Lily Neo
Singapore
“Thank you, Mr Speaker. May I ask Minister for Health on MOH's capacity in coping with serious cases of COVID-19 in terms of adequacy in respirators and in our ICU beds. Am I correct to say that already half of NCID's ICUs are taken up? What will happen when it reaches its full capacity?”
“But even so, with the right measures of social and medical assistance in place to assist them with their daily living, they can still age gracefully in the comfort of their own homes.”
“Thank you, Mr Chairman. Yes, I will keep it short. Minister earlier said that MSF will proactively reach out to families in HDB rental homes to assist them, to possibly buy their own HDB flats. Many of these families lamented that they cannot afford it. How does the Minister plan to do it?”
“Thank you, Mr Chairman. May I ask the Minister whether there is a possibility of more widespread community spread of COVID-19? And will MOH be able to cope with this? And whether does our Government have more specific measures in place to cope with this scenario?”
“Thank you, Mr Chairman. Earlier in my speech, I asked whether there are assessments by HDB for applicants of Joint Singles Scheme (JSS) to ensure that they are free from mental illnesses and medical conditions before compelling them to stay together.”
“Many of them have lived in rental housing for more than six years and some more than 10 years. Thus, there are signs of entrenchment. What are the schemes in place and the success rate of such schemes, to assist them in looking for better options in their housing needs and to help them get out of their predicaments?”
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“Mr Speaker, two supplementary questions, please. May I ask the Minister whether SERS will be affected or delayed due to the announcement of VERS? Secondly, will the Government be burdened financially with this VERS programme?”
“I feel that MOH needs to develop homecare and community care, presently very scarce, as quickly as possible to cater for our fast escalating need to help severely disabled people remain in their own homes. The other options of long-term care, apart from homecare and community care, are care in nursing homes, community hospitals, as well as day-care and palliative care centres. While we address the financial issue of long-term care with the implementation of CareShield Life, it is vital to continue providing the infrastructure for long-term care for the severely disabled who need institutional care. Of course, daycare centres and nursing homes will have to be increased in number and in quality, and I hope that MOH will also provide humane palliative care with better support and services. Sir, I would like to conclude that severe disability very often results from complications of chronic diseases. Thus, as a strong advocate of preventive medicine myself, may I beseech MOH to endeavor fullest to assist Singaporeans to keep healthy and to prevent chronic diseases and to have good control of their chronic diseases, should they have them. Thus, will MOH consider incentives, for example, premium discount, tied to our insurance schemes, CareShield Life and MediShield Life, to nudge or motivate people to achieve better health and to keep chronic diseases at bay?”
“In 2020, the Government will take over the coverage, thus there is no risk for the private insurers for future claims. May I ask the Minister about the underwriting arrangements with private insurers and especially on the return amount of all the surplus premiums, including interest and investment income to MOH? There is a difference in premium payments between men and women with CareShield Life. While I can understand that women live longer, I feel that there can be better inclusiveness and fairness. My concern is that women may have lesser means to pay for premiums compared to men. Women are earning less due to family commitments and may have even lesser savings to spare with increasing age. I welcome the provision for people who are disabled at the age of 30 years to join and to receive payouts immediately after paying for one premium. This reflects the inclusive society that we aspire to build. But I am saddened that this idea of inclusive society does not extend to gender equity by requiring women to pay higher premiums for CareShield Life. I hope the Minister will reconsider on this one. Sir, those older Singaporeans, especially those above 67 years, will have to pay very high premiums for CareShield Life. Many will not be able to afford the premiums. What kind of assistance is available to assist those, not covered under CareShield Life, being struck with severe disability and have financial difficulty? May I also ask if the Interim Disability Assistance Programme for the Elderly (IDAPE) will still be available with the cessation of ElderShield in 2020? Sir, for many severely disabled individuals, they prefer to be cared for in the familiar comfort of their own homes and with their families.”
“The annual premium is around $206 million with opt-outs, while the payout amount is about $8.32 million. The number of claimants last year was in the region of 1,750. Considering the disability prevalence rate presently of about 5% for those 65 years and above, it means that there are already some 15,000 people requiring aged-care facility per year. Could the Minister give an explanation for the low number of claimants? Is the main reason being the three ADLs' eligibility as too onerous? Could it also be that the claiming process had been made difficult? Many people had lamented that they forgot to claim ElderShield. For those who tried to claim ElderShield, the process was daunting in filling up forms and looking for assessors. There are presently only 120 general practitioners (GPs) who are the certified assessors. I want to declare that I am not one of them. I am glad that under CareShield Life, there will be an increased pool of assessors to include occupational therapists, physiotherapists and nurses. May I ask MOH to ensure that the assessment process be simplified with consistency and conformity, so as to enable assessors to give equitable assessments to all patients? Assessors had given feedback that, presently, the grading levels for each ADL can be quite small and slight, making it hard to assess the patients. Other feedback includes requests for assessment forms to be made more user-friendly. Stroke patients are often struck with severe disability. Will it be onerous for such patients to claim for CareShield Life and how soon after being afflicted can such patients claim? It had been reported that private insurers collected some $2.6 billion in premiums for ElderShield and only about $133 million had been paid out in claims.”
“In the context of Singapore, with increasing smaller families and dual-income families, caring for the severely disabled family members at home is usually with the help of domestic helpers. The payout of $600 will be inadequate for this domestic help, let alone paying for other hefty expenses, such as medical equipment, higher medical costs, physiotherapy and so on. The latter are usually required by the severely disabled individuals. Whilst I understand that keeping the premium of the CareShield Life affordable is necessary, the adequacy and usefulness of CareShield Life are just as important. In this context, I feel that three out of six ADLs for payout are too onerous, two ADLs criteria would have been a better proposition. The reason is that those with just two ADLs alone, like inability to feed or to go to the toilet, will already need full-time assistance. Even the loss of just one ADL can already make significant impacts on one's life in mobility and in income. My concern is that with lesser CareShield Life, for those with two ADLs, their families may take the option of sending their dependent family members to community hospitals or letting them overstay in acute hospitals, resulting in higher burdens in the end for the families and for the Government. May I ask the Minister whether CareShield Life can allow the purchase of "riders" with higher premiums for those who want to have better peace of mind and opting for one or two ADLs instead of three ADLs? This is a better option than going to private insurers that will never be like the not-for-profit Government policy proclaimed for CareShield Life. Presently, ElderShield has a relatively low claims-to-premiums ratio outcome.”
