You are not alone... Community Services and Outreach

Thank you for tuning in to this session. I'm Dr. Roslin and pleased to have two guests from AIC with us to share on our community and our rich services in Singapore. Hi, Praline and Signe, could you please introduce yourself to our listeners? Hi, Bob Dunlund. I'm Signe from Care Integration and Operations Division. I'm a care consultant and I'm based at AIC-Link at Van Dau Singh. I'm a nurse by training. My role at the counter is to AIC-Signe and care giver in collaboration between health and social care. I also support the hospital on discharge planning, ensure end-to-end process from assessment, care keeping, and raising record in hospital for service management. Hi, hi. My name is Preaching. I'm with the Primary and Community Care Development Division, AIC, Agency for Integrated Tech. This is my fourth year in AIC. My portfolio is mainly service development. Typically, over time as the care needs evolve, we need to actually review the services that we have, and then we need to enhance them over time to meet the evolving care needs, and we also, as we better understand the care needs, we are also in like constantly reviewing constantly developing new services to plug whatever service gaps that we notice. So, a very big part of my role is conceptualising services and then work with service providers to implement them, and then we study them because we are actually taking a rather evidence-based approach, meaning before we roll it out on a larger scale, it is important that we do a few things, the number one is we understand the preconditions that are required for certain things to succeed. So, for example, if you want, we want our service providers to be providing certain care to do a certain care model, to provide care in a certain way, we then need to find out what are the input and resources that we need to put in place, what are the training needed, the capability building that are needed. And then after that, we ramp it up, and then we evaluate them, and then we make improvement along the way. So, this is so that when we scale it up, the service model is, in a sense, more, more, it is really implementable, scalable, and people find it useful. So, that is pretty much what I do in AIC. Before that, I was with the RHS, National Health Care Group and National Health Care Group Policlinics. My pharmacy is by training, by the way. Right. And just to make interesting, you mentioned things like you are pretty much involved in how the services will be evaluated and structured according to the health status of our population. Is that any particular parameters that you actually look up for to monitor, to see whether the health services are actually well utilized or needs to be re-adjusted? The current population we are serving is mostly elderly. Yeah. So, I think first of all, we have to have a good sense of the needs on the ground. So, information can come from various sources. For example, feedback from the ground, feedback from our hospital colleagues. They are also statistics make available, right? Like, we would know, okay, in a certain region, they are actually more elderly, residing in certain region. Then we also know of the centers are, occupancy are very high. We then need to plan more services or increase the capacity for certain regions. So, these are some of the parameters that we are looking at as we plan services. But a lot of time I must say, right? It really depends on information sources from everywhere. Some of the demographic shifts, we know that people are living longer, the family unit is shrinking. So, with some of these things, you then work on better supporting care giver. Because we know the changing demographic that we are seeing. So, these are some of the the data points that we are looking at. Right. So, Cindy, can you just share with us some of the community-based services that is available? So, they are center-based services and home-based services. Center-based services will be day care, dementia day care, and day rehabilitation. So, day care center is to promote aging in place for frail and physical. Physically, disabled seniors in the community and some for senior who has frequent work at home. Our patients staying with the care giver who needs to work in a day time, in short, is to provide support and respect to the family or care givers. And for dementia, day care center is for senior who is diagnosed with dementia by a registered doctor. The center will have my simulation activities to slow down the deterioration of the elderly, physical, and mental function. And it also supports seniors in the community and task delay institutionalization and task delay institutionalization. So, care giver will send their loved ones to the center for activities in the morning and bring their loved ones back home in the late afternoon or evening, depending on the center operating hours. And for day we have center, their aim is to improve, restore, and all to prevent deterioration of functional functional abilities of the elderly through a customized session on rehabilitation program at the center. And the client must be certified as suitable and can be benefit from the rehab to improve his or her functional status by either a Singapore Medical Council registered doctor or a full registered therapist from ALI Health Professional Council or a Singapore Nursing Board Register Advanced Breakfastness. And the validity of the period of the certification is six months. And therapies at the center will then assess the patient and determine how many sessions the patient will need to attend. Per session is usually about 30 to 45 minutes. And for home-based services like home medical, home nursing, and home rehabilitation is for home-bound patients. And what is home medical? Home medical is scheduled doctor, home visit for uncomplicated, acute, or sub-acute, or chronic disease management. And they provide prescription for medication top up. So the doctor will schedule a visit once every quarter late. And they do not do ad hoc services like weekly visiting, specialist review. They also do not see client who require close off frequent monitoring, for example, titrating