Considerations when choosing nursing home

The notion of sending one's elderly parents to a nursing home remains largely a taboo in Singapore.

Like many conservative Asian societies, many Singaporeans consider that the idea of putting one's parents in someone else's care conflicts with the child’s responsibility of filial piety. There is no doubt that we should always care for our parents; Afterall, there were the ones who supported us when we were most vulnerable and helpless when we were young. While the elderly need familial support the most at their old age, the reality is that some families may face financial difficulties in putting aside their full-time jobs to provide the necessary support for their loved ones and the option of hiring in-home caretaking services may also be too costly for them. In other cases, some children may need to travel frequently for work and this deprives their ability to provide full-time support for their elderly parents, especially when the latter may require specialised medical attention that outstrips family members’ capability to care for them.

Regardless of what circumstances one may face, if a family has explored all caretaking alternatives and still struggles to sufficiently care for their elderly parents, perhaps nursing homes are a justified option for them to consider. This is evidently a difficult decision to make, but if there is truly a need for sending the elderly into a nursing home, perhaps what families can do best in their circumstances is to choose wisely an option that best caters to their loved ones.

 

Applying for a nursing home

In Singapore, the government necessitates that the elderly fulfils a certain set of criteria for the family to even send them into a nursing home. One can apply for entering into a nursing home via the Agency for Integrated Care (AIC) platform.

To be eligible for entering into a nursing home, the elder is required to fulfil these criteria:

• Must be facing physical or mental disabilities due to illnesses.
• Must be experiencing difficulties in their mobility (such as being bed-bound or wheelchair-restricted) which impede their abilities to perform daily activities.
• Must have tried all other care options such as daycare, in-home nursing care and etc.
• Existing family members or other caregivers must prove that they are unable to care for the elderly.

Depending on the level of care needed by the elderly, the monthly expenses of a nursing home can range from $2,000 to $3,600 (before MOH subsidies). There may be additional charges included, such as a mandatory one-time refundable deposit and other administrative costs, and this also depends on the types of nursing homes that one may choose to engage in.

 

Types of Nursing Homes available

Types	Information
Nursing homes under social service agencies receiving MOH subsidies	The elderly must meet a means test criteria to be allowed to these nursing homes and receive the MOH subsidies. The social service organisations may provide additional financial and social assistance for the elderly if needed.
Nursing home under social service agencies that do not receive MOH subsidies	The elderly will not be subsidized by MOH. However, social service organisations are still able to provide the necessary financial and social assistance for needy elderly.
Private nursing homes under the MOH portable subsidy scheme	Elderly who meet the means test criteria may be eligible for MOH subsidies and be referred by AIC.
Private nursing homes not under the MOH portable subsidy scheme	The elderly will not be supported by any MOH subsidies and they will need to fully pay their expenses.

 

On the AIC platform, families can use the E-care Locator to search for nursing homes that cater to the needs of their loved ones and are at the most convenient location for them. For the application of subsidized care, especially for nursing homes that receive MOH subsidies, families will be obliged to seek the referral from Medical Social Workers, attending doctors or Social Workers who are currently caring for the elderly. Based on the referral, the AIC team will refer families to nursing homes that suit their circumstances and preferences.

Currently, there is a new programme, named Go Respite, which allows families to plan ahead and identify a suitable respite option that is able to meet their needs and those of their loved ones. For families that are already considering the option of the nursing home, Go Respite allows them to settle the necessary administrative procedures now so that when their loved ones actually access the facilities in the near future, it will shorten the administrative time needed for the elderly to be admitted into the nursing homes.

 

Choosing a nursing home

Besides the administrative concerns of applying into a nursing home, one should also consider the general condition and environment of the specific place when making a decision. Here is a general guideline of questions you should ask when choosing a nursing home:

• Professional Competence: Does the nursing home provide specialised care that caters to the conditions of your loved one? What are the daily or monthly activities which the nursing home engages the elders?
• Amenities: What are the room types available for your loved one? For multiple bedding rooms, are they comfortable for the elderly to rest at? Are the safety measures sufficient for the elderly? Are the facilities suitable for the mobility of those who are wheel-chair bound?
• Accessibility: Where is the location of the nursing home? Is it convenient for your family to travel easily when visiting your loved one? What are the visiting schedules for families?
• Environment: Is the atmosphere welcoming and uplifting for the elderly? Is the nursing home overcrowded and noisy? How do the residing elderly interact with one another as well as to the staff? Are the people friendly to one another or does the environment seem stifling and depressing?
• Meals: What is the quality of the food provided for the elderly? Does the nursing home cater to your loved one’s dietary requirements or preferences?
• Staff: Are the staff properly trained and do they have the required professional certifications for elderly with special medical conditions? What is the staff-to-elderly ratio? Are the staff overworked and will that impact the attention given to your loved one? What is the general atmosphere of the staff’s working attitudes? This is especially important as the staff will interact most closely with your loved ones on a daily basis.