“Mr Speaker, Sir, I stand to support the Motion raised by Minister for Health. Sir, ElderShield review is overdue and thus the newly enhanced scheme, now called CareShield Life, is indeed welcome. I feel that with CareShield Life in place, our Government has completed the provision of the basic safety net for long-term care for all Singaporeans, especially with regard to their healthcare. This is taken together with the implementation of MediShield Life, as well as with our existing MediSave and MediFund schemes. This will give many Singaporeans peace of mind on their healthcare and long-term care needs. I first spoke on ElderShield in May 2002, several months before its implementation. In fact, this is the 12th time I am speaking in this House on this topic. Before its implementation in 2002, I already raised the concern over its inadequacy in its payout of $300 and in its tenure of payment of five years. This payout was upgraded with another $400-version subsequently. Those individuals with three out of six ADLs, which are washing, dressing, feeding, going to toilet, walking and transferring, such as moving from a bed to chair and vice versa, are totally dependent on others for their daily living. In fact, Minister Gan Kim Yong himself asked in this House, in this Chamber in 2002, on the reasons for citizens opting out of ElderShield at the time, whether it was because of the $300 payout or because of the difficulty in qualifying for the payout with three ADLs. Today, I still want to raise the same concern that a $600 payout in the year 2020 will still be inadequate. Moreover, this amount will remain flat without adjustments to inflation after start of claim.”
“In many cases of abuse, the best way to end their plight is to remove the vulnerable from their homes and place them at designated facilities that can provide better support and care. May I ask MSF what are these places and whether we have such avenues and such facilities available before enacting this Bill. We have to make sure that the vulnerable are not worse off with our intervention. I also hope that MSF will ensure that the vulnerable adults at risk receive as much information on their alternate care and assistance available to them. The fear of the unknown, away from their familiar environment and the fear of losing whatever little care and support they are getting may prevent the vulnerable adults at risk from giving their consent for interventions involving removal and out-of-home placements. This is especially so for the seniors at risk. Under Part 2, clauses 5 and 6, this Bill empowers the Director or a protector to assess an individual or a vulnerable adult to be assessed by a qualified assessor. May I ask the Minister if the assessors can do both the physical health assessment, such as detecting malnutrition and body injuries, as well as mental assessments, to detect mental anguish, trauma and depression? Every assessment can only be complete with both physical and mental well-being taken together. Will these assessors be at hand on the enactment of this Bill? I hope that MSF will implement this Act thoroughly to ensure its success. Areas of priority are good publicity, getting the buy-in from the community and enough personnel that will carry out their duties diligently. The success of all these will save our vulnerable adults from unnecessary pain and suffering and this is only rightly so in our inclusive caring society.”
“Such relevant information includes poor hygiene, malnutrition, dehydration, physical injuries like bruises and fractures, unexpected injuries, mental trauma, depression as well as social isolation. The people in the community, the family and friends as well as the neighbours, and the frontline personnel, such as medical doctors, nurses and social workers, play an important role to ensure the success of this Bill when it is enacted. In our society, there is a strong disapproval of abuses, especially so on the vulnerable. I hope MSF will spare no effort in facilitating the community to play their part in our responsible and caring society. There is a need for easy one-stop reporting and good follow-up provided by MSF. The convenience of a designated 24-hour hotline to call for reporting on information will be useful. I hope that with this Act and the good execution efforts by MSF, we can prevent another case of Ms Annie Ee who died from the injury of frequent abuses over a long period. May I ask the Minister whether this Bill goes far enough in creating a criminal offence for the abuse or neglect of a vulnerable adult? Does this Bill send a strong signal to the perpetrators on their wrongdoings? Now that there is this Act, we need to have a deterrence to ensure that family members do not push their dependants away to MSF by causing neglect. Otherwise, perpetrators can walk away from their responsibilities, if they know that they can get away easily. Under Part 3, clause 19(1) and (2) of this Bill, the Minister is empowered, by notification in the Gazette, to designate any premises in Singapore as a place of temporary care and protection for the care of vulnerable adults from abuse, neglect or self-neglect. I welcome this.”
“There were also stories of unpaid borrowings by children, deceit in transferring of HDB ownership and so on. Thus, this Bill is not complete with the omission of the financial abuse issue. During one of my house visits, I saw one debilitated senior on her bed through her house gate. She was too weak to even sit up or talk to us. The home was in an unhygienic state. Her gate was locked by her only son when he left to work early in the morning and would only come back late at night. I considered it as a case of neglect, either due to circumstances or willfully. But the senior would not complain as she was too afraid to lose whatever she had left and had resigned to her fate. Thankfully, we managed to find her son and persuaded him to allow us to assist with his mother's daily needs and medical needs henceforth. I hope this Bill will enable individuals like this to be identified early and help rendered before it is too late. The role of the community is important to better protect the vulnerable adults. Extended families and neighbours are usually the first to know of the vulnerable adults at risk. Publicity and raising awareness on this topic and information on the kind of assistance available are thus very important. I welcome Part 4 of clause 23, which provides protection to whistleblowers for providing the information on abused or neglected cases. This clause protects whistleblowers from liabilities. This fact must be well publicised to encourage more people in the community to report. In publicity materials, tips on what to look out for will be useful to further raise the awareness.”
“Mr Deputy Speaker, Sir, I stand in support of the Vulnerable Adults Bill. I have always been concerned about the vulnerable adults and have, since 1999, raised the issue on better protection of our vulnerable adults and, especially the abused seniors. I have spoken about the predicament of vulnerable adults being abused and have beseeched our Government to better assist them at least nine times in this House. I am glad, indeed, that MSF will soon put into law to better safeguard the vulnerable adults. Over the years, during my speeches on this topic, I have raised the issues of neglect of the vulnerable, physical abuse resulting in injuries, emotional trauma, psychological anguish, deceit of funds and financial abuse. I am glad most of these are now covered in this Bill. However, this Bill does not cover financial abuse, as mentioned by other Parliamentarians earlier. We need to address financial abuse in these vulnerable adults. Let me elaborate. As mentioned by my Parliamentary colleague Mr Seah Kian Peng earlier, a 2014 study by Trans Safe Centre, a charity that specialises in tackling elder abuse, showed that about one in three involved a senior who had been financially abused. With each passing year, the growing numbers of seniors will reach 900,000 by 2030. Many of them would have some savings from their long working years and they may be subjected to financial abuse. This will be an increasing problem with time. I have heard residents and patients relating to me that they had to give in reluctantly to their difficult children who might be drug abusers, ex-convicts or gamblers when they demanded money from them. The seniors said they were afraid of their children; scared of their tantrums, tempers and abusive words if they did not give in.”
