Speech by Mr Ong Ye Kung, Minister for Health At the Aic Community Care Work Plan Seminar, 3 May 2024

Friends and Partners in the Community Care Sector

Ladies and gentlemen

1. Ageing is the most important social development in Singapore now, without a doubt. I will therefore start by explaining Singapore's ageing situation.

Ageing Singapore

2. We will reach super-aged status by 2026. This is when the proportion of the population aged 65 and above reaches the 21% mark. We are now at 17% to 18%.

3. However, this 21% is at the national level. When we look more closely at the 24 regions in Singapore, seven of them are already super-aged. From West to East - Jurong East/Boon Lay, Clementi, Bukit Merah, Ang Mo Kio, Serangoon, Toa Payoh and Geylang already have more than 21% of their populations aged 65 and above.

4. Five more regions will reach that threshold in the next couple of years. But make no mistake, as years go by, almost the whole island will be red.

5. We can also take a closer look by age bands. The number of older seniors aged 85 and above is also rising fast. The absolute number of people in this age band was about 36,000 ten years ago. Today, it has gone up by almost 80% to 64,000 and it can double in several years down the road. For us in the community care sector where you physically have to take care of the seniors, these are absolute numbers. This is the absolute amount of work that we need to do. They are not just statistics.

6. Older seniors aged 85 and above will need a lot more support.

• Today about one in five has difficulties with three or more Basic Activities of Daily Living, which is eight times higher than those aged 65 to 79.

• 60% are frail to severely frail - four times higher than those aged 65 to 79.

• 4% are at higher risk of social isolation - three times higher than the younger seniors.

7. Seniors below 85 have a range of needs too. Some of them may also be frail and will need care. Most have chronic illnesses such as hypertension and diabetes. In fact, about 70% to 80% of them have hypertension and diabetes, which have to be managed. As for those who are not sick, they are always at risk of falling severely ill.

8. The needs of seniors are therefore very varied and wide-ranging. Our job at the Ministry of Health (MOH) is no longer just sick care, but to help them recover and get back to their normal lives, after a bout of sickness. We also need to help them remain well, active, and healthy, leading dignified and meaningful lives.

9. These are the objectives of the community care sector.

10. At this event last year, I shared that MOH was planning another programme that will be as significant as Healthier SG, to focus on preventive care for seniors. Today, this has been rolled out, and is called Age Well SG.

11. We have implemented Healthier SG and Age Well SG last year, because we are an Ageing SG.

12. Active ageing is not a new objective. We have implemented many programmes before, but none as comprehensive and far-reaching as Age Well SG. It is for the long term, covering all parts of the island, with deep interventions in communities, and will be well-resourced.

13. In 2023, we planned, secured resources and rolled out Age Well SG. I have just announced that this financial year (FY), MOH will be disbursing about $100 million to over 200 AACs, a significant jump from $60 million to 157 AACs in the previous financial year. It is a big jump in resourcing.

14. 2024 will be a year of execution, where we focus on putting the resources to good use. This will be the focus of my talk today.

Progress of Active Ageing Centres (AACs)

15. Let me first give a stocktake of Age Well SG. We have many AAC leaders in the audience today, and I want to thank you for the significant progress that we have made in such a short time. Thank you very much. Let me try to put some of your accomplishments and achievements in numbers:

• The number of AACs has more than tripled from 60 in 2021 to 208 today.

• The number of seniors engaged and taking part in AAC activities per year has more than doubled, from about 17,000 in FY21 to more than 49,000 in FY22. This is the latest number that we have. We are now into FY24 and I expect the engagement number to be even higher.

• Engagement of seniors is improving very fast. One in five AACs has engaged more than 30% of seniors in their assigned populations.

• I should explain that for AACs, 30% is not a low benchmark at all. This is because many seniors - perhaps up to half - will not need to come to AACs as they are still working or already engaged in community programmes or have their own social groups. So we are only targeting the other half.

• So, 30% is actually the majority of the remainder. Our penetration rate is improving and it gives me confidence that we can do a lot better in the years to come.

16. AAC activities are also getting more varied and interesting, going far beyond the stereotypical programmes. Seniors at NTUC Health AAC are learning to code robotics and teaching other seniors how to do the same. Montfort Care's Goodlife Studio at Bukit Purmei trains seniors in carpentry and woodwork.

17. MOH is also improving. For one, we stopped insisting on putting every senior through the Community Screener Tool! It saves time and effort and enables AACs to pay more attention on doing what matters most, which is to outreach to and engage seniors and hold interesting activities for them.

