Parliament Primer: The silver tsunami
The following are excerpts of debates on caring for an ageing population. These took place during the Aug 13 & Sept 11 sittings of Parliament.
MEDISHIELD COVERAGE BEYOND MAXIMUM AGE
The number of MediShield policyholders who exceeded the current lifetime limit of $200,000 was 11 in 2010 and 43 in 2011. We expect the number to continue to increase as policyholders age and accumulate more claims over time.
Hence, to provide more assurance to MediShield members, we intend to extend the MediShield lifetime limit from $200,000 to $300,000, as well as the policy year limit, from $50,000 to $70,000. We will also raise the MediShield maximum coverage age from 85 to 90 years to benefit older Singaporeans.
Based on the current life expectancy profile of our population, a relatively small proportion of Singaporeans live beyond age 90. As such, risk-pooling through insurance may not be the most effective way to help the very old defray their healthcare costs.
Help is currently available through other means, like Medifund Silver, which is dedicated to our elderly, and annual Medisave top-ups under the GST Voucher scheme. The Government has also enhanced subsidies in the primary care and intermediate and long-term care sector to further improve the affordability of such services.
We understand that Singaporeans are concerned about coverage beyond age 90, and will continue to study possible options to address this.
TRAINING EMPLOYEES FOR THE SILVER INDUSTRY
By 2030, we expect that the number of seniors above 65 years old will nearly triple to reach over 900,000. By then, one in five residents will be over 65 years old, compared to fewer than one in ten today.
Correspondingly, the needs of seniors in terms of healthcare and aged care, will increase significantly. It is therefore critical that all of us continue to stay ahead of the curve so that we can better look after our older Singaporeans.
The Ministerial Committee on Ageing (MCA) is leading the Government’s efforts to facilitate ageing-in-place, which covers many aspects such as making our physical environment more “age-friendly”, ramping up aged care services and infrastructure, and promoting active ageing.
On the recruitment front, we are working with relevant stakeholders in the intermediate and long-term care (ILTC) sector to make careers in the sector more attractive. In particular, MOH has set aside up to $12 million in FY2012 to assist VWO ILTC providers to support pay increases for doctors, nurses and allied health professionals in a bid to attract and retain staff in the sector.
MOH is also reviewing the pay of healthcare support workers, in tandem with a review of their job scopes to make their work more challenging and meaningful. We have also put in place a framework to train people for jobs in the silver industry, across the Community & Social Services and Healthcare sectors, as well as put in place programmes to help those who are keen to make a mid-career switch to jobs in the industry.
In addition, we have many courses to up-skill the manpower within the industry. First, we have put in place a holistic academic and vocational training framework to equip people for jobs in the silver industry. As the demands and needs of the silver industry changes, our training framework will have to continue to evolve in tandem in order to respond to these needs.
Our post-secondary education institutions offer courses in gerontology or gerontology-focused areas, catering to both young people and working adults. For example, Temasek Polytechnic offers a full-time diploma in Gerontological Management and Nanyang Polytechnic offers an Advanced Diploma in Nursing with specialisation in Gerontology.
Additionally, courses are also offered in healthcare, health promotion and social work, which cover the key services commonly tapped on by the elderly. In the course of their studies, students undertake assignments or attachments with hospitals and elderly care centres to gain first-hand experience in working with the elderly.
The number of full-time and part-time courses in gerontology, healthcare and social services areas has increased from around 30 in 2008 to more than 40 in 2011, while intake for these courses have increased from around 2,000 to close to 3,000 yearly over the same period.
We will also train more healthcare professionals locally by expanding the intakes in our schools. For example, the Lee Kong Chian School of Medicine will open next year. With the third medical school, we expect to boost our locally-trained supply of doctors to 500 across the three medical schools, a significant increase from the intake of 330 last year. We will also be training more nurses and pharmacists, by expanding the annual intake for nursing from 1,700 to 2,700, as well as for pharmacy from 160 to 240.
Second, we have put in place Professional Conversion Programmes (PCPs) to help Professionals, Managers and Executives (PMEs) who are keen to make a mid-career switch to jobs in the silver industry. These PCPs allow them to pick up the relevant skills and transit smoothly into the new sectors. For the silver industry, we have six PCPs in place. WDA launched the PCP for registered nurses in 2003. Since then, we have progressively introduced other PCPs relevant to the silver industry, such as PCPs for social workers and eldercare professionals.