“May I ask the Minister whether there is a hydration protocol in place to prevent heatstroke before and during exercises for our soldiers? What is this protocol and is it sufficient to prevent heatstroke? I would also want to ask whether the thermometer that CFC Dave Lee was using was in good order.”
“Mr Chairman, Sir, my cut on breast cancer has not been answered.”
“It was just as well that I continued manually writing and recording on the usual hard copies whilst I entered electronically entailing double work. There is also another concern of late, that of cyber security. NEHR also needs getting accustomed to, even if the staff and nurses are IT-savvy, thus they have to be retrained, entailing expenses on the adoption of NEHR. When MOH rolls out NEHR more widely, I hope the above challenges can be addressed to ease its adoption. There will be patients who prefer to opt-out from NEHR record sharing for various personal reasons. I hope MOH will give flexibility of choice that includes opt-out options to those who request. 6.15 pm Tobacco Control”
“Sir, I wish to declare that I am a general practitioner. MOH has previously indicated its intention to repeal the Private Hospitals Medical Clinics Act (PHMCA) enacted in 1980. In view of the fast-changing medical and IT development, the intention on repealing it is timely, to align MOH's priority and better safeguard patients' interests. Embracing IT is necessary for the provision of medical care at a higher level of proficiency and efficiency. Having this new Bill will also improve governance of healthcare providers and ensure continuity of care and accountability. I hope MOH will be thorough and will not leave out any inadequacy of governance to tackle unfavourable healthcare practices that have no recourse with the present Act. This will ensure that the new Bill will be relevant and encompassing. MOH has sought public feedback on the draft Healthcare Services Bill earlier this year. I would like to seek an update from the Ministry on the feedback given, and the progress of the Bill, including the provisions to contribute to the National Electronic Health Records (NEHR). I favour the NEHR system because health records follow the patients. This means convenience for patients and accuracy of medical information, without them having to repeat their medical histories and medications at every visit to a clinic. This is especially important in emergency settings when patients cannot relate. I want to share the challenges I face when I adopted a clinic IT system that contributes to NEHR in my clinic last year. My very first concern was what happens if the IT system should suddenly fail, a possibility from any computer or IT glitches? I stand to lose all the medical records of my patients. The system did fail; true enough.”
“Sir, breast cancer was the top killer of women cancer sufferers in Singapore from 2011 to 2015. The Breast Cancer Foundation conducted a nationwide survey last year and found that more than half of the 1,005 women aged 15 and above who were surveyed had limited knowledge of breast cancer. Only 45% of the women did self-examination as well as went for medical check-ups. Early detection of breast cancer in the early stages of the disease offers a higher chance of survival. This is because breast cancer is one of the easiest cancers to beat, if found early. May I ask MOH if there is an improvement in the early detection of breast cancer since the start of national screening in 2002, and have we achieved better outcomes on the prognosis of breast cancer in the past 10 years with better treatment? In order to further improve the early diagnosis of breast cancer, could MOH please enhance our national screening programme? And how can MOH raise public awareness of breast cancer further? Giving Babies a Chance at Life”
“I hope that such models of care can be expanded quickly as we are fighting a tide of the increasing numbers of seniors who can benefit from such holistic care services. There are health and social benefits in volunteering. It offers seniors significant physical, emotional and cognitive health benefits. Could MOH promote volunteerism in seniors? Could MOH provide a broader spectrum on the types of volunteering to attract more seniors? Can these seniors be reimbursed for volunteerism similar to the Pioneer Generation (PG) ambassadors? I hope MOH will spare no effort in ensuring this new initiative takes off well, to enable seniors to stay healthier and happier and age more gracefully in place, living with their loved ones in their own homes, and in their familiar environment in the community.”
“Community Aged Care Services will require many social and medical personnel, especially for seniors who are house-bound with partial or full disability. I hope MOH will spare no effort to provide these personnel as it will determine the outcome of these services. Could MOH train healthcare workers and consider using not only full-time paid personnel but also family members, community volunteers and so on? Healthcare aides can be trained for specific skills, like simple dressing of wounds, simple grooming, toe-nail cutting for non-diabetics using sterile techniques, assisting with feeding, catheter care, prosthesis use and so on. This will free up medical staff like the nurses. I am also happy that AIC will act as the single agency on delivery of holistic aged care services to seniors across both the health and social domains. Many seniors living alone with medical conditions and mobility problems can be managed at home with these holistic services. Like the one at Chin Swee, AIC assists with the nurses and healthcare aide team that look into the needs of the seniors daily in supervising their medical conditions and daily living essentials. A team of one nurse and five foreign healthcare aides, together with SAC staff and grassroots volunteers, can look after a few hundred residents. This has enabled residents to have lesser frequency of hospital visits and enabled them to stay in their own homes despite their illnesses and immobility. With AIC under MOH being the agency in charge of SACs, I feel that we can achieve better preventive healthcare, meaning early detection and treatment with better follow-up of patients to achieve good outcomes in preventing irreversible medical conditions that result in permanent impairment in health and mobility.”
“Sir, I am happy that MOH will take on policy ownership for the spate of aged care services across both the health and social domains from April this year. This will enable the long-term needs of our seniors to be catered more comprehensively. As I have said in my Budget speech, I hope MOH will spell its objectives clearly for a good outcome. The operation details will need a lot of consideration and supervision. It will need the considered effort of Senior Activity Centres (SACs), stakeholders and staff to come on board with a shared mission. Some centres may have become entrenched in their own ways of operation and MOH may face and need to address some resistance to change. Will MOH adopt the concept of physical, mental and social well-being for the seniors in the Senior Cluster Network (SCN) so that these seniors can stay active and healthy through having daily balanced nutrition, physical activity and cognitive stimulation? 4.45 pm Thus, daily meals and activity programmes must be provided with an aim in mind, that is, to assist these seniors remain in the community and ward off frailty, diseases and immobility. May I ask MOH what kind of emphasis will be placed on these aged-care services? How many administrative staff and medical staff will be deployed to manage the present SCN? Are there enough personnel to take over the transfer from this April? Is MOH poised to train present and future personnel to provide for these aged care services? Will MOH be planning to provide SCN centres in more constituencies? Will MOH consider setting up SACs for every cluster precinct of 1- to 2-room flats as surveys have found that seniors who live in this type of housing tend to be more frail?”
