Transforming Community Eldercare
Madam Iris Chan is an 80-year-old widow who lives in Sim Drive alone. Her husband passed away about a decade ago and she is estranged from her daughter. She is battling multiple medical issues which has led to frailty and poor eyesight. As her eyesight deteriorates, she struggles with doing certain household chores and is unable to pack her own medications. She eventually developed heart failure and became largely home-bound.
After some time, she gradually recovers and undergoes surgery for her eyes. Although she is no longer home-bound, she has limited mobility and is dependent on a walking frame to get around.
Throughout this time, she feels lonely, afraid of not being able to meet her daily basic needs and that no one would know if anything were to happen to her. She also lives in fear that as she becomes frailer, she may need help visiting the doctor or carrying out daily living activities. With rising healthcare costs, the pressure of financing her care needs also weigh upon her.
The account of Madam Iris, though fictional, is grounded in the real-life experiences of seniors who battle multiple chronic conditions and are left with the daunting task of navigating the healthcare maze on their own. As they often have to see multiple providers for their various care needs, care becomes fragmented and in many cases, it is the seniors themselves who have to shoulder the responsibility of coordinating their own care needs.
Community care in Singapore
It is estimated that by 2030, a quarter of Singapore’s population will be aged 65 and above. With this, care burden is expected to increase.
The Ministry of Health (MOH) has been increasing our capacity for eldercare services, bearing in mind that the workforce will only shrink with an ageing population. In response, we need to build up a strong community care system so that our elderly can age in place in a sustainable manner.
The MOH’s vision of a community-based support system is one that is:
1. proactive in going upstream to support seniors, pre-empting issues of social isolation and ill health more effectively;
2. broad-based in serving seniors, beyond those who are low-income and frail; and
3. integrated in weaving together social and health support to support seniors.
Integrated care for seamless services, better outcomes
The integration of community care services is vital to meet the growing healthcare needs of seniors in a rapidly ageing society. More seniors will require support in the community to meet their evolving and varied needs to age in place successfully.
As health challenges typically increase with age, seniors may battle multiple medical issues.
A 2017 study done by Duke-NUS Medical School’s Centre for Ageing Research and Education and the MOH found that the proportion of older adults in Singapore aged 60 and above with multiple chronic diseases has surged over the years. Some 37 per cent of survey respondents reported three or more chronic health conditions in 2017, up from 19.8 per cent in a 2009 study.
Seniors often have to see different care providers for their needs, resulting in fragmented care and sometimes, even deterring them from receiving the care they need. Care integration ensures better continuity of care for seniors as their physical and cognitive function changes with age or illness. It also provides a one-stop, multidisciplinary shop for seniors to meet all their care needs seamlessly.
With the goal of delivering holistic services for better outcomes, Methodist Welfare Services (MWS) moved towards an integrated care model. In 2018, MWS began to consolidate and integrate our services into 3 key clusters: Community Eldercare Services, Residential Services and Family Services.
Our Community Eldercare Services cluster aims to support our seniors to age in place by providing a spectrum of services to meet their evolving needs as their level of frailty changes.
Comprising all our non-residential, community-based eldercare services, the cluster includes our:
· 7 Senior Activity Centres (SACs) and Active Ageing Centres (AACs);
· Senior Care Centre (SCC); and
· Integrated Home Care & Home Hospice (HCHH) service.
The SACs/AACs engage isolated seniors through social, health and wellness activities in the community; the SCC offers day care and community rehabilitation services; while HCHH provides the chronically ill and frail with a suite of home-based services.
This continuum of care for older adults will help prevent unnecessary long-term institutionalisation, and support them to live in the community for as long as possible. As opposed to institutional care, community care allows seniors to maintain their independence and enjoy a higher quality of life.
The connectedness of services within the cluster also allows seniors to enjoy seamless care from different healthcare services under the same familiar trusted brand, and reduces transitions in care.
