, 3% of aged 65 and above were not able to move by themselves while another 8% need help with ADLs.

 

Planning for LTC

Many people fail to plan because it is an emotional topic and they do not want to think about it. For those who do think about it, they do not understand what it involves and also often underestimate the cost of LTC. 

To understand why planning is so important, let’s look at some key statistics locally: A good 10 percent of people above 65 in Singapore need some form of assistance and this is ratified by studies in the US where there is a 40 percent chance of someone who reaches the age of 65 to enter in a nursing home.

Start today to understand and plan for the possibility of one of your aged parent or relative who might need LTC and reduce the emotional and financial stress when it does happen. With the rising cost of healthcare, you want to be prepared financially by either setting aside the necessary funds or buying the right insurance. With a plan in place you would also have more control and choice over when and how to obtain LTC services.

The information following would give you a good handle of what is available and get you off to the first start.

 

LTC facilities & support

There are several options to receiving LTC services. It can be through an institution or from the family, which depends on the individual’s preference, degree of care and financial ability.

Essentially each category can be summarised as follows:

 

INSTITUTIONAL-BASED (RESIDENTIAL) FACILITIES

As the name suggests, institutional-based facilities are those caregiving that are provided through institutions. In the Asian context, this seems as an undesirable option as patients would generally prefer to stay with their own families and the Government is also encouraging “ageing-in-place”.

Minister Lim Boon Heng explained this concept during a public forum in September, “Ageing-in-place involves enabling the elderly to age in the home he has grown old in, in the community he is familiar with. For those who are more frail, with limited mobility and needing care, we are expanding efforts to make our living environment barrier-free and to provide the social and community services to support them at home. For those with terminal conditions, ageing-in-place involves preparing well so that the patient remains in the comforts of his home and there is no uninformed rush to the hospital for emergency treatment.”

Here are the options:

• Nursing homes – Nursing homes provide long-term skilled nursing care for elderly patients. This option is usually for those who do not have families or the family members are unable to provide the level of care needed.

Patients who are eligible for Ministry of Health (MOH) subsidies are placed by the Integrated Care Services into VWOs (Voluntary Welfare Organisations) and selected private nursing homes under the MOH portable subsidy scheme. Patients who are not eligible for subsidies can also admit themselves into any nursing home. Cost can range from $1,300 per month for eight-bed room to as high as $4,000 for a single bed room.

• Chronic sick hospitals – These hospitals provide long-term skilled nursing care for elderly patients with advanced, complicated and medical conditions that require greater supervision than those in nursing homes. Such services usually cost more and can range from $1,900 to $6,400 depending on the type of care required and the quality of accommodation.

• Respite care – This option provides short-term custodial care for patients who exhibit challenging behaviour. It also helps caregivers, who after a prolonged period of care giving, to receive some short-term respite, for example, vacation or time out. Daily rates are usually about $80 to $90 per day for a nine-bed room to $130 and above for single bed room.

 

HOME-BASED (COMMUNITY-BASED) FACILITIES

For those patients who are being cared by their families, there are several home-based services available for the caregivers to rely on:

• Care by family – This seems the preferred option for patients here. For caregivers who require necessary knowledge and skills in caregiving, external courses and trainings are available. Eligible caregivers can receive a Caregiver Training Grant of up to $200 per year (from the National Council of Social Service).

Families may also consider hiring a foreign domestic worker to provide additional help. Cost of domestic help including Foreign Wage Levy would range about $600 to $700.

• Home medical – Usually comprises of a team including a doctor, nurse and social worker to provide ongoing holistic care to the homebound through regular home visits. Frail or bedridden older patients who have multiple medical or nursing needs with permanently disability or unable to leave the flat would be suitable for this service. A referral from a doctor or hospital is needed. Cost is about $200 to $350 per visit.

• Home nursing – House-bound or bedridden older patient who require nursing procedures will require home nursing. Such care includes wound dressing, injections and change of feeding tube. A referral from a doctor or hospital is needed. Cost is about $200 to $350 per visit.

 

ICS & means testing

For those who need financial assistance, they would come under the purview of ICS. They are a central body that manages and coordinates referrals and step-down facilities to ensure seamless flow of services to patients who leave the hospitals. Previously, means-testing would determine four level of subsidies a patient will get if he or she needs step-down services. However if a patient requires care in community hospitals, the subsidy would be expanded to nine levels from 1 October 2009 in view of relatively huge bills. With this enhancement, MOH estimates that one in two subsidised patients would pay less.

 

Government subsidy for LTC services (except community hospitals):

TOTAL FAMILY INCOME (BASED ON FAMILY OF FOUR)	SUBSIDY LEVEL
≤ $1,320	75%
$1,321 – $3,200	50%
$3,201 – $5,200	25%
$5,200	0%

 

TOTAL FAMILY INCOME (BASED ON FAMILY OF FOUR)	SUBSIDY LEVEL FOR SINGAPORE CITIZENS	SUBSIDY LEVEL FOR PERMANENT RESIDENTS
≤ $1,440	75%	65%
$1,441 – $2,200	70%	60%
$2,201 – $3,000	60%	50%
$3,001 – $3,800	50%	40%
$3,801 – $4,600	40%	30%
$4,601 – $5,200	30%	20%
$5,201 – $5,400	20%	10%
$5,401 – $5,600	10%	0%
$5,600	0%	0%

 

Although this is an emotional topic but it is precisely of this that you should start talking to your elderly parents and relatives about what would be acceptable level of care for them in the unfortunate situations needing LTC. In fact, you should also be thinking about what level of care you would like to have for yourself as well. Decide on the level of care today and start determining if you need to set aside the cash or buy the right insurance so that you do not have to compromise when the situation happens.

 

Eddy Cheong is the head of risk management and financial planning at Providend Ltd. He is also a trainer at Providend Centre of Financial Education (PCFE), which brings financial knowledge to people of all life stages and from all walks of life. Visit us at www.providend-cfe.com or e-mail us at info@providend-cfe.com. 

(PHOTO CREDIT: Providend)

 

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