“I would like to seek a clarification from the Minister. Now that MSF is playing a much larger role in funding services and programmes, how does MSF also ensure that it does not erode the role of the community in giving them the space to continue to provide resources for the less fortunate?”
“Could MSF intervene in such cases and recommend for these individuals to rent HDB flats on their own, following psychological assessments? Many homeless people do not like the shelter homes, such as Pelangi Shelter, as they prefer to have freedom to move about. Can MSF provide a better concept for shelter homes catering to the homeless group, giving them the flexibility of going out and about, staying in touch with their friends in the community and continuing to work whilst residing in a shelter home? Youths in Criminal Justice System”
“Sir, may I ask MSF how many people sleep on the streets in the past year? Is the number for homelessness getting bigger over the years? Does MSF monitor the reasons for those who sleep on the streets? Is there any ongoing outreach to them island-wide in order to understand their problems? How can MSF help this group better? Could MSF follow up individually and provide long-term solutions? Many of them may have a variety of problems, such as family feuds, HDB housing issues, mental issues, employment and financial issues. These issues will need close follow-up with various Ministries and assistance rendered to achieve permanent solutions. Unless we provide such assistance, it is going to be an unending problem. It is futile trying to discourage them sleeping on the streets by chasing them away as they will just go sleep at another location. I have had residents sleeping in Chinatown staircases or plastic chairs due to frequent quarrelling with co-tenants in HDB rental flats due to incompatibility of personality and character. Our housing policy requires two individuals to share HDB rental homes. This can create a lot of problems, especially for those having to stay with strangers because they do not have family members to rent with. This is especially so for many seniors who have difficulty adjusting due to their seniority. There are some individuals who just cannot live with strangers despite many transfers of HDB rental homes. Apart from sleeping on the streets, MSF may also encounter them coming for ComCare as they cannot continue working, because they cannot sleep at night or they face daily living issues due to unreasonable co-lessees, according to them.”
“The objective is to encourage Singaporeans to be caring towards others, especially towards the less well-off in our society. It is also to encourage Singaporeans to have a volunteering culture where people readily give assistance to the vulnerable, needy, seniors and the less advantaged families. It will be good if we can also promote graciousness in the society where Singaporeans are considerate and caring to families, friends and neighbours in our everyday life. On SG Cares, will MSF facilitate having a register of the disadvantaged families, vulnerable children and needy adults? This register will help them better by providing a convenient one-stop matching service of available volunteers to the recipients by enabling appropriate needs to be dispensed and without duplication of services. I believe MSF is the right Ministry to collate all those in need as MSF receives many requests for assistance from residents. MSF may need to do a last-mile approach here with staff putting in more efforts to rigorously find out the relevant needs of those in difficulty. Such a detailed register will enable urgent cases to be detected and attended to more promptly. Good capture of information and data can help those in need efficiently and in a targeted way to achieve better outcomes. It will be good to have follow-up on cases which are assisted to ensure continuity. It will also be good for MSF to allow sharing of this data with other Ministries for cross-referrals and coordination in providing assistance.”
“Sir, in order to support our seniors in the community, will the Ministry of Health (MOH) place the Community Network for Seniors (CNS) programme under the purview of senior cluster networks where there are such centres like the Senior Activity Centres (SACs)? This will provide a one-stop centre for a targeted approach in care and also to prevent duplication of effort to achieve the best outcome. Getting the involvement of grassroots volunteers, VWOs and befrienders will add value to SACs. The volunteers from CNS can be channelled as befrienders to assist in the social aspects of the seniors in need and especially those staying alone at home. Volunteers can also supervise medicine taking, deliver food, escort seniors to hospitals or clean their homes and so on. Pioneer Generation Office (PGO) will be renamed Silver Generation Office (SGO) and reach out to new cohorts of seniors aged 65 and above. SGO will be housed in the Agency for Integrated Care (AIC). This would be useful for better coverage of our seniors to ensure that no one who needs care is left out. I hope AIC can help to have a register of seniors in need and the types of assistance they require so that appropriate assistance can be provided for a better matching of volunteers to provide relevant assistance. The SGO can also act as the liaison agency to refer all mobile seniors to join the nearest SAC for physical, mental and social well-being. SGO can also pick up cases that need medical care or follow-up to AIC. SG "WE CARE" Campaign Sir, in conjunction with the launch of SG Cares, I would like to suggest that MSF move a national campaign calling it "WE CARE" campaign, like the courtesy campaign some years back.”
“Sir, can I take my two cuts together, please?”
“Just giving them ComCare financial assistance will not be able to achieve this aim. Their needs have to be looked into holistically in order to lift up the family as a whole. Therefore, equipping parents with skills and finding them employment or assisting their spouses to move away from prejudices and mental barriers to employment can be useful. Their housing needs may need urgent fixing. Their children should be assisted in terms of well-being, health and education. Most social workers and MSF staff are required to undertake such a hands-on personalised approach to solve the various needs of each family by going the last mile in outreach and care. MSF will need to liaise with various Ministries and other relevant agencies and VWOs to give permanent solutions. Most times, many of their issues cannot be solved overnight. So, these families have to be assisted with continuing follow-up. Only with such last-mile approach can the needy families achieve sustained and long-term benefits. We need to adopt this policy urgently to lift this group so that the following generations will not be in the same predicaments as their parents. In other words, let us give them a better chance of climbing the social ladder. Extra effort and last-mile approach must be put in to solve their difficulties. By looking for the root causes of their predicament and working out the long-term solutions with the families, may I request MSF to prioritise assisting the most urgent cases quickly by having a register with data about them? With better use of information technology (IT), MSF can have faster and better targeted assistance and better follow-up for long-term solutions. Integrating Health Care and Social Care”
“Mr Chairman, Sir, SSO has been doing a good job assisting residents in need. It gives better accessibility and faster delivery of assistance to many residents. May I ask MSF whether SSO will be finetuned further to serve residents even better? What kind of achievements has been attained by SSO since its inception in helping families in need? How many households has SSO helped thus far? Is there a key performance indicator (KPI) to measure its outreach and effectiveness? How has SSO been collaborating with other Ministries, agencies and the community partners for a concerted effort in tapping resources to assist such families? Could MSF expand assistance to give permanent solutions to families in need by providing last-mile outreach and care? I beseech MSF to spare no effort in assisting our less advantaged families, especially those with children. These families need the concerted efforts of MSF to get out of their predicaments and have a more level playing field for their children. I have raised this issue and the provision of holistic care for these less advantaged families in this House repeatedly in the past and I seek your indulgence for repeating it again today. Could MSF take a holistic approach in helping these families? Most of the time, these families have a slew of needs, as in housing, income, care for children or care for sick family members and so on. They are usually families with low skills, low paying jobs and some are single-income families. There is thus an urgency to assist this group of needy Singaporeans with more lasting solutions. While they need immediate cash assistance to tide them over, it is more important that they acquire long-term capabilities so that they are able to sustain themselves.”