of insulin, palliative cases, reflust, and three months of prognosis. And for home nursing, we'll be partners visiting the patient to follow up chronic illnesses to perform procedure like change of urine, catheter, or building tube, medication packing, wound care, health education, teaching the caregivers on how to monitor blood pressure or blood glucose. So homeless do not provide daily injection, ad hoc service, or standby service, changing of invasive tube that require video scope P or X-ray. They also do not change in newly inserted track E or P-E-G percutaneous endoscopy gastro forming. They also do not provide weekend service. And home therapy is a form of active rehabilitation provided in a total of 18 section over six months. And the client must be assessed to be unsuitable or unable to receive rehab at the community hospital, or others and the base rehab facility, for any of the following reason, like clinical conditions that render the homebound and inhibit them from attendings and the base rehab, example, like low sitting tolerance, or there's a lack of barrier-free access from the client's house to the center-based rehab, or there's no available caregiver as coach kembali untuk menghubungan kata-kata yang baik daripada hidup dan dihubungan kata-kata yang baik daripada hidup. berapa kata-kata yang baik daripada hidup dan dihubungan kata-kata yang baik daripada hidup. dihubungan kata-kata yang baik daripada hidup dan dihubungan kata-kata yang baik daripada hidup. daripada penyakit. So our home health service is not at home or emergency service. If they need at home service, they will need to call private service provider or to visit the A&E. And those senior who can still use wheelchair or modernized wheelchair to go out to the community, we will always encourage them to continue to be active in the community. Thank you, Sinyi. You have provided us with a very comprehensive overview of what A&C service has provided. I think that is awesome because I think it seems to cover majority of the needs of our society, especially so when the innate of facilities and resources after having suffering from conditions. So how are all these services being coordinated and integrated in the care of our elderly? Today, we are actually doing it in different ways. So AIC as an agency was set up by the Ministry of Health to oversee and coordinate and facilitate integration of elder care services. In fact, I think we have been in existence for more than a decade. So we started off as a small unit and then incorporated because we see the needs, and therefore a dedicated entity is required to do that service coordination. I understand AIC actually started as a unit doing nothing-home placement. And then it evolved over time and the scope expanded. And then in recent years, you know, AIC as much with the civil generation office. So the civil generation office is the outreach arm today. And then we have 16 satellite office, civil generation satellite office on the ground. And then so when it comes to service coordination, service integration, I think the first point is knowing the needs. Right? So how do we get to know the needs on the ground, the needs in the community? It is actually true our outreach arm. So we have volunteers, we call them civil generation ambassadors. They reach out to the seniors, right? They go door knocking. And that's how we then the first step is creating awareness. And then knowing they're also doing some kind of screening to pick up needs. And then those needs are then being a brought back to that means whatever needs that we uncover. It was then being channeled to the relevant party like we have this community networks for seniors also. So these are these are people who then link the people up to the services that they need. So that is the really the first point, right? And then in the hospitals for those who are admitted to the hospitals, they are actually the care, the caring office. So this is an office that provide advice, counseling and services in terms of in terms of the services that may be suitable for the clients that we are seeing, the schemes that are available to help them. So I think he's actually from that office, from that division. And then for inpatient, we have a rifle team that go to the hospital ward. And then work with the doctors and the nurses and the ward before the as part of the discharge planning to kind of facilitate the elder to go to go home, like to go home. And then to put in place the services that can support them after the discharge. So these are just some of the some of the things that we are doing and then recently we also launched a new baseline service model. So so under this new baseline service model, we basically consolidated active aging befriending and care information and referral services into this active aging centers and active aging care hubs so that we can cater to our release. To elderly regardless of their income and frailty, so it's really regionalized care. And then getting the anchor provided to oversee the different aspects of care, putting everything under under one roof. So so in that way, it kind of tighten the integration and the coordination by region. And we are expecting to have about 280 centers, I learned white by 2024. Yeah, so these are just some of the ways and means to tighten the integration at the program at the service level. We also have this thing called the integrated home and daycare program. So for seniors with very complex care needs in multiple domains, we have one dedicated provider looking after the senior in all aspects. So doing the case management, the coordination. So a senior with very complex can needs, right, just by going those who is in this program, they can go to the centers on days, they are well. But when they do need home care, the same provider will be coordinating and providing the home care services to them at home. And if meals are needed, transports are needed, the provider are also doing the coordination. So it's really one provider as a custodian of care as a captain of care for seniors with very complex care needs. There's also another services, another service called the community case management