Adequacy of Places for Home Care and Centre-based Care Services for Elderly

Assoc Prof Daniel Goh Pei Siong asked the Minister for Health (a) how many places for home care and centre-based care services for the elderly are there currently; (b) how many referrals for each of these services have been received by the Agency for Integrated Care in 2015; and (c) how many of these referrals have been turned down and what are the main reasons for turning them down.

The Ministry of Health (MOH) has been working to expand home and centre-based care capacity to better support our seniors to age-in-place among their family and friends. We currently have a capacity of 6,900 home care and 3,500 centre-based day care places. This is an increase of 80% from the 3,800 home care places, and a 67% increase from the 2,100 daycare places, in 2011. We are on track to meet our target of 10,000 home care places and 6,200 daycare places by 2020.

We have also been working to increase awareness of home- and centre-based care so that seniors and their families can consider these services for their care arrangements. In 2015, the Agency for Integrated Care (AIC) received home care referrals for about 8,500 seniors, and day care referrals for about 7,800 seniors.

AIC does not turn down referrals. Its role is to facilitate the placement of seniors needing home or community care services or other appropriate aged care services. Once a referral is received, AIC works with the seniors and their families to find the most appropriate service to meet their needs. Not all referrals for home or centre-based care services translate into actual take-up for a variety of reasons. Of the referrals that did not result in services being taken up, about half were because families opted for alternative care arrangements such as hiring a domestic helper. Another reason for not taking up the service is seniors being readmitted to the hospital as their conditions were not stable.

I thank the Senior Minister of State for the detailed answer. Is there a waiting list, therefore, for those people who are not going to change the referral, because the spaces and the type of care that they want are not available? Is there a waiting list and is there a criterion in which those put on the waiting list can be bumped up if there is an urgent need?

I thank the Member for the supplementary questions. Let me explain that the capacity required, which I have noted in my earlier answer, is smaller than the referral numbers for three reasons. First, not all referrals, as I have said, eventually choose to take up the service. Some could be because they have got alternative care arrangements, domestic helpers; some because the seniors are re-admitted to hospitals; in fact, there are also some where the seniors are concurrently referred to multiple services, both home and community care service, while they actually only need one.

In 2015, of the referrals received, about 5,600 home care referrals and slightly more than 3,000 daycare referrals were admitted into service.

Secondly, the difference in numbers is also because whilst we have a flow of referrals during the year, we also have a flow of discharges. During the year, there may be patients who are discharged from home care or day care because they no longer need the service, because the conditions have improved, they have alternative care arrangements, or they have passed away.

In 2015, about 3,800 home care clients and 1,200 daycare clients did not continue with the service, which frees up capacity for others who need the places.

Thirdly, for day care services, seniors may not need to have the service every day. They may take up the service three days a week. Therefore, one day care place can serve more than one senior.

Taking all these into consideration as well as the fact that we have been ramping up capacity, there is no wait time for home care. We have sufficient capacity for home care. There is some wait time for day care. The median waiting time is about 20 days. The reason, really, is because of geographical imbalance between supply and demand. In some places – for instance, the Central region, mature estates, ageing profile – it is not easy to find sites for new senior care centres.

Sometimes, it is also because of patients' preferences. For instance, they want a day care centre in a certain location for convenience's sake. So, there is some wait time. Of course, there has also been increasing demand for day care places.

But let me assure Members that we are working very hard to ramp up our supply of home and day care places, and we are on track to meet our target for 2020.

In the meantime, for those who are waiting for day care places, AIC works with the patient as well as the families for interim care arrangements. They can get on either to the home care services available or they can avail themselves of the Interim Caregiver Service (ICS). When the senior is discharged from hospital, we can offer ICS whilst they are waiting for longer-term care arrangements. ICS can be for a period of two weeks, in the first instance, and up to three months while they are waiting for longer-term care arrangements.