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Update From Modern Aging Singapore: Kickoff Workshop

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Modern Aging Singapore kicked off in the middle of August. So far, the program has seen active participation and support from aspiring entrepreneurs. About three hundred students, health practitioners, researchers, and members of the public attended the Kickoff Workshop held at the NUS I Cube Building Auditorium on the morning of August 15.

Attendees were treated to four presentations from experts in aging and business: Overview of Aging by Prof. Angelique Chan of Duke-NUS Graduate Medical School, Healthcare and Business by Dr. Jeremy Lim of Oliver Wyman, Home and Center Based Care by Dr. Ng Wai Chong of the Tsao Foundation, and Product Design for Seniors by Hunn Wai of design firm Lanzavecchia + Wai.

MA2Prof. Chan highlighted some key trends and statistics on aging in Singapore. One surprising point was the high prevalence of social isolation among seniors here. This finding spurred aspiring entrepreneurs to think of novel solutions to address this trend.

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Dr. Lim went on to outline the aging sector in terms of business potential. One suprising finding, according to theNational Center for Policy Analysis, is the average net worth in 2010 was 848,000 USD for sixty five to seventy four year olds and nearly seven hundred thousand dollars for those above seventy five. These figures encouraged aspiring entrepreneurs to enter the aging sector.

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Dr. Ng discussed the current status of home and center based care in Singapore. He highlighted specific needs in these care settings frequently used by seniors. This discussion allowed aspiring entrepreneurs to hone in on key areas of need and address these pain points. For example, some challenges in these settings include the quick and painless transferring of patients from bed to chair and vice versa, and increasing the time health practitioners can spend with seniors.

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Mr. Wai rounded off the presentations with insights from product and design perspectives. He introduced examples of good design for seniors, such as mixed use canes and walkers, or stylish back braces. This presentation especially inspired aspiring entrepreneurs to consider seniors’ lifestyles and tastes when introducing new product ideas.

In addition to expert presentations, attendees also heard two senior role models share their life experiences and lessons. Younger members of the audience seemed glad to hear the wise advice dispensed by the seniors. The kickoff event concluded with a networking lunch. Participants became so engrossed in conversations around aging that they lingered past the scheduled end time.

Currently, Modern Aging Singapore has progressed to the business curriculum and selection phase. The top twenty teams have been selected and paired with industry mentors to hone their business ideas. The twenty teams will soon be pitching at the semifinals judging event for the top six spots. Meanwhile, all participants of Modern Aging Singapore are able to access the same business and aging curriculum on the Modern Aging Online Learning Portal to continue learning and improving their business ideas. If you would like to access the Portal, please write an email request to info@modernaging.org.

Find out more about Modern Aging, at www.modernaging.org.

Informal Child and Elder Care in Singapore: South Central Community Family Service Center

At ACCESS Health International, we like to feature good examples of community and elder care. A recent visit to the South Central Community Family Service Center in Singapore reveals a thriving space where different generations of neighbors visit, work, and play with one another.

The South Central Community Family Service Center is located in the southern part of Singapore. The Center is shown as a red dot on the map.

The South Central Community Family Service Center is located in the southern part of Singapore. The Center is shown as a red dot on the map.

The South Central Community Family Service Center is just one of many other Family Service Centers in Singapore. Family Service Centers are an important part of the “Many Helping Hands” approach of the Singapore government toward social services. The Many Helping Hands approach emphasizes the involvement of multiple sectors in providing for the social welfare needs of people. Family Service Centers are run by Voluntary Welfare Organizations and are supported by the Ministry of Social and Family Development, the National Council of Social Services, Community Chest, or the Singapore Totalisator Board [1]. This is one way the government supports and encourages care provision by nongovernmental entities.

The South Central Community Family Service Center is unique in one respect. In January 2013, the Center became an independent entity with its own board of directors. The mission of South Central Community Family Service Center remains the same: to promote the wellbeing and self reliance of families. The main focus is supporting lower income individuals and families in the Bukit Ho Swee, Henderson, Redhill, and Indus Road neighborhoods. Between 2013 and 2014, the Center managed an average of four hundred cases. Casework involves counseling or referral to specialized services. For example, children from families lacking in basic necessities may face challenges in schoolwork or dealing with classmates. Center staff can counsel children or their parents on managing these problems. Where necessary, families are referred to other services, such as specialized psychiatric help or financial aid.