service. So this is a group of case managers, social worker and nurses working together to kind of help clients with very complex social and medical needs to do service mapping to link them up to the various services. And typically under, we call it CCMS, typically under this service, they would be holding the client for around six months to make sure the condition has stabilized before they discharge the client from this case management service. So these are all the services and the system level changes that are happening to tighten the integration and the collaboration. Right, right, and thank you for sharing and pushing you mentioned that all this information, right, all the services needed a referral. So what I understand is that we have a different form of referring platform. I know it could be either from the hospitals where the nurse or doctor will raise a referral or they will try to activate the AIC referral management team. I wanted to just understand this RMT, how does this work? So yeah, a referral management team, we will usually receive the referral from the Watson clinics or even a high copy referral from when the clients are meet to us. So the doctors, the nurses, the therapies or the social worker will do the recommendation to the patients and caregivers and activate the service online, like I mentioned, and to our team. So they can also ask doctors to find the referral form and submit or email to AIC link or to our AIC inquiries email and patients or caregivers is in the office, they can approach us at AIC link at the restructured hospital or call online or visit our AIC website. So after the referral source submit to the referral to AIC, the referral management team will review and assess the case and we will then assign to the relevant service provider based on patient's medical needs and preference. And the service provider from the community then arrange assessment with the patient and the service provider. Providar akan terus berada di perlukan kembali untuk mencari kembali. Jadi, awak akan melihat rafro yang bisa terlalu kelihan. Saya hanya jika Syirah tahu, rafro di kelihan dari kelihan, mereka juga akan membuat kelihan yang berlaku. Jadi, rafro yang akan terlalu membuat kelihan yang terlalu kelihan yang terlalu kelihan. Rafro, ya. Jadi, perlukan kelihan yang terlalu membuat kelihan yang terlalu membuat kelihan yang terlalu membuat kelihan saya. So there's a very good piece of information because usually all these rafro will have to be conducted through hospitals in order to have the subsidized rate. But actually, clinics can also provide that same subsidy platform as well. And also, you have the third platform on reaching the AIC, which is the direct link counter, or they can actually call the AIC hotline or through the website. For such rafro, how do they actually get subsidized rate? So I think we have to take subsidy and service eligibility separately. First of all, for services, for example, home medical, you need to have a doctor and more in order to raise that available because the doctor would then certify that this person is homebound and he needs home medical services. So that is service eligibility, but I think subsidy is a separate method. It's under the means testing framework. So that takes into consideration the households per capita income. So you have to look at it separately. You can be eligible for a service, but because of your household income, you are not eligible for government subsidy. Right, right. So we need to say that regardless of the source of rafro, you are actually eligible for subsidies. As long as your means test that is being carried out, puts you into the criteria of receiving one. And could you share some other schemes or grants that can actually help to defray the cause of caring for our elderly? So, monetary assistance, like home care giver grants, foreign, foreign domestic worker levy concession, casual life and netty save for disabled senior can also help to defray the cause of caring for seniors. So like for home care giving grants is a 200 cash assistance for per month for the care of a patient at home. For Singapore citizen or permanent resident having parents, child or spouse who is a Singapore citizen, and at least moderate disability. Household income per person is 2008 or less or any value of the property for household without income is 13,000 or less. Live in Singapore, not residing in a long term care institution, for example, nursing home. They can apply for this home care giving grant. And for foreign domestic worker grant, for foreign domestic worker levy concession for person with disability is lower levy of $60 per month. For a household which hires foreign domestic worker to care for a patient aged between 17 to 66 years old. Singapore citizen at least mild disability. Live in Singapore, patients is living with a helpers employer. And we have casual life for casual life policy holder. They can receive from $600 per month in 2020 for life. And the patient must have at least severe disability. And our very new grant is called the MediSafe Care for Singapore citizen or permanent resident. They can receive up to $200 per month from his or her own MediSafe account. And all from their spouse MediSafe account. So as long as they are aged 30 and above and have at least severe disability. They can receive up to $200 per month. And so what are the different level of disability is formal disability. It is that the patient requires the patient require some assistance with at least one activities of daily living. And activities of daily living include feeding, bedding, toiletting, dressing, moving and transferring. And for moderate disability is always require some assistance with at least three activities of daily living. And for severe is unable to perform at least three activities of daily living. Thank you so much for sharing about all these grants and schemes where our elderly can actually apply for to help them in their care. So moving forward that within AIC, other than the services and resources that has been put into place. And I can see there's a trend of people like going towards technology based kind of interventions. Is it the same for AIC as well? You