Streamlining Eldercare Series - Part 1: The Journey from Independence to Dependency

Streamlining Eldercare Series

This three-part series examines how eldercare in Singapore can evolve into a more cost-effective and sustainable system.

Singapore faces the challenge of an ageing population, with more individuals living longer and requiring complex care. The eldercare system must evolve to become more sustainable, effective, and person-centered. This three-part series explores how eldercare can be transformed to address these pressing needs.

• Part 1: Focuses on the individualized care of dependent older adults transitioning from hospitalization.

• Part 2: Explores bold, transformative solutions to enhance Singapore’s eldercare ecosystem. Article can be found here.

• Part 3: Highlights strategies to empower older adults to adopt healthier lifestyles and prevent future dependency. Article can be found here.

This first article begins by examining the journey of frail older adults, the challenges they face during hospitalization, and the seamless care approach necessary for sustainable eldercare.

The Journey from Independence to Dependency

In Singapore, a typical "at-risk" older adult in my personal opinion is between 75 to 84 years old—classified as "middle-old." While many in this group remain independent, they often live on the edge of frailty. Cognitively, these individuals are intact or may have very mild cognitive impairment (MCI), allowing them to manage both Basic Activities of Daily Living (ADLs) such as bathing and dressing, and Instrumental ADLs (IADLs) such as managing finances and cooking.

However, an acute health crisis or a chronic condition exacerbation can disrupt this balance, pushing an older adult into dependency. Hospitalization, often the immediate solution, marks a pivotal shift from independence to requiring long-term care.

Common Causes of Hospitalization Among Older Adults

Several health conditions often lead to acute hospitalization in this population:

1. Falls and Fractures

Falls are among the leading causes of emergency admissions for older adults. These incidents, often related to underlying sarcopenia or osteoporosis, result in fractures—commonly in the hip or lower limbs—that can immediately impair mobility and independence.

2. Cognitive Decline and Neurological Disorders

Conditions like dementia and Parkinson’s disease are significant contributors to dependency. These disorders manifest in ways that strain caregivers and disrupt the older adult's daily functioning:

• Wandering and confusion may lead to emergency admissions.

• Behavioral and Psychological Symptoms of Dementia (BPSD) such as aggression or withdrawal cause immense caregiver stress.

• Physical decline due to poor appetite or refusal of basic care further complicates management.

3. Chronic Diseases and Their Complications

Long-standing illnesses like hypertension, diabetes, and cardiovascular conditions frequently result in life-threatening events:

• Strokes (ischemic or hemorrhagic) are a leading cause of disability.

• Diabetic complications such as foot infections often necessitate amputations.

• Fluid overload in congestive cardiac failure patients requires immediate intervention.

4. Degenerative Conditions

Years of wear and tear lead to musculoskeletal issues such as:

• Arthritis in weight-bearing joints, limiting mobility.

• Spinal conditions, including prolapsed intervertebral discs, causing severe pain and functional decline.

5. Infectious Diseases

Even seemingly simple infections can have catastrophic effects on older adults:

• Flu can progress to pneumonia, causing respiratory failure.

• Skin infections such as cellulitis or complications from shingles can escalate into systemic infections, requiring hospitalization.

6. Cancer and Treatment-Related Decline

Cancer treatments, especially chemotherapy, often lead to severe weight loss and physical weakness, increasing dependency and palliative care needs.

Hospitalization and Its Challenges

While hospitalization addresses the immediate health issue, it often leads to unintended consequences, such as permanent functional decline. Strict bed-rest policies and "fall risk" labels in non-geriatric wards can exacerbate muscle deconditioning and reduce independence.

Discharge planning becomes a complex process, involving not just medical recovery but also social and logistical considerations. Families, caregivers, and healthcare providers face challenges in creating a sustainable care plan for these older adults.

A Seamless Solution: Introducing Team Lotus Eldercare (TLE)

To address these challenges, hospitals can partner with community-based teams like Team Lotus Eldercare (TLE). TLE represents a holistic, multi-disciplinary approach to transitional and long-term care, ensuring a seamless journey from hospital to home.

TLE’s Comprehensive Team Includes:

• Doctors and Nurses: Provide medical care tailored to the older adult’s needs.

• Medical Social Workers: Assist with financial aid applications and social support coordination.

• Therapists (Occupational, Physical, Speech): Help regain functional independence.

• Nutritionists: Create personalized dietary plans to improve health outcomes.

TLE functions as an extension of hospital care, bridging the gap between acute treatment and community-based support.

The 3 Critical Factors for Long-Term Care

Effective eldercare planning depends on addressing three critical factors:

1. Accommodation (A): Does the older adult have a suitable place to live?

2. Manpower (M): Is there a caregiver available to provide necessary support?

3. Finances (F): Can the family afford the associated costs of care?

Customized Solutions for Different Family Scenarios

Effective eldercare planning hinges on addressing three critical factors—Accommodation (A), Manpower (M), and Finances (F). By categorizing families based on these factors, tailored solutions can ensure no older adult is left without appropriate care. Below, we explore the eight family scenarios and the proposed customized solutions:

1. Families with Accommodation, Manpower, and Financial Stability

These families are the most self-sufficient, possessing a safe place to live, a dedicated caregiver, and adequate financial resources. For such families:

• Solution: After discharge, TLE continues providing care through private home care services, ensuring continuity. This model mirrors the Chronic Disease Management Program (CDMP), where families can use CPF savings to offset costs.

• Support Available: Private home care services from TLE. Access to subsidies for chronic care management under CDMP. Coordination with specialists and regular home health reviews.