The entrance was decorated with cheerful cartoon sheep to welcome the year of the sheep.

The entrance was decorated with cheerful cartoon sheep to welcome the year of the sheep.

Besides casework, another focus of the Center is community engagement. To this end, Center staff organize events to involve nearby residents and create community spirit. As the Center is located on the ground floor of a block of residential flats, it is accessible and open to residents in the neighborhood. Our visit took place during the Lunar New Year period. As seen in the photo, festive decorations lining the entrance created a welcoming and friendly atmosphere.

Outreach worker Erwin showed us around the Center. Erwin explained to us that a guiding principle for the Center and staff is community cooperation and participation. This principle is informed by the Asset Based Community Development approach to community work. This approach ensures sustainability because initiatives are driven by the residents themselves. Residents volunteer to help care for their neighbors’ elderly relatives or children. Residents worked together to plant a community garden full of useful medicinal herbs.

Residents take ownership of the community garden and bond while caring for the plants. (Photo: South Central Community Family Service Center)

Residents take ownership of the community garden and bond while caring for the plants. (Photo: South Central Community Family Service Center)

The Center is a collaborative environment. The community garden is a visible fruit of this collaborative environment. The garden had been an empty space in front of the Center. Center staff wanted to galvanize residents to work on a common project. Residents contributed ideas and voted for the winning project: a medicinal herb and vegetable garden. Because the idea came from residents, the garden has been adopted and cared for by residents.

Residents contribute ideas to keep the garden fresh and growing. Residents can vote for the next plant type by placing a marble in the respective bottle.

Residents contribute ideas to keep the garden fresh and growing. Residents can vote for the next plant type by placing a marble in the respective bottle.

In the picture above, one can see a board where residents can vote on the next plant type. At the time of visit, sweet potato leaf was the leading candidate. The board itself was constructed by hand by a resident who is a carpenter by trade.

The Request and Offer board matches community resources to areas of need.

The Request and Offer board matches community resources to areas of need.

Inside the Center hangs another board, where residents can request items or services they need, or post offers of items or services they can give. The platform helps match community resources to people who need them most.

Residents streamed in and out of the Center throughout our visit. Erwin pointed out a pair of young siblings playing games on the couch. Erwin told me the siblings come to the Center after school ends to wait for their parents to get off work. I also saw groups of elderly chatting with one another at tables and chairs. The open space created by the South Central Community Family Service Center helps with informal child and elder care as residents look out for and engage with one another.

Outreach worker Erwin, in gray, briefs volunteers on a house visit activity.

Outreach worker Erwin, in gray, briefs volunteers on a house visit activity.

Near the end of our visit, there was a briefing for a large group of about twenty five volunteers, both young and old. They were preparing to give out yusheng packs to shop owners and residents at the Lengkok Bahru neighborhood. This showcased lower income families and children as goodwill ambassadors as part of this “Lo Hei Outreach”. The yusheng salad is traditionally eaten during the Lunar New Year, and Lo Hei is the dialect term for tossing the salad. Family and friends gather to Lo Hei together, signifying prosperity and togetherness. The briefing was punchy and positive with the staff recognizing the contributions of volunteers.

The South Central Community Family Service Center is an example of successful informal community and elder care. The staff and volunteers have created an open venue where residents are encouraged to join community activities and contribute their talents. Can their model of community involvement and ownership be replicated elsewhere? For example, could elder care as a larger industry move toward being more community based and operated? Share your thoughts with us by leaving a comment.


1. The Singapore Totalisator Board, also known as Tote Board, manages the surplus funds generated by Singapore Turf Club and Singapore Pools. They channel funds in support of various causes in Singapore such as arts and culture, social services, community development, education, health, and sports.