“Ageing Gracefully@Home (AGH) is a grassroots initiative of Kreta Ayer-Kim Seng Constituency that is intended to benefit weak seniors living alone in HDB rental flats in Chin Swee, Kreta Ayer and Jalan Kukoh precincts. It is a holistic care programme for seniors who are staying alone and are unable to take care of themselves. AGH provides, where required, one or more of the following services: daily meals, daily supervision, including daily home visits, befriender services, blood pressure checks, medicine intake checks, home counselling, nursing and homecare, transportation to and from hospital and physical improvements in the home. We paired an active elderly, or AGH Befriender, with a frail or immobile one, or AGH Beneficiary, so that the Befriender will visit and socialise with his or her Beneficiary each day. We also have a team of full-time healthcare aides and nurses to look after these residents. This programme enables seniors, who would otherwise be hospitalised or be given some institutional care, to remain in their own homes. This programme makes seniors happy with graceful ageing in place. I hope AIC will be duplicating this at other precincts, especially those with 1- or 2-room flats. In conclusion, Sir, let us make Singapore the best place for all our seniors to live in their silver years.”
“He lived alone. Social help was arranged for his daily living and food was sent to him daily. A physiotherapist visited regularly for his rehabilitation. Within six months, from being immobile, he could slowly walk again. Today, 10 years later, after his stroke, he is attending his SAC and other events organised by the Kreta Ayer-Kim Seng grassroots. My appreciation to all my Kreta Ayer-Kim Seng grassroots volunteers here. Best of all, Mr Tan could continue to live independently by himself, albeit walking with a limp from the stroke episode. I attribute his achieving partial recovery and independence to the appropriate assistance and support given to him at the very early stage of his illness. I have other stories similar to Mr Tan’s but, due to time constraint, I can only mention just this one. With AIC under MOH being the agency in charge of SACs, seniors like Mr Tan can be referred quickly from the SACs for the assistance required to achieve better outcomes. This is vital to prevent irreversible conditions resulting in permanent immobility. Our ageing demographic profile will increase the number of seniors who require assistance in their own homes. This is inevitable, especially in precincts with many seniors, such as Chin Swee precinct. Over the years, many more residents have become “housebound” due to medical conditions and chronic diseases like diabetes and hypertension. Thus, the need for homecare that enables these seniors to remain in their homes. Mr Heng Swee Keat launched Ageing Gracefully@Home (AGH) programme at Chin Swee in 2014 − I notice that the Finance Minister is nodding, that means you remember, thank you − with Temasek Care supporting it for three years and AIC since then. I want to register my thanks to both Temasek Care and AIC here.”
“Occasionally, sprucing up or eradicating bed bugs from their homes by volunteers can help in home-care. I am very glad that the Finance Minister has mentioned setting up Community Networks for Seniors (CNS) programmes nationwide by 2020. CNS was piloted in 2016 with the aim of connecting different stakeholders in a community to jointly engage and support our seniors. SACs are the choice centres for coordinating befrienders with the seniors and will be a one-stop centre for a targeted approach, preventing duplication for the best outcome. I hope to see MOH expanding preventive healthcare and community care by setting up more SACs islandwide, especially at 1- or 2-room housing precincts. The Minister for Finance also said that the Agency for Integrated Care (AIC) will be the central implementation agency to reach out to seniors and their caregivers as well as coordinate the social and health-related services to them. Aged-care providers can now work with AIC as the single agency on the delivery of holistic aged-care services to seniors across both the health and social domains. Sir, this is, indeed, a welcome boon for holistic care services and will enable many, who may otherwise need institutional care, to remain in their own homes for as long as possible, even despite illnesses or mobility difficulties. Let me elaborate. Preventive healthcare means to prevent getting diseases or disability. Preventive healthcare also means a better chance of partial or even full recovery if treatment is provided quickly should one get sick. Mr Tan, not his real name, is aged 88 and a member of Chin Swee SAC. He suddenly stopped turning up and was missed at the centre some 10 years ago. On visiting him, he was found to have suffered a stroke. He was in bed and could not walk.”
“Now that MOH will be taking ownership of the Senior Cluster Network (SCN), I hope MOH will promote this concept of promoting physical, mental and social well-being of our seniors and keeping them healthy, active and happy. This will need the concerted efforts of SCN staff and stakeholders coming on board with a shared mission. Execution of the programmes daily can run into many challenges as seniors may have their own preferences. For instance, one of our difficulties in our SACs is to get our seniors to do more exercises daily. They prefer more sedentary and fun activities. Some just want to only pick and choose the subsidised daily meals and outings, but are reluctant to participate in daily exercises. Hence, SAC staff must adhere to the concept of physical, mental and social well-being through coupling the exercise programmes with meals, outings and fun activities to achieve this mission. Incentives had to be introduced over the years to cajole more to take part in the daily exercises. Activity, especially in exercise, is much reduced after retirement for many seniors to the detriment of their well-being. Getting the involvement of grassroots, VWOs, volunteers and befrienders will add value to the SCNs. Community involvement, especially grassroots assistance, will add a human touch and care to the seniors, especially those in need. Taking them to festive activities organised by grassroots organisations can bring cheer to many, especially those living alone. Visiting them, especially by familiar grassroots leaders or befrienders, at their homes when they fail to show up at the centres and giving them medical or social assistance quickly if they are ill are very useful.”