Third, we are also building up skilled manpower for the silver industry through our Continuing Education and Training (CET) programmes. Under the Singapore Workforce Skills Qualifications (WSQ) system developed by WDA in close collaboration with industries, we offer a total of more than 300 courses for the Community and Social Services sector and 100 over courses for the Healthcare sector. Examples of these courses include the WSQ Professional Diploma in Community and Social Services (Seniors Services) and the WSQ Advanced Certificate in Therapy Services.
While we continue to improve on the numbers and quality of our training courses and conversion programmes, we are aware that the success of our efforts ultimately hinge on the take-up of these courses. In this regard, WDA works closely with industry partners to extend awareness and outreach and to promote training and career opportunities in these sectors.
For example, in February 2012, two career previews for the PCP for Social Workers were organised by WDA, the National Council of Social Services (NCSS) and SIM University. The event drew about 400 attendees and led to the successful enrolment of about 50 candidates. The Agency for Integrated Care (AIC) has also been showcasing the training and career opportunities in the ILTC sector at job fairs, and is working with the sector to create a portal on the ILTC sector so that potential recruits can easily access information on career opportunities in this growing sector.
I am heartened to note that an encouraging number have come forward to go for these courses and successfully completed them. In 2011, over 3,000 trainees were trained in WSQ courses for the Healthcare, Community and Social Services sectors, a sizeable increase from about 600 in 2008.
But we must do more. We will continue to consult and work with relevant stakeholders such as industry players, social organisations and workers alike to strengthen our suite of course offerings and improve on the awareness and outreach programmes. We continue to welcome feedback and suggestions as we seek to improve our efforts on this front. MOM and WDA will also continue to work closely with other relevant Ministries and agencies such as MCYS and MOH in a Whole-of-Government approach under the Ministerial Committee for Ageing, as we seek to enable our seniors to age in place.
SPECIAL EMPLOYMENT CREDIT SCHEME
The Special Employment Credit (SEC) was introduced in 2011 to support employers and to raise the employability of older low-wage Singaporean employees. To date, $35.9 million has been paid out to 58,000 employers for employing 189,000 eligible older Singaporeans in 2011.
In 2012, the SEC was significantly enhanced to provide greater incentive to help employers attract and retain older Singaporeans. The age criterion was lowered to age 50, when it was previously age 55. The income cut-off was raised to $4,000 per month, when it was previously $1,700 per month. The SEC payout was also raised to 8% of the monthly wage, which means that the maximum payout (of $240 per worker per month) has been increased by about seven-fold.
The first payment of the enhanced SEC, for eligible workers hired in the period January to June 2012, will be made to employers in September 2012. Eighty-five thousand employers (a 50 per cent increase) will receive about $230 million (more than a six-fold increase) for employing 383,000 eligible Singaporeans (a two-fold increase) in the first half of 2012.
Among Singaporean workers aged 50 and above, about 85 per cent were eligible for the SEC. The Government encourages employers to take advantage of the SEC by hiring older workers. We should learn to appreciate and value older workers for their valuable experience and expertise. As our population ages and our labour market remains tight, organisations will position themselves well for the future when they embrace older workers as part of their workforce.
COMMUNITY SILVER TRUST FUNDS
Gan Kim Yong :
The Community Silver Trust, or CST, was set up by the Government to provide a dollar-for-dollar matching grant to encourage donations into the intermediate and long-term care sector in Singapore. The Trust is managed jointly by the Ministry of Health (MOH) and the Ministry of Community Development, Youth and Sports (MCYS).
We have disbursed $20.13 million to 27 Voluntary Welfare Organisations in the health and social services sectors for donations received in the first three quarters of FY2011. This will enable them to build up their capabilities and programmes in intermediate and long-term care.
About 12,000 clients currently served by these VWOs stand to benefit from this additional funding. We have also received the applications for CST matching grant for donations received in the fourth quarter of FY2011 and are processing them for disbursement in batches from September onwards.
ESTIMATED EXPENDITURE ON HEALTHCARE AND LONG-TERM CARE FOR THE ELDERLY
Gan Kim Yong:
The Ministry of Health’s budget in FY2012 is an estimated $4.7 billion, about 20 per cent higher than last year’s expenditure. The bulk of this goes to patient subsidies, building infrastructure and developing new services, programmes and manpower capabilities.
