Please tell us about key programmes or activities that Tsao Foundation has implemented in relation to health and care for older people
The Foundation’s four key initiatives provide a range of community health and psycho-social care services for the life-course, enabling a continuum of care and opportunities for lifelong learning and continuous participation. Thus meeting the needs of mature adults and their families – from wellness to end-of-life care, they are as follows:
- Hua Mei Centre for Successful Ageing – a one-stop provider of primary healthcare and care management (which together form a ‘person-centred medical home’, an integrated primary health and social care service model that targets, especially, elders with complex needs), specialised dementia care management, centre-based care for frail elders, home-based medical/nursing/palliative and end-of-life care for homebound elders, and traditional Chinese medical and acupuncture services. Elders can use single or multiple services at any one time, and transit from one service to another based on prevailing need.
- Hua Mei Training Academy – a capacity-builder in aged care offering certificate courses from market entrance to advanced practice levels – including in-house developed training for community geriatric nurses, counsellors and other aged care professionals – it also offers lifelong learning programmes to equip individuals with the skills to prepare for their own ageing and for caregiving.
- International Longevity Centre Singapore – with evidence-based policy advocacy as its mission, this centre also has a strong focus on senior empowerment and community development, especially targeting issues like social isolation and barriers to participation.
- Community for Successful Ageing – a whole community, population and public health approach to successful ageing whereby population surveys are used to ‘case-find’ individuals with high health risks and vulnerabilities such as social isolation, who then get offered an integrated package of bio-psycho-social care services upon the further assessment of their circumstances and care planning – or in the absence of those needs, are invited to take up active ageing and civic participation opportunities.
Integrated and comprehensive healthcare delivery is by the Foundation offering the same service suite as at the Hua Mei Centre for Successful Ageing, and in collaboration with an intentional network of service providers in the vicinity, so as to enable a seamless continuum of care across settings. Alongside the healthcare system is the development of OPA’s around self-care and health as well as elder empowerment and leadership.
In Asia, caring for older people is mainly the responsibility of family members, what do you think are innovations or mechanisms that could help ease caregivers’ load and pressure?
Family caregivers can benefit from a long-term care system that takes into consideration not only the needs of older people, but theirs as well. It might include the following:
- public education and outreach so that caregivers can be cognisant of their role and know where to seek help. Many slide into being caregivers without realising it and are therefore unprepared for a role that may well be physically, mentally and emotionally challenging;
- training in eldercare for caregivers – on the necessary caregiving skills to address the physical and psycho-emotional needs of the older person, and also the services and resources available;
- training in self-care for caregivers for their physical and psycho-emotional wellbeing. Much of caregiver stress is related to worry and relationship issues so it is useful to have an understanding of their own emotional response to caregiving, as well as how their relationship with family and the care recipient will impact them, and be affected by their caregiving role.
- caregiver support services – including psycho-emotional care (such as counselling and group support), respite services and financial support (for example, vouchers) to procure equipment, consumables and services. The caregiver’s own future financial and health security ought to be addressed as they will be foregoing their ability to earn and save for their own old age – and this is concerning especially for single women caregivers. Accessible professional health and social care that meets the various needs of older people will serve not only the older person, but caregivers as well.
We have seen a lot of news article and researches discuss the role of community as a key actor in providing health and care to members of their communities, why do you think that’s the case?
Their purpose would be to promote healthy ageing – optimising health and disability-free ageing and minimising the need for long-term care – and also to ensure that all older persons get the care that they need.
To reap the longevity dividend, the key strategy is to enable the population to have healthy, disability-free ageing. Increasing medical needs, including for long-term care, and higher utilisation of hospital services are also key causes of rising healthcare expenditure and other costs to society.
Accessible and affordable community-based health and social services such as primary care and healthy lifestyle programmes encourage higher level of participation, promote and enable healthy ageing and prevent chronic diseases such as hypertension and diabetes from resulting in disabling conditions like strokes and limb amputations.
It also takes a village to care for our elders, as with smaller families (from decreased fertility coupled with migration) to care for an increasing population of older people, it would be challenging for societies to afford paid services for all the elders who need long-term care. The community must play a role in the care of frail elders by mobilising community resources to supplement family caregiving and formal services, especially in places where formal aged care services are not yet widely available.
Essentially, it is important for the elders’ quality of life to be able to live and work in the community that they know, where they have longstanding social networks, and to which they belong.
How can government support community initiatives and improve community-based services?
While institutional care (such as nursing homes) are necessary, experience in developed countries already addressing an ageing population shows that it should be the choice of last resort, due to its cost, as well as the often negative impact on the elders’ well-being for having to leave their home and community.
Governments need to make community care the basis of long-term care, provide resources and incentives to pilot innovations in the community, and replicate successful models.
Governments also need to build long-term care systems that provide financing and appropriate regulation of community-based services to ensure adequate access and quality of care.
There are also other infrastructure components that governments need to provide, such as vigorous health promotion and disease-prevention initiatives, adequate primary and acute healthcare, and seamless linkages between community and acute health care services, as well as health and social care, within a regulatory framework for standards and delivery, along with an efficient transport system that enables access to the services.
The upcoming HelpAge Regional Conference is based on the theme “Family, Community and State in Ageing Society”, what is your response to the theme?
This is very timely; as most societies can no longer depend solely on the family to care for the long-term, complex needs of frail elders, the community must step in to take a stake in the wellbeing of older people in their midst by supporting family care and providing additional resources.
The state must provide the infrastructure for an equitable long-term care system that can ensure sustainable financing, quality and access for all citizens.
Everyone must play a part, so there needs to be proactive initiatives and partnerships across all sectors, including the private sector.