“Assoc Prof Ng Tze Pin, who led the studies, said, "Frailty is not an inevitable part of ageing and, with the right intervention, we can reduce the number of elderly who need to seek treatment for this syndrome". The SLAS, which was conducted from 2010 to 2013 and was first published in 2015 in the American Journal of Medicine, determined that a healthy diet for seniors is one that has sufficient calories and protein. Assoc Prof Ng Tze Pin explained that, with old age, the body becomes less effective in converting amino acids into muscle, causing the seniors to be more susceptible to muscle degeneration. One way to slow down this degeneration would be to consume enough protein. Through my observations over the years, I noted many of our seniors do not consume enough protein. One of the reasons is that protein is more costly. This nutritional deficit is even more pronounced with those seniors living in 1- or 2-room rental flats. SLAS followed 3,000 Singaporean residents aged 55 and above and found that older adults from lower-income groups, who are single and have no formal education, tend to suffer from physical frailty. And 41.1% of the frail subjects lived in 1- or 2-room public housing. In contrast, 16.7% of the robust ones were living in other housing types. Since Kreta Ayer-Kim Seng SACs have been catering to seniors living alone in the 1- or 2-room rental flats all these years, it will be interesting to find out the incidence of frailty for the seniors living at Indus, Chin Swee and Kreta Ayer precincts. Perhaps, Prof Ng can be persuaded to send his team there for a comparison study.”
“Three more SACs, run by grassroots leaders using the same concept, were added over the years at different precincts of our constituency. I have always been an advocate of preventive healthcare because I am a medical doctor. Hence, we have applied this concept at our SACs from the very beginning and have practised it till today. The concept of physical, mental and social well-being is to facilitate our seniors to stay healthy through having daily balanced nutrition, getting physical activity and receiving cognitive stimulation. So, daily meals and programmes are provided with this aim in mind. Balanced nutrition wards off diseases. Physical exercise keeps the bones and muscles strong to minimise falls and fractures and to facilitate good mobility and independence. Social and mental well-being prevents isolation and depression. Together, all these will enable mobile seniors to be active, healthy and happy and to remain in the community by warding off frailty and dependency. Sir, whilst growing in age is a norm, becoming frail with age is not necessarily so. Frailty is a geriatric syndrome where organ function drops below a healthy level. When key organs, such as the heart, kidneys, lungs, muscles and brains, start to function below optimal levels, there will be reduced resistance to diseases, with increased incidence of incapacity and dependency. The Singapore Longitudinal Ageing Studies (SLAS) by NUS examined 250 seniors above 65. Those who adopted a regimen of good nutrition, physical activity and cognitive stimulation were less frail than those who did not. In mild cases, their frailty could even be reversed. Those who fulfilled only one factor, such as eating well but not exercising regularly, did not fare as well as those who managed all three.”
“Mr Deputy Speaker, Sir, I stand in support of the Motion raised by Finance Minister, Mr Heng Swee Keat. Today, I would like to speak on the Finance Minister’s announcements on the overall national effort to better support our ageing population. MOH will take on policy ownership of the spectrum of aged-care services across both the health and social domains from April this year. I agree with this new approach, provided the agendas and the targeted outcomes are spelt out clearly from the beginning and the execution details are adhered to in order to achieve the desired aim. I shall elaborate. I would like to request the relevant Ministries to use this new approach to enable our seniors to have healthier and happier lives. Lives where seniors, with increasing years, can still enjoy active, healthy and fulfilling days, live in their own homes and environment within the community and have little or no dependence on institutional care. Many seniors prefer such independent living with their loved ones and friends in the community. This is achievable by advocating preventive healthcare. The ideal outcome will be a happy populace living well and gracefully. I want to share my observations and experience in such care. MSF will transfer its functions under the Senior Cluster Network (SCN), which include the policies and planning of Senior Activity Centres (SACs), Cluster Support and Caring Assistance from Neighbours (CAN), Carers and other programmes, such as befriending services, to MOH. In Kreta Ayer-Kim Seng (KAKS) constituency my grassroots leaders and I started Senior Activity Centres with the concept of promoting physical, mental and social well-being of our residents. The first one was started 20 years ago with the help of Thye Hua Kwan Moral Care.”
“Let us continue to aim for a community that is inclusive of everyone, including especially our seniors. Let our seniors be welcomed by society, businesses and community alike. Let our seniors be respected, not patronised, and let the wealth of knowledge and experience they have to offer be valued. I hope our Government will consider my suggestions above and implement measures towards achieving an even better society for all.”
“Seniors-friendly adaptations in design inside HDB flats will enable many to continue living independently despite disability. Common spaces with consideration for a micro-community with, for example, recreation and community areas to enable seniors to lend support to one another and to engage with one another will prevent social isolation. Support services within the same block or close vicinity that are useful are Seniors Activity Centres, clinics, minimarts and food outlets. There is an increasing recognition that new technologies can offer new ways of supporting people with medical illnesses and disabilities and facilitating them to continue living independently at home. They can play an important role in self-care and prevention of advancing disability. Telecare and telehealth services are also becoming increasingly recognised as effective ways to prevent or manage some health conditions that effectively facilitate independent living. Mobility. Researches have shown that roles that require physical activity engage the brain and provide social interaction that are especially good for individuals because multiple area stimulation appears to reduce the risk of dementia and promote brain health. Thus, enabling people, as they age, "to get out and about" through the provision of accessible, affordable and flexible transport systems is essential for ease in mobility. Mobility is a key determinant towards an individual’s ability to access social or physical services and to engage in community activities. Seniors who live in inaccessible environments are less likely to go outdoors and are, therefore, more prone to isolation, depression, reduced fitness and mobility problems. Thus, let us continue to enhance a seniors-friendly public transport system.”
“Social isolation may contribute to depression, grief, stress, anxiety, alcoholism and medication misuse, failure to seek help when needed, and an extremely high suicide rate, particularly among older men. Independent living. In its submission to the Second World Assembly on Ageing 2002, the World Health Organisation observed that age-friendly built environments for people with disabilities facilitate access to the appropriate range of housing and housing-related support services that are delivered in an integrated and sustainable manner. This promotes equality of opportunity, individual choice and independent living. These can make a difference between independency and dependency for all individuals and is particularly important for those growing older. For instance, older people who live in an unsafe environment or areas with multiple physical barriers are less likely to venture out and are, therefore, more prone to isolation, depression, reduced fitness and increased mobility problems. It will be good if HDB continues to promote and support universally recognised seniors-oriented housing designs and compositions that allow for an environment that may be easily accessed and used to the greatest possible extent by persons of any age or having any particular physical, sensory, medical ill-health or disability. We must try to design and develop seniors-friendly living spaces and buildings which are suitable for their physical and social needs. The priority of the Government's policy is to support seniors to live independently in their own homes and communities for as long as possible. Planning, designing and building local environments that are safe and accessible to seniors are, therefore, vital to supporting them to live in their own homes and local communities.”