The Work Ahead

18. Now that we have a national strategy, laid a good foundation, with more resources and less administrative burden, we need to get down to get work done. Today, let me put to you, the five things that AACs should focus on.

19. Number one, outreach. It is not difficult to fill up an AAC with seniors, but even if we do that on a daily basis, chances are we are probably touching I think less than 5% of the senior population of the area under the AAC. These are the people we know. The challenge is how do we reach out to the people that we don't know, who are still in their flats and apartments.

20. AIC will support you with outreach, by sharing data on where seniors are living. AACs need to mobilise volunteers and Silver Generation Ambassadors to door knock and befriend seniors. This work requires perseverance, diligence and constant toiling on the ground. Through befriending, we will gain their trust and they will join our activities.

21. Second, engagement. We do this by organising interesting activities. I talked about how activities have become more varied in a few AACs. We need to do this across the board.

22. One low-hanging fruit is to make use of the Health Promotion Board's (HPB) programmes. They have come up with a fitness package for seniors at the AACs. Exercise and fitness are always a crowd puller. In addition, organise talks, outings, sing-a-longs. Make an effort, especially, to organise activities that uncles will enjoy.

23. We also need to get seniors to volunteer under the new national Silver Guardian programme. There are many jobs they can do. They can participate and organise some activities, and guide fellow seniors. We can create many roles for them. I just announced the launch of this programme, with the aim to train and match 2,400 Silver Guardians by 2028.

24. This Silver Guardian programme is not to solve your manpower problem, even though it may be able to help. The main purpose is to get seniors to do something useful for others whichgives them a sense of self-worth, and the ability to help others.

25. Third, partnership. There are many partners in the community, beyond AACs - People's Association, HPB, SportSG, religious organisations, interest groups, etc that are already active in the community and are already reaching out to seniors. We should leverage them and synergise our efforts with them, so that AACs can become the community hub that connects seniors to the many activities that are available in their community.

26. In that spirit, AACs should not have this "real estate" mindset that all your activities must be in your AAC. Treat the entire estate as an asset that you can leverage and make use of all spaces in the community. Singapore has wonderful public spaces we can use that many other cities around the world do not have. Make use of void decks, fitness corners, coffee shops, parks, libraries and community clubs. Many activities that are held at those premises can be co-organised with other community partners.

27. We have specifically set aside funding for "Ground-Up Initiatives" (GUIs) to encourage AACs to develop partnerships and new activities to engage the seniors.

28. Fourth, health. Many AACs are still understandably finding your footing under the new Age Well SG operating framework. Over time, we will need to incorporate a higher tempo of health services in the activities of AACs.

29. This means tapping on the Healthier SG GP network in the community, as well as tapping on our clusters and public hospitals. We have set up the healthcare clusters, with the objective to support community partners including and especially AACs.

30. What are some possible health services? One, common now in many AACs, is the community health posts within AACs.

31. Community nurses will visit an AAC say once a week or once a fortnight. Seniors can approach them for health checks, especially those ordered by their Healthier SG GP, check on their chronic conditions and ensure medication compliance. So imagine, you go to a GP, the GP gives you a health plan which says you are due for a blood test. Then you go to the AAC the following week, where there will be a blood screening test that is ongoing. So you start to connect the dots together.

32. AACs can also conduct workshops to educate seniors on various health-related subjects, such as how MediShield Life works, to get them and their loved ones to prepare Advance Medical Directives (AMD), understand sensitive subjects like palliative care and start to discuss about it.

33. Final area, coordination. AACs represent one band of the spectrum of community care for seniors. For seniors with more serious conditions or need rehabilitation, we have Senior Care Centres or personal home and day care. For those who have become frail or near frail, they may need home care, or be admitted to a nursing home or a community hospital from time to time. For those approaching the end of life, there is hospice and palliative care.

34. Most community partners provide discrete care services, we provide one band out of the whole spectrum. We are specialists. Yet the needs of seniors are varied and changing, and can move to and from the spectrum of care. Today, the process of transiting from one community care provider to another, if we are honest, can be smoother.

35. Seniors can be made to go through repeated care assessments when they transit to new settings within a short duration. For seniors with multiple needs, it can also be a challenge to coordinate our actions because of a lack of platforms to share information. For example, one provider may notice changes in the senior's condition, but unless that information is transmitted to the other care providers, our care will not be proactive or coordinated enough. And we end up dropping the ball.

36. We need to make care transitions from one setting to another more seamless. Last year, we shared some ideas on how we can do this.

37. One idea was to over time, evolve within each sub-region a lead or anchor provider that can deliver multiple services, and with other providers in the community supporting it.