• Outcome: The older adult benefits from personalized, high-quality care in familiar surroundings, minimizing hospital readmissions.

2. Families Lacking Accommodation, Manpower, and Financial Stability

These families face significant challenges, with no home, caregiver, or financial means to support care. For these vulnerable individuals:

• Solution: Referral to MOH-funded or subsidized nursing homes run by charitable organizations. These facilities provide basic care, medical oversight, and shelter.

• Support Available: Financial aid programs like MediFund or Medical Fee Assistance. Placement in government-supported nursing homes or community care facilities.

• Role of TLE: While TLE will not provide ongoing follow-up in these cases, it ensures a smooth transition during the discharge process. Assistance with applying for financial aid and securing placement.

• Outcome: Ensures that even the most disadvantaged older adults have access to essential care and safety.

3. Families with Accommodation and Manpower but Limited Financial Resources

These families can provide housing and caregiving but struggle to meet the financial burden of long-term care. For these families:

• Solution: Collaboration with charitable organizations to subsidize care and access government grants for essential support.

• Support Available: Home Personal Care programs to assist with daily living activities. Subsidized hospital equipment (e.g., hospital beds, wheelchairs). Subsidized consumable medical disposables such as diapers, milk feeds etc (Up to $2000 per year) Application for national disability grants or long term insurance schemes such as ElderShield/CareShield Life payouts, MediSave Care, IDAPE and ElderFund. Home Caregiver Grant (Up to $4000 and Pioneer Generation Disability Assistance Scheme ($100/month support) for those with just moderate disability. Community Chest or charitable donations for additional funding.

• Role of TLE: Regular home visits to monitor health and functional status. Assistance in navigating and approving complex grant applications.

• Outcome: Ensures that older adults can remain in their homes, cared for by familiar individuals, while alleviating financial strain.

4. Families with Accommodation and Financial Stability but No Manpower

In cases where families have the financial means and housing but lack caregiving manpower, professional caregivers become essential.

• Solution: TLE helps families recruit, train, and integrate formal caregivers (e.g., migrant domestic workers or private nurses) into the care plan.

• Support Available: Lotus Eldercare Academy provides trained caregivers tailored to the older adult’s needs. Transition training for the caregiver during hospitalization to familiarize them with the patient’s specific care requirements.

• Role of TLE: Acts as a liaison between the family and caregiver agency. Provides ongoing supervision and support to ensure the caregiver’s effectiveness.

• Outcome: Older adults receive professional care at home, reducing stress on family members while maintaining high-quality, personalized care.

5. Families with Financial Stability and Manpower but No Accommodation

Families in this situation have financial resources but lack a place to stay or caregiving support.

• Solution: Options include rentals / buying of Community care apartments from HDB or shared senior living arrangements.

• Support Available: Shared Senior Care facilities under TLE or private vendors. Rental of properties (HDB studios, private apartments) through TLE-linked property agents.

• Role of TLE: Provides long-term follow-up in shared senior care or private accommodations. Ensures the older adult’s health and wellness are monitored and supported.

• Outcome: Older adults maintain a sense of community in shared senior living settings while receiving expert care from TLE.

6. Families with Accommodation but No Financial Stability or Manpower

These families have a place for the older adult to live but lack funds and caregivers.

• Solution: Transforming the family home into a shared senior care facility to generate rental income.

• Support Available: Rental subsidies from co-living arrangements to cover caregiving and medical costs. Assistance with grants for financial relief, including ElderFund and IDAPE.

• Role of TLE: Facilitates the shared living arrangement by sourcing tenants and setting up care systems. Provides continued health and medical care for the older adult.

• Outcome: A creative approach that leverages existing assets to fund care while keeping the older adult in familiar surroundings.

7. Families with Manpower but No Financial Stability or Accommodation

These families have caregivers available but lack housing and financial means.

• Solution: Placement in shared senior care facilities, where the caregiver’s involvement reduces costs.

• Support Available: Caregivers contribute time and skills to subsidize accommodation and other expenses. Assistance from TLE to secure necessary grants and equipment.

• Role of TLE: Ensures both the caregiver and older adult receive appropriate support and resources.

• Outcome: Creates a collaborative model where caregivers and older adults coexist in a supportive environment.

8. Families with Financial Stability but No Manpower or Accommodation

For affluent families without caregiving manpower or housing:

• Solution: Placement in private nursing homes or shared senior living options with full-time professional care.

• Support Available: Assistance with navigating subsidies for private care where applicable. Shared senior living options for a balance of independence and community.

• Role of TLE: Optional follow-up to ensure the older adult’s care quality remains high.

• Outcome: Older adults are cared for in high-standard facilities with access to professional resources.

The Vision of Seamless Care

TLE’s approach ensures that every older adult, regardless of their circumstances, receives tailored care solutions. By leveraging community, government, and private resources, this model bridges the gaps in eldercare, providing continuity and stability. Each family scenario is addressed with compassion and practicality, ensuring dignity and quality of life for older adults while easing the burden on families.

This framework not only improves eldercare outcomes but also lays the foundation for a sustainable and resilient healthcare system for Singapore's ageing population.

TLE embodies the concept of continuity, bridging public, private, and charitable services. With a familiar care team, older adults experience less disruption in their care. Hospitals retain oversight, ensuring accountability and better resource utilization.

This integrated approach strengthens the eldercare system, enabling older adults to age with dignity while alleviating the financial and emotional burden on families.

Stay tuned for Part 2, where we delve into transformative solutions to enhance Singapore’s eldercare ecosystem for a sustainable future!