“Good health is a prerequisite for anyone expecting an active and fulfilling life. Many chronic diseases are largely preventable. Chronic diseases, especially diabetes and hypertension, are considered one of the most significant health challenges in developed countries and represent a major component of service activity and expenditure, as well as a major contributor to disability, ill-health and mortality among the older population in these countries. Many of these are also key risk factors for the development of dementia. It has been reported that the cumulative lifetime disability for those who smoke, are obese and do not exercise is four times greater than those who are of a healthy weight, exercise and do not smoke. Traditionally, models of care have tended to focus on those with the most medical needs. I would like our Government to ensure subsequent future service provisions reverse this trend so that equal priority is accorded to both medical treatment and the promotion of health and well-being. Shifting the focus towards promotion of lifelong good health would lead to a significant increase not only in life expectancy but also in disability-free life expectancy. So, the emphasis of our healthcare policy should be to prevent and reduce disability and premature mortality by supporting the development and implementation of policies towards this aim. While there is evidence that it is difficult to change the behaviour patterns of seniors, research has also found that changes in lifestyle, even in later years, can bring health benefits. Research indicates that retirement tends to decrease the level of physical activity needed for a healthy lifestyle.”
“The National Environment Agency (NEA), Town Councils and Community Centres may recruit such volunteers and even for just one-day events. (g) Employer-supported volunteering, where corporations support the commitment of their employees for activities through “community day or days” each year. These can be further encouraged in quality and quantity and in having more businesses, especially small and medium enterprises (SMEs) involved. (h) Retired Employee volunteering programme, where workplaces that have alumni or retiree programmes can incorporate volunteer opportunities. Our Ministries can pilot such programmes where employees can continue as mentors, volunteering especially to ease the transition of new employees. It will be useful to have a volunteer centre with coordinators to offer programmes that appeal to different groups with different interests and to match and place the volunteering services with the community groups and organisations. This will provide a one-stop convenient avenue and will maximise outcome. Senior adults may experience challenges and barriers to volunteering in relation to transportation, scheduling issues and out-of-pocket expenses. I would like to suggest implementation of reimbursements for costs incurred, similar to that granted to the "Pioneer Generation (PG) Ambassadors” programme, so that volunteers are not overly burdened financially in the course of volunteering. Health. Health is defined as a state of complete physical, mental and social well-being, and not merely by the absence of disease and infirmity. Seniors considered the deterioration in their physical or mental health as the biggest threat to their well-being. As life expectancy increases, it becomes more important that the added years to life are accompanied by good health.”
“May I urge our Government to set up policies and programmes aimed at promoting volunteering among seniors and strengthening the capacity of organisations to involve seniors with a broader spectrum of engagements. Let us promote and provide avenues for volunteering as a meaningful occupation that provides direction as well as purpose and passion, just like the fulfilment that comes from meaningful paid work where individuals find fulfilment, meaning and personal identity. This form of volunteering can be viewed as "serious leisure", "career volunteering" or "career redirection". I would like to suggest the following areas to further broaden the spectrum of volunteering. (a) Retirement planning typically focuses on financial planning; modules on volunteering should be part of all Retirement Planning programmes. (b) Recreation can be made more meaningful with volunteering roles, such as being a swimming buddy with someone with a physical disability, being a singing coach in nursing homes, being a volunteer playing chess with youths in a drop-in centre and so on. (c) Lifelong learning volunteering is a way to transfer skills gained or to learn new skills, in this context, volunteering prepares one for a new career. (d) HDB and private condominium volunteering is a great way to get more connected to the neighbours, especially in door-to-door canvassing, in collecting information about their environment or in patrolling their estates. (e) Skills-based volunteering, where many adults who have indicated an interest in using their skills and experiences for volunteering is a good approach. (f) Environmental volunteering may be ideal for adults who are interested in environmental issues, collecting information about the environment.”
“These are all good recommendations and I hope that our Government can consider them and make them available soonest. Volunteerism. There are health and social benefits in volunteering. It offers seniors significant physical, emotional and cognitive or brain health benefits. It also enhances social support and social inclusion. The brain is involved in feeling as well as thinking, and this means that finding meaningful and purposeful activity is particularly important. This can be accomplished through volunteering by finding roles that are personally meaningful. Matching and placing volunteers in the best role for each individual is worth the effort. Many studies have found that engaging in voluntary work in later life is a strong predictor of better self-rated health, daily functioning, physical activity and life satisfaction. Voluntary work in later life is also associated with a decrease in depression, hypertension and mortality among seniors. In addition to health benefits, volunteering can enhance social support networks, increase social status and reinforce knowledge and skills. Volunteering also provides a role identity and sense of purpose for those retired from paid work. Seniors can better integrate socially when they find structures for volunteering. There is a need to increase awareness of opportunities and community needs and to facilitate opportunities for engagement. People are looking for a range of options where they can see the value and impact of their contributions in their community. More people are interested in group volunteering, short-term assignments, as well as virtual volunteering, and they view volunteering as a way of transferring or gaining skills. Some of our SkillsFuture Credit courses can be tailored for this purpose.”
“Active labour market participation may be enhanced by establishing flexible retirement arrangements: through forming a working environment that is suitable to the needs of all generations, continuous education, promoting positive images of senior employees and anti-discrimination policies, and recognising and lowering barriers of entry into the workforce so as to include the seniors in our economy. The barriers of entry would include stereo-mindset of employers, skills mismatch, lack of job flexibility, technological barrier and lack of incentives for businesses and so on. I agree with many parts of the 2016 blueprint report on Action Plan for Successful Ageing by the Ministry of Health (MOH), especially on employability with ageless workplaces and lifelong employability. In this report, it says that many seniors want to work beyond the official retirement age to remain financially independent and to keep themselves active. Seniors hope to have meaningful job opportunities to fulfil their aspirations at their stage of life. Suggestions from seniors and employers in this blueprint report include the following: redesign jobs to offer older workers greater flexibility, make training accessible and effective for older workers, set up a dedicated seniors-only national job bank to lifelong learning, review or extend the retirement age as some think it should be extended to 70 while some others feel it should be abolished entirely, provide good career guidance and transition programmes a few years ahead of the re-employment age, promote mindset change among employers on the value of older workers, allow older workers to try out jobs via internships or job trials, recognise employers who treat older workers well, and promote intergenerational workplace harmony.”