A New Perspective: Design Thinking for the Elderly

This post is the first in a series of articles focused on design thinking and aging. In future posts, we will explore the use of personas in designing solutions for seniors. We will also address problems identified by seniors themselves.

Imagining the ecosystem surrounding seniors in Singapore. Examples given are not exhaustive.

Imagining the ecosystem surrounding seniors in Singapore. Examples given are not exhaustive.

Last week, the ACCESS Health Singapore team attended a DesignSingapore forum titled Rethinking Health and Wellness for the Elderly. Among the fresh perspectives and opinions shared at the forum, one point really stood out to us: Often, designers who design products for seniors view seniors as isolated individuals. In reality, the elderly live and interact with others in their families and communities, such as family members and health professionals. They engage others in their external environment multiple times throughout the day: when getting coffee, seeing their neighborhood doctor, seeing specialists at hospitals, visiting community centers, going to the supermarket, and even through online sites and discussion boards. Behind these interactions, or touchpoints, lie many higher level entities that share an active interest in the wellbeing of the elderly, such as ministries or charities.

This learning point came from applying design thinking and ethnography to aging. One principle of design thinking is that all design activity is social in nature. Ethnography aims to explore social phenomena from the point of view of the subject, in this case seniors. At the forum, videos were shown of interviews with various seniors and their caregivers. These seniors and caregivers were asked what challenges they faced in daily living. Beyond these answers, researchers also followed the seniors on their daily activities, like cooking and exercising, in true ethnographic fashion.

In one clip, a frail senior was shown cooking for himself. His legs are weak so he sits on his wheelchair at the stove. But this position is often low and awkward. Upgrading to an adjustable height chair could make cooking easier for him.

A video still showing a senior cooking. An adjustable height chair could make cooking easier. (Photo: DesignSingapore)

A video still showing a senior cooking. An adjustable height chair could make cooking easier. (Photo: DesignSingapore)

One woman interviewed in the video had left her job to care for her father full time. Even while providing fulltime care, she said, there are moments when she cannot be there, physically, to catch her father if he falls. Such personal examples peppered the forum, turning abstract issues into real and moving stories.

When we think of the people, places, and organizations seniors interact with, many opportunities come to light. One senior featured in the video had lost his leg to amputation due to diabetes. After being fitted with a prosthetic, he still found it tiring to navigate his neighborhood. He told the interviewers that he was truly glad to receive a motorized personal vehicle from a welfare organization. Some limitations remain. Narrow corridors and places without ramps are inaccessible to him. However, he is now able to take public trains and go shopping, everyday tasks that would have been nearly impossible before. The motorized vehicle has improved his quality of life. In this case, an organization found a solution that has allowed this senior to engage more with the people and places around him.

A motorized personal transport like the one pictured can help seniors unlock and explore more of their community and environment. (Photo: Free Images)

A motorized personal transport like the one pictured can help seniors unlock and explore more of their community and environment. (Photo: Free Images)

Engaging ethnography and design thinking for the elderly may seem unconventional. But some researchers acknowledge the benefit of taking into account social and environmental aspects of aging. A recent BMJ article reviewed existing ideas and concepts of Successful aging refers here to physical, mental, and social wellbeing in older age. The authors found that traditional conceptions of successful aging focused largely on individual bodily health. For example, the Activities of Daily Living scale tests a senior’s ability to complete a basket of self care tasks. These tasks include feeding, toileting, and grooming.

The authors found in their review that psychosocial and external factors are important to successful aging too. Yet, the authors found that these factors are underrepresented in traditional models of successful aging. For example, the Activities of Daily Living scale does not measure social activities such as holding a conversation or enjoying a sport outdoors. The authors wrote, “[Successful aging] is clearly not simply a physiological construct, so it seems intuitive that psychosocial components should be included in otherwise biomedical models of [successful aging].” The authors concluded that conventional models for aging can benefit from including social and external components of seniors’ lives.