38. However, it is quite clear that this hierarchical, business-like model does not quite work for the community care sector. The DNA of this sector is not for one provider to dominate over another, but to do good together. We help one another out as partners and friends. It is an egalitarian sector.

39. Further, relationships with the seniors, and co-operation between providers, are core to the success of the community care sector. So, the potential loss of social capital may not be worth the structural neatness.

40. AIC has therefore reworked the model.

• We will adopt a common care assessment tool to reduce or eliminate repeated assessments.

• We will develop a common care plan for each senior.

• There will be an assigned single point of contact to try to ensure information flow across all care providers in a sub-region.

41. In other words, we will simply have to work harder to coordinate more amongst partners, rather than to change partners. This, in my view, is the most practical and effective way forward to serve seniors. I am glad to learn from AIC that most of you support these changes. We will work out the details with you.

42. The five areas I mentioned - Outreach, Engagement, Partnership, Health, and Coordination - will be our implementation priority for the coming year. If you take the first letter of each priority and move them around, it spells CHOPE - C-H-O-P-E.

43. It tells us that as a sector, we will 'chope' this as our mission to help seniors; we will 'chope' their time to attend our activities; we will 'chope' the premises and the volunteers to organise interesting activities; we will 'chope' each other as good partners. MOH will try to 'chope' the budget for you.

Setting An Example

44. There is a potential and major ally for the AACs, and that is the Grassroots Adviser of the area. The Adviser knows many community partners and government agencies. They can help us make connections, unlock obstacles, open up premises, link up partners and mobilise volunteers to make things happen.

45. I urge all AACs to engage your local Adviser and put forward a strong implementation proposal that can serve our seniors better.

46. I am the Grassroots Adviser of Sembawang Central. This is my other job besides being the Minister for Health. I need to set a good example for other Advisers.

47. I am thankful to have two good AAC operators to work with - Blossom Seeds and TOUCH Community Services. Whatever policies we develop at MOH, I try it out on the ground, discuss with our two operators and do my best to make things happen.

48. For example, I do a lot of outreach personally, through my weekly home visits. The good thing about being doing outreach is that the residents recognise me. This is a picture taken during one of my many weekly visits, with Mr Lim and Mdm Wong.

49. Whenever I meet a senior, especially if they are staying alone or as a couple, I will ask them to come visit our AACs and join in the activities. I will emphasise to them that everything is free, and we will 'belanja' them.

50. Their faces always light up without fail. Perhaps it has been a long time since someone invited them somewhere. My volunteers will then follow up on the day of the activity, and they are very likely to show up.

51. One of my pet activities is communal dining. I believe that food has a great ability to bring people together. Blossom Seeds through its own initiative and fund-raising efforts has been organising lunch gatherings for seniors twice a week.

52. I want to go further and have been nagging our Resident Committees (RC) to work with AACs to implement weekly communal dining at the void decks or RC centres, where it is very convenient for seniors to gather to prepare food and enjoy it together.

53. We worked with the Housing & Development Board (HDB) to install simple cooking facilities like a rice cooker and induction stove at the selected void decks. We have to look into details like locking up the socket to prevent illegal tapping of electricity.

54. We have gotten a few sessions going and will be tapping on the GUI fund to sustain it.

55. One of our most recent sessions was Thosai making. It is led by Mdm Meenachee. She lives alone, and we approached her to join an AAC and teach other seniors how to make Thosai. We had a good turnout and I hope more seniors will step forward to share their recipes.

56. I am also encouraging seniors to exercise. I always ask seniors if they have seen my TikTok videos, which have many tips to teach you how to exercise. Brisk-walking is a very easy exercise to pick up, and so we have started monthly mass brisk-walking in Sembawang Central, with a couple of hundred participants each time. I needed outside help, and so got Jack Neo and his Pa-Pa-Zao group to help. I hope that through such activities and collaboration we raise awareness that briskwalking is good and generate word of mouth and more people will participate in the future.

Closing

57. Our seniors belong to the generations that built Singapore. They are our parents and grandparents. Most have already retired, and in their golden years. They deserve to age with purpose and dignity.

58. The Government rolled out the Pioneer and Merdeka Generation Packages to give them peace of mind in their golden years and also to honour them. We can now go further, to surround them with love, laughter and friendship and the conditions to maintain good health.

59. I have shown you some of the efforts in Sembawang Central. But I am sure many regions can do better than Sembawang Central, which is a relatively new area with very few programmes in place. We had to build many programmes up from scratch. So please share best practices, 'chope' your time and energy to get AACs going and take good care of our seniors. Thank you.