Bridging the health-social care divide
While meeting the healthcare needs of seniors is crucial, other dimensions of wellness such as social and emotional cannot be neglected. In line with MOH’s goals, MWS’ support for our senior beneficiaries focuses on integrating social and health services.
Under the Eldercare Centre service model rolled out in May 2021, MWS SACs/AACs proactively reach out to socially isolated seniors to provide psychosocial support, as well as assess their needs and make relevant care referrals, regardless of their income levels or housing type. This is part of preventive care that reduces the risk of mental ill health and allows for early detection and intervention of physical and mental health issues.
Early intervention lessens the economic burden on the elderly as it enables them to remain in the community, reducing avoidable hospital admissions and minimising institutional care (Mullvihill, 2011). This, in turn, helps to alleviate the burden on the national healthcare system.
For instance, seniors identified by MWS SACs/AACs to require home-based care like housekeeping and help with errands and daily activities might receive an internal referral to MWS HCHH.
In addition, the MWS Allied Health (AH) team cross-refers clients to services across MWS’ community eldercare centres for right-siting and integration of care.
Since 2021, the MWS AH team has begun implementing adaptive sports programmes for preventive care across our community eldercare centres. Adaptive sports are sports which have been modified to allow people including seniors of differing physical abilities to play.
The MWS SCC – Eunos team also plans to collaborate with MWS SAC – GreenTops@Sims Place to implement the Healthy Ageing Promotion Programme For You (Happy) for seniors at the SCC. The programme helps seniors to maintain their functional ability and lead a good quality of life.
This is in line with the government’s “beyond healthcare to health” approach, as part of a multi-pronged strategy to rein in soaring healthcare costs. The approach focuses on upstream interventions by promoting active ageing and healthier lifestyles.
In the case of seniors with multiple care needs as depicted in the fictional account of Madam Iris, the interconnectedness across MWS’ Community Eldercare Services results in better patient outcomes.
How would MWS’ integrated care play out in Madam Iris' case?
While Madam Iris is still relatively mobile without eyesight issues, she continues her appointments with her primary doctor. As she is staying alone, staff and volunteers from the MWS SAC/AAC in her neighbourhood reaches out to her to assess her needs and befriend her. Upon the staff’s encouragement, Madam Iris starts joining activities at the Centre, like morning exercises, cooking classes and terrarium workshops, which help her stay active and socially engaged.
With the trust built up over time, she starts opening up to MWS befrienders about her health and financial problems and estrangement from her daughter. As her eyesight deteriorates and she gradually becomes home-bound, the MWS SAC/AAC team refers her to MWS HCHH to help with housekeeping and medication management. Volunteers from the MWS SAC/AAC also visit her to help with daily errands. Madam Iris feels less alone, and assured that there are people to regularly check in on her.
After recovering from heart failure and undergoing eye surgery, although Madam Iris is no longer home-bound, she misses her independence as she is now reliant on a walker and unable to walk long distances. Her case is discussed internally between the various multi-disciplinary teams in MWS, and she is referred to MWS SCC – Eunos to undergo community rehabilitation services. She is supported by our friendly team and new friends she meets at the Centre. She is glad to be able to continue meeting her care needs in a different care setting with a familiar, trusted service provider.
Throughout her care journey with MWS, Madam Iris’ situation and care needs are shared and discussed between the SAC/AAC, SCC and HCHH teams to obtain a holistic view of her circumstance to help her reach her personal goals of care. By consolidating care plans for those with complex needs, MWS hopes to be able to journey with seniors as their condition changes through life.
An integrated care model improves the seniors’ quality of life, and gives them greater accessibility to care services with less hassle that could otherwise cause them to delay or forgo healthcare.
Integrated care comes at a cost, as more resources are put in to streamline the various services, organise case discussions to ensure continuity of care, and more. At MWS, we invest in this as we believe that a person-centred care approach allows our residents to age in place successfully.
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