Design thinking and ethnography can be applied at all levels of the ecosystem surrounding seniors. Consider seniors, the people they interact with, the people and places they engage with, and the organizations that help support them. Imagine a senior living out a typical day in this environment. What gaps and opportunities do you see? Are there any potential collaborations between organizations? We feel these added perspectives will help craft more targeted, efficient products and solutions to help seniors.

Taking a Cue from Lee Kuan Yew on Aging Well

Mr. Lee celebrating his seventy seventh birthday with his wife, Kwa Geok Choo, on September 16, 2000. (Photo: Edward Wray, Associated Press)

Mr. Lee celebrating his seventy seventh birthday with his wife, Kwa Geok Choo, on September 16, 2000. (Photo: Edward Wray, Associated Press)

Lee Kuan Yew, the founding prime minister of Singapore, passed away on Monday morning. As the first prime minister, Mr. Lee helped shape many policies in the formative years of independence. As the Singapore population matured, aging became an issue of concern for Mr. Lee. He shared some personal views on aging at a forum in 2010, when he himself was close to ninety.

Mr. Lee said, “I think the most important single lesson I learned in life was that if you isolate yourself, you’re done for. The human being is a social animal – he needs stimuli, he needs to meet people, to catch up with the world.”

Mr. Lee also said, “You must have an interest in life… If you’re not interested in the world and the world is not interested in you, the biggest punishment a man can receive is total isolation in a dungeon, black and complete withdrawal of all stimuli, that’s real torture.”

Indeed, part of aging well is maintaining social support and engagement in activities. Population trends in Singapore indicate that, in the future, many more elderly will be single and living alone. We must create opportunities to help these elderly avoid isolation.

How can this be done? Many are thinking of solutions. The ACCESS Health Singapore team spoke to a professor in architecture. She explained to us that simply adding a small space to common corridors for residents to sit and mingle can draw them out of their flats. Eventually, she said, the residents may venture down their blocks and into the community.

There must be other ways to help our elderly age well. People from all sectors are thinking of novel ways to make a difference in the Singapore silver industry, a promising development. Mr. Lee’s advice was for individuals to take an interest in the world and to avoid isolation. How we can help is to think of creative ways to encourage these individuals to do so.

Perhaps then we can live out Mr. Lee’s wish, “Have a purpose driven life and finish well, my friends.”

How Singapore is preparing for future elderly care

Affordable Excellence

William A Haseltine, President of ACCESS Health International, has written a book called “Affordable Excellence: The Singapore Healthcare Story. How to build and Maintain Sustainable Healthcare Systems”. For anybody interested in policymaking regarding elderly care, the last chapter about how Singapore is planning for the future, is of particular interest and well worth reading. This chapter explains why it makes sense for other countries to watch and study what Singapore is doing to prepare for a major increase of elderly in the population. The chapter gives an understanding of the demographic challenges that Singapore is facing and goes through all major initiatives that are undertaken to address these challenges, both public and private.
The book is published by the Brookings Institution and National University of Singapore Press and can be downloaded at no charge from the ACCESS Health website and from Amazon as an e-book, also at no charge.
Source:Affordable excellence : the Singapore healthcare story : how to create and manage sustainable healthcare systems / William A. Haseltine. – Singapore : Ridge Books, c2013.

Senior-friendly Smartphones

In the case of increasing life expectancy and low fertility rates, the percentage of elderly in Singapore is on a rise. The percentage of elderly aged 65 and above increased from 7.3% in 2000 to 9.3% in 2011.

This percentage is expected to rise up to 18.7% by 2030. This shows that the percentage of elderly in Singapore has been and will be increasing drastically over the years. Indeed, the ‘silver tsunami’ is approaching Singapore.

With the growing concern for the elderly, ideas and innovations are constantly tapped into to find new ways to counter the problems the elderly faces.One such take was by a Singapore-based sustainable business incubator, Silverline — which has decided to take on an initiative with SingTel. While several elderly are unable to afford to buy and use smartphones due to the price and perhaps not being IT-savvy enough, Silverline has offered an ingenious way which can kill two birds with one stone. One, it solves the problem the elderly faces. Two, it also reduces e-waste, which is an environmental problem.