As a significant part of healthcare expenditure, like infrastructure and manpower, is shared across the entire user base, it is not possible to provide a precise breakdown on the amount that is spent specifically on the elderly only.
Under the Ministry’s Healthcare 2020 plan to ensure accessible, affordable and quality healthcare for all Singaporeans, we had earlier announced initiatives to increase subsidies, expand capacity, increase salaries and invest in the training of healthcare staff, better integrate care, and step up health promotion programmes.
Taking these efforts into consideration, we project that the Government’s overall expenditure on health will double over five years, and may reach up to 3.5 per cent of GDP by 2030, from the current 1.6 per cent.
These projections are sensitive to factors such as economic growth, population growth, changing medical technology, healthcare consumption patterns, as well as changes to healthcare services delivery models, among others.
We expect the rising proportion of elderly in our population to be one key factor driving this growth, given the greater need for healthcare services among the elderly and the generally longer period of care needed. Currently, the Government’s tax revenues are between 13 to 14 per cent of GDP. We expect it to remain at around this level if we hold tax rates constant.
SUPPORT FOR FRAIL ELDERLY AND THEIR CAREGIVERS
In March this year, my Ministry announced a series of initiatives to build up community- and home-based eldercare services to better support ageing-in-place. We are on track to roll out the measures progressively over the next few months.
Last month, MCYS unveiled the “3-in-1” concept for Integrated Day Facilities or IDF for short. First, the IDFs will offer integrated care services for the frail elderly, combining social day care, centre-based nursing, community rehabilitation and dementia care.
Second, IDFs will provide information, coordination and referral services to better support families and caregivers. Third, the larger IDFs will provide gym and social space for community use.
By second quarter of next year, we should complete the building of two new IDFs – one in Tampines and the other in Toa Payoh, and the upgrading of six existing day care centres to IDFs. Another new IDF at Serangoon will be completed in the second half of 2013. By 2016, there will be about 40 IDFs serving up to 6,000 elderly. Details on the location of the remaining IDFs will be announced in the next two to three months.
My Ministry is also introducing social home-based care where the elderly at home can receive care services such as personal hygiene, housekeeping and laundry from a single care worker. We are working closely with our partners to recruit and train these care workers so as to launch this service in the fourth quarter of this year. By 2016, we will scale this service to benefit up to 4,000 elderly.
I am also happy to share that the Foreign Domestic Worker (FDW) Grant of $120 per month will come into effect from October this year. Applications have opened since 6 August this year. Households which employ a Foreign Domestic Worker to look after an elderly or person with disabilities and meet the eligibility criteria can apply for the grant.
To provide greater support for the vulnerable elderly in the community, my Ministry will organise the existing Seniors Activity Centres (SACs) into a hub and spoke concept, where Anchor SACs will support clusters of SACs to strengthen and expand their reach.
Anchor SACs will perform additional roles, such as closer monitoring through home visits, case management and counselling services for vulnerable elderly in the community. We expect the first six Anchor SACs to start operations by December this year. By 2016, we will have 16 Anchor SACs supporting some 39,000 elderly Singaporeans.
In planning the number and distribution of eldercare facilities, we take into consideration the demographic profile of each region, the adequacy of existing services and the availability of suitable premises. I am confident that most Singaporeans support the vision of ageing-in-place and understand the need for eldercare services to be developed within our communities.
We will continue to engage the local communities, refine the implementation strategies as well as review our services from time to time to ensure that they remain relevant and adequate.
As the life expectancy of our Singaporeans go into the 80s and 90s, there will be people in the 50s and 60s who are required, not only to take care of their elderly parents in their 80s and 90s, but also at the same time, take care of their children who might be in the early 20s or some in the 30s.
Indeed this is one of the big challenges for our society as we face an ageing population. MCYS will continue to look at how we can better support this group of people because some of them may be near retirement and they might need some other specific help.
On top of the current schemes, we are also going to look at what other new schemes we may be required to implement to cater to this specific group of people that the Member has highlighted, who are in the 50s or 60s. They are near retirement or just past retirement but perhaps still with the need to take care of their elder parents. In the next few months, as we re-organise ourselves and focus on the potential gaps in our social safety nets in the future, this will be one area that we will be looking at.