“As a start, we need to change the prevalent negative discriminatory attitudes towards our seniors as useless, as a ticking demographic time bomb and as a burden that society can ill-afford. Senior citizens should be viewed as assets who can be tapped on for their wisdom, experience, values and expertise. Labour market participation. There is evidence that longer working lives have beneficial effects on an individual’s physical and psychological well-being. Some evidence also show that a worker’s productivity does not necessarily decline with age; any decline in physical capacity is often compensated by qualities and skills acquired through experience. In essence, it is health status rather than age that is a key factor in determining productivity levels. The 2014 results from the Institute of Policy Studies (IPS) indicate a large proportion of Singaporean seniors have expressed interest to continue working after the age of retirement. Ninety percent of the respondents have indicated that working is a good way to stay financially independent, connect with society and retain their sense of self-worth. The latest report by Oxford Economics said that Singapore's labour supply will shrink by 1.7% in the 10 years through 2026, and by 2.5% in the following decade after accounting for changes to the participation rate. This will make the country the worst hit of a dozen economies in the report even though it was Japan that has recorded the biggest workforce decline over the past 10 years. Given our shrinking workforce, it will be good if we can increase the labour participation of seniors.”
“Mr Deputy Speaker, Sir, the title of my speech today is "Golden Opportunities in Silver Years". It is about a change of policies and communities willing to assist seniors live meaningfully and independently and be assets to society and country throughout their silver years. I would like to propose that we plan and maximise the potential of the silver population so that they can have better opportunities and, at the same time, allow society to reap the benefits of the Silver Dividend. The strategy is a call for affirmative concepts of people of all ages, a society for all ages that celebrates and prepares properly for the whole population so that everyone can be healthy, active, positive and productive individuals throughout life. Every citizen can contribute to the public good, helping themselves and others, as well as striving for positive fulfilment through meaningful engagement. In our population demography, there are many positive opportunities that we can tap on, from the large numbers of healthy and active seniors in our society, to be workers, mentors, caregivers, child minders, consumers and volunteers. To successfully manage the economics of our ageing population, we need good forward planning and strategic policy choices that have the cooperation from all sectors of our society. People are capable of living self-reliant lives with new possibilities that make living exciting and productive through the right policies in labour market participation, social inclusion as well as healthcare in place. We need policies that can enable and support all ages to enjoy physical, social and mental well-being.”
“May I ask the Minister how many cases of intellectually disabled people are under Public Assistance, presently? Am I not correct to say that there are about 4,800 Public Assistance recipients, which is about 0.1% of total resident population in Singapore? May I ask the Minister whether MSF can be more compassionate and relax that eligibility criteria for Public Assistance to cover those intellectually disabled people, especially those with no family support?”
“May I ask the Minister whether there is a register for intellectually disabled people, so that they can be followed up with and assistance given to them should they require it? May I also ask the Minister whether MSF could have prevented the unfortunate circumstances that caused the death of Ms Annie Ee? Could she have been put under Public Assistance scheme where she could have received more assistance and need not have to stay with the people who abused her?”
“While my Ministry will continue to enforce against any person who smokes in a smoking prohibited place, I would like to urge all smokers to be considerate when smoking in public places and to smoke only in permitted areas so as not to cause disamenities to others.”
“Question No 3. The Senior Minister of State for the Environment and Water Resources (Dr Amy Khor Lean Suan) (for the Minister for the Environment and Water Resources): My Ministry's long-term goal is to prohibit smoking in all public areas except at designated smoking areas. This is to protect non-smokers from the harmful health effects of second-hand tobacco smoke. The National Environment Agency (NEA) actively conducts inspections and patrols to ensure compliance with smoking prohibition regulations. Persons caught smoking in areas where smoking is prohibited, such as in shopping malls and food shops, are liable for a maximum fine of $1,000. In 2016, about 19,000 tickets were issued to smokers for smoking in prohibited areas, including more than 2,600 tickets issued to those found smoking in food establishments. As smoking is prohibited in more than 32,000 premises, it is not possible for NEA to watch over every location. It is also not possible for our officers to respond immediately to every report of smoking in a prohibited place before the smoker finishes his cigarette. The operators and managers of smoke-free premises, therefore, have a legal duty to stop patrons from smoking or to request patrons to leave the premises if they refuse to stop smoking. In cases where the patrons do not stop smoking or leave the premises, the operator or manager of the premises could seek assistance from NEA. In 2016, NEA took about 400 enforcement actions against the operators and managers of premises who had not fulfilled their duty under the law.”
“Madam, may I seek clarifications from Minister Gan on my suggestion earlier on SAFEcare based on smart technology and preventive medicine? Does he not agree that this concept fits into two out of three of MOH's shift plans? Does he not think this concept, in fact, will reduce our total dependence on nursing homes? Therefore, will he not endorse, especially to enable our seniors to age gracefully in their homes?”
“In fact, men here top the world in terms of the number of healthy years they live, according to the Lancet report. Could MOH step up the healthcare awareness and promotion for prevention of chronic diseases, osteoporosis, heart diseases and mental illnesses among women? May I ask for the work progress of the Women's Health Committee that was set up in 2012? Is there a target for achievement and what else can be done to get a better outcome to reduce problems faced by women in combating ill-health? Can there be a more ground-up approach that involves corporations and community groups to get better outreach to the wider audience? Caregivers of Mentally Disabled Persons”
“This will enable better planning, especially in the area of medical personnel, towards catering for these conditions. Do we have enough geriatricians, physiotherapists, community doctors and hospice-care doctors? We do need more community medical personnel that can visit patients in their homes in order to provide good homecare. We should train more medical workers using shorter course modules as in wound dressings, change of catheters or nasogastric tubes and so on. In England, medical workers are trained in just months to accomplish these tasks. Does MOH have enough dieticians to help in the fight against diabetes? Dieticians are also needed to advise all centres, especially the Seniors Activity Centres, that provide food for groups of people to ensure healthy diets. The use of medical technology to improve quality of living is the way forward. Does MOH have a designated team or department to look into the availability, applications and effectiveness of medical technological devices that can enable better healthcare monitoring, especially for elderly care, and test them on their effectiveness? Does MOH have collaborative partnerships with Institutes of Higher Learning (IHLs) to develop new technology, while researching and developing cost-effective systems that promote an age-friendly living environment in homes? According to the Global Burden of Disease 2015 published in the Lancet last year, women spend the last nine years of their lives in ill-health. In 2015, life expectancy for women here was 84.9 years and, for men, 80.4 years, making people here among the longest living in the world. But women spend 10.7% of their lives in ill-health, and men 9.4%.”