 “The mobile phone industry works by enticing customers to swap their old phones for new ones in just a year or two. That is a tremendous waste. Electronic devices can leak toxic chemicals once they are disposed of.” – Silverline

Sliverline saw an opportunity in these wastes and decided to turn it into their advantage to them. By introducing a new policy, SingTel customers who are renewing their contract and purchasing a new smartphone with SingTel will be offered the option of gifting their old devices to a senior citizen. In this way, both parties are able to gain something out of it. When the user decides to get the newest model, his/her older phone still can come into good use and benefit the society (in this case, the elderly) and also the environment (in this case, decreasing e-waste).

By collaborating with SingTel, the user also gets to enjoy the benefits such as having a cut in their monthly bills.

Therefore and however, these smartphones that the elderly can expect are not just any ordinary smartphones. They are refurbished second-hand devices that come along with senior-friendly apps installed.

An example of such an application is Connect, which presents the contact list in a visual format to aid the visually impaired.  Another senior-friendly application, Well Being, provides reminders for taking medicine, drinking water, and doing exercise.

These are just some of the apps that are available out of several others, which can be found here.

Furthermore, if a user decides to nominate a senior citizen they know (normally it would be their parents), a refurbished smartphone by Silverline will be provided on the spot — with the addition of a mobile plan being fee for the senior citizen and will be added to the customer’s existing monthly mobile bills. This in turn for the business parties involved will create a new market.

The solution also poses some challenges to be overcome. Even though social workers are available to help out the elderly in using the smartphones, it will still take time for the elderly to get used to it.

Here is a video on how one of the many elderly is being impacted.

http://www.youtube.com/watch?v=9ug8wSAGfSU&feature=player_embedded

We believe that this project is the start of a neat solution socially, environmentally and economically.

Sources and references:

1)    http://www.singstat.gov.sg/stats/themes/people/popinbrief2011.pdf

2)    http://sgentrepreneurs.com/2012/10/15/with-its-senior-friendly-smartphones-newton-circus-silverline-hopes-to-reduce-digital-divide-save-environment/

3)    http://silverline.mobi/

4)    http://www.intmath.com/blog/singapores-population-bubble/808

5)    http://www.youtube.com/watch?v=9ug8wSAGfSU&feature=player_embedded

Palliative Care in Singapore

According to the WHO definition of Palliative Care:  “Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” (WHO Definition of Palliative Care[1]).

In Singapore, palliative care started as a grassroots movement in the mid-1980s to meet the needs of patients dying of cancer at home. The first home care team worked out of a university lecturer’s apartment in Gillman Heights. No doctors were trained in palliative care and there were limitations on the kind of care and setting where care could be provided.

Things changed a few years later. Singapore saw its first doctor trained in palliative care in the late 1980s. The first palliative care home provider – the Hospice Care Group – was formed in 1987. In 1988 Assisi Home and Hospice was established. This was followed by Agape Home and Hospice and the Hospice Care Association in 1989, Dover Park Hospice in 1995, Metta Hospice Care in 2001 and the palliative arm of Bright Vision Hospital in 2002. In 2007, the Lien Centre for Palliative Care was established to promote research and education in palliative care in Singapore and the region.  Since 1996, the restructured hospitals have also been building up expertise to support palliative care for their patients.

Palliative care has now advanced to the point that it can help manage and stabilise patients’ symptoms, and reduce their suffering. Due to greater and more structured training opportunities for healthcare professionals (palliative care is a subspecialty of medicine now), and a steady expansion of palliative care services, even treatments such as blood transfusions and intravenous infusion can be provided to patients in hospice care.

Palliative care is primarily provided by hospices (at an inpatient, home, or day-care setting).  There are four palliative care providers that offer inpatient hospice care, six providers that offer home hospice care and two that offer day hospice care.

Many restructured hospitals, as well as some community hospitals and nursing homes have also developed palliative care services, including  to meet the needs of certain specialty groups, such as children (for example, in KK Women’s and Children’s Hospital).  These services have largely evolved to meet the needs of patients admitted; the provision of palliative care services is not the main function of these institutions.

