Ageing & Disability Causes of Severe Disabilities in Elderly of Lower Social Economic Group in Singapore Dr Tan Jit Seng & Ms Teo Shing Yuen Lotus Eldercare Health Services Lotus Eldercare Pte Ltd Singapore

Introduction Singapore is one of the fastest ageing societies in the world In 2030, citizens age 65 and above will increase to 900,000; from 220,000 in 2000 FromStatistical Indications on the Elderly done by our Ministry of Community Development, Youth and Sports in 2005:Statistical Indications on the Elderly done by our Ministry of Community Development, Youth and Sports in 2005 – 1.7% requires some physical assistance to move around – 0.4% requires total assistance to move around – 0.5% is bed ridden and requires regular turning in bed.

Interim Disability Assistance Program For the Elderly (IDAPE) Government assistance schemes providing financial help to needy and disabled elderly Singaporean Singapore Citizen born on or before 30th September 1932 The elderly must pass a financial MEANS testing to apply for this schemeMEANS

Study Investigate the causes of disability in elderly in the lower social-economic group who has applied for IDAPE claims over the span of 2 years under Lotus Eldercare Health services in Singapore

Method All patients between November 2013 and October 2015 who applied for IDAPE assessment through Lotus Eldercare Same assessor to assess patient’s ability to perform the 6 Activities of Daily Living (ADLs) Patients are either assessed in their homes, nursing care facilities or restructured hospitals in Singapore

Results A total of 203 patients were assessed for IDAPE by Lotus Eldercare, between the period of November 2013 to October % of the patients are female and 34% are male

Results Age of patients The median age is 87 years old and mean age is 88.7 years old

Results Most direct cause of disability

Results Severity of disabilities There are 6 Activities of Daily Living (ADLs) that are assessed. They are: – Washing or bathing – Dressing – Feeding – Toileting – Transferring – Mobility

Results: Severity of disabilities: – For each activities, points are graded on the level of dependency that patient has. 1 point: Independent 2 points: Minimal to Moderate Assistance 3 points: Maximal Assistance 4 points: Total Assistance – Thus, for a patient who is dependent totally on the caregiver for all 6 ADLs will score 24 points

Results

Results Score (points) No. of patients % of patients

Results Time from onset of disabilities to date of assessment: – Varies greatly from a few days to 37 years – Mean is 17.6 months – Median is 4 months

Discussion Financial security is one of the main factors in Ageing in place concept. Insurances play an important part of financial security but the cover is unlikely to be enough at prevailing rates. For disabled elderly from the lower social-economic group, who are dependent on activities of daily living, the main option will still be subsidised nursing home care. To encourage Ageing in place concept, many new policies had rolled out in the last 5 years in Singapore. Together with less stringent financial assessment, more dependent elderly are able to age at their own homes. 14

Other Policies Enhancement for Active Seniors (EASE) provides slip resistance treatment to existing floor tiles of bathroom; toilet grab bars and ramps installation, where technically feasible, at a very subsidised rates. (Housing & Development Board, 2012) Foreign domestic worker (FDW) Levy concession for families who employ full-time FDW to look after their love ones with disability can pay a lower monthly concessionary levy of $120 instead of $265. (Agency for Integrated Care, 2015) This is further enhanced with Foreign Domestic Worker Grant of another $120 per month for families passing the financial means testing. (Agency of Integrated Care)

Other Policies Pioneer generation package was launched in the 3rd quarter of 2014 and with that, Pioneer Generation - Disability Assistance Scheme (PG-DAS) provides $100 cash payout a month to help dependent seniors with their care needs. (Agency of Integrated Care) For those very dependent elderly bed bound or on nasogastric tube feeding, after passing financial testing, dependent elderly can claim funding on 3 categories of care needs, namely, assistive devices and hospital furniture; transport; and home healthcare items (Consumables). For devices, up to 90% of actual cost of the device will be given. Both transport and home healthcare items will dependent on the level of the financial test results.

IDAPE & Eldershield IDAPE is but one of the sources of funding for Long term dependent care of the elderly in Singapore for the lower social economic group. Eldershield is the equivalent of IDAPE and the premiums are paid out from MEDISAVE under our Central Provident Fund savings. Singapore Citizens and Permanent Residents are automatically cover under ElderShield at the age of 40. The current payout of $400 per month is higher than IDAPE payout of $150 to $250 per month for 72 months.

Causes of Severe Disability Top 5 cases of severe disability in elderly in the lower socio-economic group includes, Stoke diseases, Falls with or without fractures, Infections like pneumonias and urinary tract infections, Dementia, and Functional Decline from multiple chronic diseases or ageing with sacropenia. Cancers, although one of the leading causes of mortality, are not in the top 5 causes. (Ministry of Health, Singapore, 2015) This could be due to a shorter physical dependency period of the patients from the start of the disability to death. Patients suffering from cancers might also not being advised or encouraged for IDAPE claims by the service providers and the social workers.

Questions? Dr Tan Jit Seng: Ms Teo Shing Yuen Lotus Eldercare Health Services, Lotus Eldercare Private Limited 16 Collyer Quay Level 20 Singapore