start to see people using maybe apps to track certain things and all that, right? So I think that is the health aspect of things. I think over time, partly because of COVID-19, we are also seeing more people using apps like video call platforms to communicate with their friends and family. So when you are using the different technology to socialize, to connect with people, maybe even discuss issues with your family, with your friends, you get advice. All of that to me is part of a self-management using the very common software that we know. So if I take a step back, the very old school technology that we are talking about, maybe things like bad pressure monitor, like glucose monitor, you have to go to the doctor. But today, if you are very motivated, what you need to do, what you can do is you take your medication, you monitor your baby. So I think those are actually very traditional technology that we are talking about. There are also a lot of applications on our phone that allow us to track our daily level of activity, our sleep quality, among other things. And then for seniors who are living alone, they are home monitoring technology. So you have sensor at home, detecting faults, and then trigger the caregivers or emergency respondents when there is a potential adverse incident at home. So all these are technology. And then if you are talking about telehealth, what I am seeing is, I think COVID-19 has really catalyzed quite a bit, especially during the circuit breaker. So, you know, because centers are closed and we are trying to, you know, limit the movements of health care worker across the settings, so we started seeing nursing homes and the hospitals using telehealth as a form of maybe providing consultations to the resident. And I, in the center, when the center were closed during the circuit breaker, we saw our providers offering some kind of recreational and social activities to the clients when they, when the clients are home based, that base in home. We saw, for various services, there are different levels of telehealth adoption, but definitely we are seeing more and more of such mode of care delivery. I think we are good. We will likely continue to see this grow at different pace, but I think maybe what is very, very important for us to notice. Right, whatever technology that we are using, at the end of the day, it should not be placed a proper clinical consult. And those who are using by over tools, especially those apps on the phone, right, we need to be quite careful, because it should really, because these are not medical devices. That using it, I think, for a weather healthy person, it's okay. But if you are talking about a frail elderly, then all this technology should only be used to complement care and not to substitute a proper, you know, proper physical visit or proper diagnosis by a medical professional. Right, right. It seems like technology is not something new as you have said. But it's just read, it's really about the type of technology that we are being exposed to. And of course, with the evolution of new advancement, that's where we can actually infiltrate the use of technology and bring patients closest to us. So technology in some way enhanced the self-management among our elderly. Do you have any challenges and you would like to share with the people here, to appreciate how AIC is providing the services to us? I wanted to mention that a lot of times, caregivers always thought that, "Oh, AIC can provide home services." But I think the expectation must be, because the service, the service is really for home-owned patients and not for patients who still can go out even with their wheelchair or motorized wheelchair. So like, for example, if patients, they still can go out, we do want to encourage them to still continue to be active in the community rather than to stay at home with for the service to come. Actually, our aim is to encourage them to be active in the community to socialize. So building on Singapore's point about caregivers as well, I echoed the part about socialisation. I think we need to be aware of the importance of socialisation. I think as we age, sometimes our social circle strings as well. So it's important that we continue to expand our social circle. Make friends do activities, whether or not you do it in the senior activity centres. Then when you get a bit further, go to the senior care centre. But I think the part about going out and widening the social circle for mental health, for overall well-being, it's so important. And the other thing that I think is very, very important is also care givers' involvement in care. Because the very big part of that social relationship is actually the ones that we build with our close ones, our family, our caregiver. So sometimes our providers will be able to do better if caregivers are more involved. And then there is a constant communication seeking to understand what each other. What each other are trying to do where we are coming from, sharing information that are important in the care of the client. So because after all, whether or not the seniors are going to the centre or when the career is going to the home. I think the interface is a transient one. And maybe the dimension that we are seeing is very limited. So I think for seniors with connective impairment, all the more important, the caregiver role is even more important. So I think the involvement of caregiver in the care is. And then the collaboration and cooperation between the partnership between the caregiver, the client, as well as the care provider is something that is very, very critical. Thank you both for providing us information. Committee services and resources are important pillars of the healthcare system to ensure care continuity and support for our people. With a right range of services and resources, similar coordination is important to ensure that this are allocated timely to the right side. Therefore, healthcare providers shed the responsibility in educating the people and setting the right mindset for services and resources to be utilised more effectively and efficiently to minimise wage stage. I am Dr. Ruslin and I thank you once again for joining us.