Palliative care is financed primarily by government subsidies and charity dollars.  Most home hospice services are free-of-charge for patients. Day hospice services, hospital-based services, and inpatient hospice services are offered at nominal fees, which can also be partly or fully waived depending on the patient’s financial ability.

Palliative care education is provided by a variety of organisations and institutions. For doctors, palliative care is part of the undergraduate medical curriculum. Subspecialty training is also available for some residency programmes. Palliative care is also incorporated in the formal generalist nursing curriculum for nurses and there are options for them to obtain an advance diploma in palliative care at the polytechnics. A number of different training programmes/certificates on palliative medicine/care are also run by different organisations for all health professionals (doctors, nurses, pharmacists, social workers and other health allied workers).

Public awareness and understanding of palliative care is still quite low. Many people still associate palliative care with giving up hope and treatment. The Singapore Hospice Council recently launched a new community outreach program to increase public awareness of inpatient, home and day hospice services available for end-of-life patients here.

Healthcare providers’ willingness to discuss end-of-life care and dying is also low. Research suggests that, even in hospitals, there seems to be some unwillingness of both patients and healthcare staff to talk about the potential of death.  Since 2009, health professionals have started utilising Advanced Care Planning (ACP) as a tool to start having open discussions with dying patients and their families.  ACP is currently being piloted at a few restructured hospitals, nursing homes and other end-of-life programmes.

These changes as well as some others implemented suggest that although willingness to discuss death still remains low, there has been improvement over the last few years.

In late 2011, MOH commissioned the Lien Centre for Palliative Care at Duke-NUS Graduate Medical School to formulate a National Strategy for Palliative Care in consultation with key stakeholders in the healthcare system.  The report reaffirms the important role of palliative care in the health sector as well as the importance of delivering such care in a coordinated and affordable manner. The report lists ten strategic goals and associated recommendations that address the importance of supply-side interventions such as training and ensuring adequate capacity as well as demand-side interventions such as the need for greater awareness and research. It also calls for greater leadership and governance to guide the development of palliative care services in Singapore.[2]

MOH recently accepted the report on the national strategy for palliative care. Presently, the Government has committed to expand the workforce and hospice care services to make end-of-life care more accessible to patients by committing to:

  • Incorporate a greater degree of palliative care training into courses offered in universities, polytechnics and Institutes of Technical Education.
  • Expand public education drives and awareness of the services to the terminally ill.
  • Promote specialised research and improve understanding of palliative care, by learning and adapting models used abroad.
  • Set up an implementation taskforce to put the strategies set forth by the Report on the National Strategy for Palliative Care into action in a country-wide coordinated manner.
  • Ensure that palliative care remains a key part of each regional health system.

Singapore’s ageing population and the effect it will have on epidemiological trends (increased burden of non-communicable disease, frailty and dementia, etc) and the subsequent needs required of the health system (increased demand for preventive services, long-term and end-of-life care), coupled with trends of increasing affluence, demand for more choices and declines in informal care-giving structures, suggest that the case for a greater role for palliative care, to meet the needs of patients who will face terminal illnesses, is strong.

Thus, a National Strategy for Palliative Care is welcome. To fully develop, palliative care needs more measures to promote the awareness of palliative care options, ensure that there are an adequate number of skilled healthcare professionals in the sector, introduce standards of care
across providers and settings, improve the coordination of care and ensure that there is adequate capacity to meet the demands for its care.

A greater role of palliative care will help increase the options, visibility, medical and social support for people facing end-of-life and enable decision-making based on preferences. It also allows for a more efficient use of resources for the health system.

Sources

HLC 2012. Briefing: Palliative Care in Singapore, July 26, 2012 version. Healthcare Leadership College, MOHH Holdings, Inc., Singapore.

Lien Centre for Palliative Care, Duke-NUH Graduate Medical School “Report on the National Strategy for Palliative Care,” Submitted to the Ministry of Health, Singapore, 4 Oct 2011.

World Health Organization (WHO). WHO Definition of Palliative Care .Accessed April 27 2012