 

It is important for families to personally head down to the nursing home to thoroughly check the condition of the nursing home. Beyond the initial visits, one can consider visiting the nursing home without calling ahead or dropping by at different timings and dates of the week so that there is a more holistic assessment on the different activities that the elderly will partake in and the different staff who they will interact with on a daily basis.

Always check on the online reviews of the nursing home and other related information available on the nursing home. Information on the staff turnovers in the nursing home can also hint at the staff’s working conditions, which will inconsequentially effect on the treatment of the resident elderly.

 

Applying for subsidies for nursing homes

Evidently, a nursing home requires a long-term financial commitment. To alleviate the financial burdens for the paying elderly or their family members, the government has provided much financial assistance available to offset the cost of nursing homes.

 

Intermediate Long-term Care (ILTC) subsidies

The government-funded Intermediate Long-term Care (ILTC) subsidies are available not just for the elderly but for those who require day-to-day assistance based on their existing conditions. Eligible candidates will receive financial aid that can cover up to 75% of the expenses of nursing homes.

To be eligible for the (ILTC) subsidies, the elder must fulfil the following criteria for a household means test:

• Must be a Singapore citizen or Permanent Resident.
• Must meet the admission criteria for entering a nursing home.
• Must already be receiving care from a MOH-funded service provider.

The household means test will consider the following factors:

• The gross income of the elderly, his/her spouse and all family members living in the same household.
• The total number of family members living in the same household.
• Or the annual value of the place of residence for households (if the elderly and their residing family members do not have an income).

 

ElderShield

Until 2019, all Singapore Citizens and Permanent Residents with MediSave Accounts were automatically enrolled in ElderShield at the age of 40, unless they opted out of the scheme. This basic long-term care insurance scheme targets at elderly with severe disability, which refers to the inability to to perform at least three of the six activities of daily living (namely eating, bathing, dressing, transferring, toileting, walking or moving around). Through the scheme, the elderly can receive monthly payouts ranging from $300 to $400 that can help offset the costs of enrolling into a nursing home. The Ministry of Health (MOH) has appointed three private insurers to administer the ElderShield scheme, including Aviva, Great Eastern and NTUC Income.

To check one’s ElderShield coverage, please refer to CPF Board's website, at www.cpf.gov.sg, for more information.

 

CareShield Life

The ElderShield has been replaced by the newly-launched CareShield Life for new cohorts born in 1980 and after, while those born in 1979 or earlier have the option to enrol in CareShield Life.

CareShield Life is a long-term care insurance scheme that enhances the basic financial protection for individuals, especially when they become severely disabled and need care for a prolonged duration. Singapore Citizens or Permanent Residents, born in 1980 or later, will be automatically covered under CareShield Life from 1 October 2020, or when they turn 30, whichever is later. Under this new scheme, eligible elderly can receive payouts that start at $600 cash per month in 2020, which increases annually until the age of 67 or when a successful claim is made, whichever is earlier.

Under this new scheme, the government has provided additional financial assistance for the elderly and thus, this will significantly alleviate the financial costs of engaging in a nursing home.

 

Interim Disability Assistance Programme

As some elderly Singaporeans were not eligible to join the ElderShield scheme, either because they were too old for the entry requirements or already had pre-existing medical conditions, the government launched the Interim Disability Assistance Programme for the Elderly (IDAPE) in 2002 to specifically cater to this special group of individuals.

For elderly who were born on and before 30 September 1932, or between 1 October 1932 and 30 September 1962 (both dates inclusive), with pre-existing disabilities as of 30 September 2002, they are eligible to join this IDAPE scheme. They will receive a $150 or $250 monthly cash payout (depending on their financial circumstances) for up to 72 months that can help offset their financial burdens of engaging in a nursing home service.

 

ElderFund

In one of the latest financial schemes launched by the government on 31 January 2020, ElderFund is a discretionary assistance scheme targeted at severely disabled lower-income Singapore Citizens aged 30 and older. These groups of individuals are eligible only if they are unable benefit from the schemes earlier mentioned, namely the CareShield Life, ElderShield, and the Interim Disability Assistance Programme for the Elderly (IDAPE), and have low MediSave balances and inadequate personal savings to meet their long-term care needs.

Eligible Singapore Citizens can receive up to $250 cash per month for as long as they remain eligible and like the other assistance available, it will significantly alleviate the financial burdens of engaging in a nursing home service.

For more information on other financial assistance available, please refer to the AIC website.