Louis asked the Minister for Health (a) what is the current number of ElderShield premium payers; (b) to date, what is the number of people who have received ElderShield payouts; and (c) whether the Ministry will consider setting up a coordinating office to help elders with ElderShield matters such as that of signing up, paying premiums and getting payouts.

Mr Gan Kim Yong (MOH): ElderShield is an insurance scheme that provides basic protection against the costs of long-term care arising from severe old-age disability. Depending on the policyholder’s plan, the scheme provides cash payouts of either $300 a month for up to five years, or $400 a month for up to six years.

As at end 2015, there were 1.2 million ElderShield policyholders, or about 65% of the resident population aged 40 to 83. Those aged 84 and above would not have qualified for ElderShield as they had exceeded maximum entry age when ElderShield was introduced in 2002. Instead, they can apply for financial assistance under the government-funded Interim Disability Assistance Program for the Elderly (IDAPE) if they meet the income and disability criteria.

Since ElderShield was launched in 2002 till end-2015, there have been about 12,500 successful claims, with around $90 million paid out.

Today, to ensure participation in the scheme is made as easy as possible, all Singapore Citizens and Permanent Residents with Medisave accounts are automatically covered under ElderShield at the age of 40, unless they choose to opt-out. As the scheme is operated by three MOH-appointed insurers (Aviva, Great Eastern and NTUC Income), the insurers will send premium notice letters once a year, before policy renewal. Premiums are usually paid via direct deduction from the policyholder or their family member’s Medisave account. For those without Medisave account when they reach 40 years old, the Central Provident Fund (CPF) Board will send an invitation letter to them to invite them to open a CPF account, so that they could be automatically covered under ElderShield. The insurers are also responsible for responding to queries on premiums and supporting the policyholder through the claims process.

MOH will continue to review the processes for ElderShield sign-up, premium payment and claims, including working with other organisations such as the Pioneer Generation Office, to help Singaporeans with ElderShield processes and their long term care needs.

Source: Hansard (Parliament of Singapore)

Louis delivered his budget cut on Increasing ElderShield Payout Period at Committee of Supply 2016.

Louis: Madam, with increased cost of living and added healthcare cost, I am concerned that the poor and vulnerable elders in Singapore will fall through the cracks. While MediShield Life is a good measure to cover all Singaporeans, it does not help with their living expenses when they are in recovery or out of the hospital.

This is where ElderShield comes in. However, there are some improvements that I would like to suggest. The premium costs are high for the lower income families and the process to file claims may be overly burdensome especially for the elderly. Does the Ministry have plans to review the premiums and also simplify the claim process? Can the Ministry also tap on the Pioneer Generation Office (PGO) to reach out to the other 35% of the resident population who are currently not covered by ElderShield?

Lastly, while the payout period has been extended to 72 months, will the Ministry consider extending the payout period for ElderShield to end of life instead, since there is no reason to assume that care needs would decrease after 72 months?

Mr Chee Hong Tat (The Minister of State for Health): As our population ages, it is inevitable that some of us will become frail and disabled, and require support in activities of daily living. For some, this may be a few years before they pass on. For others, the duration could be longer, as Dr Lily Neo and Mr Louis Ng highlighted.

I thank Dr Lily Neo, Mr Low Thia Khiang and Mr Louis Ng for their suggestions on ElderShield. There were also earlier proposals from the PAP Seniors Group. MOH will study these suggestions carefully, as part of our ElderShield review.

Mdm Chair, one point I wish to highlight is that increasing the payouts and coverage of ElderShield will require, in the end, higher premiums for the scheme to remain viable. So, this higher cost will ultimately be borne by everyone, whether directly through ElderShield premiums or indirectly through tax-funded subsidies.

Hence, there is a need to balance enhancements in ElderShield with the potential cost increases, so that the scheme can remain affordable for all Singaporeans. ElderShield payout is one important source of payment but it is not the only source. Pioneers, for example, can receive Pioneer Generation Disability Assistance Scheme (PioneerDAS) on top of ElderShield. So, we will look at different ways of helping our seniors, especially those who are disabled.

Other important issues for the review include whether ElderShield should be made mandatory for every Singaporean. It is now an opt-out scheme, as some Members have pointed out, and how to provide coverage for older cohorts of Singaporeans who, today, may not have ElderShield.

Similar to how we enhanced MediShield into MediShield Life, MOH will need to carefully review ElderShield in consultation with experts and key stakeholders. Our end in mind is to provide Singaporeans with peace of mind when we grow old, while keeping the scheme affordable for all.

Source: Hansard (Parliament of Singapore)

(Supplementary Question) Louis: Thank you, Madam. In line with what Minister has mentioned about whether the children should stay at home to continue to look after the senior, could the Minister explain why we are just including the income of children who live with the seniors and not the children who are not living with the seniors? We seem to suggest that children should only look after their parents if they live with the parents. So, could the Minister clarify on this, please?

Mr Lim Swee Say: Mdm Speaker, whether the children live with the seniors, we hope they will all take care of the seniors. Mr Louis Ng asked the point, if I get him right, is that why is it when we compute the per capita household income, we included only children who live with the seniors and we do not include children who do not live with the seniors. This means not so much using per capita household income but per capita family income as a criterion. In other words, we look at it as a family, whether the children are staying together or not and so on.

I think, on the whole, no outcome is perfect and so one of the key considerations of this scheme is that we would like to make the scheme as convenient for the seniors as possible. For example, under the Silver Support Scheme, the seniors need not apply for the scheme. On the per capita household income, we are able to gather the information through various sources but that should not rule out, who knows, one day in the future, when we have enhanced our information network, we may one day evolve towards per capita family income basis. But as of now we do it on a per capita household income. And let me emphasise, again. For cases if, indeed, the seniors feel that they deserve special consideration, help them to put up an appeal and, as I mentioned, we will look at the three criteria in totality. If they do not qualify based on the per capita household income criterion, but if we take into consideration the other two criteria, if we feel that, on the whole, they deserve that extra help, we will extend the Silver Support to them.

Source: Hansard (Parliament of Singapore)

Louis asked the Minister for Social and Family Development (a) how many cases have been mediated by the Commissioner for the Maintenance of Parents in 2015 and 2016; (b) how many cases have been heard at the Tribunal for the Maintenance of Parents in 2015 and 2016; and (c) what plans does the Ministry have to reduce the number of such cases.

Mr Tan Chuan-Jin (MSF): The Maintenance of Parents Act takes a "conciliation first" approach, with legal action as a last resort. This approach started in 2011 when the Act was amended to create the office of the Commissioner for the Maintenance of Parents.

The Commissioner conciliated 221 cases in 2015 and 136 from January till August 2016. Since 2011, we have seen encouraging results with a resolution rate of about 80%.

With upfront conciliation by the Commissioner, there have been fewer maintenance applications filed at the Tribunal for the Maintenance of Parents. This has also reduced acrimony and discontent between parties. Prior to 2011, the three-year average number of new applications at the Tribunal was 170. It fell to an average of 67 per year for 2012-2014. In 2015, the number was 36 and from January till August 2016, 51 applications have been filed.

At the heart of most cases is poor family relations. This could be caused by irresponsible parenting, deep rooted conflict in the family or a lack of filial piety. The Ministry will continue to promote filial piety and responsible parenting and, in particular, encourage fathers to be actively involved in raising their children. Such efforts aim to strengthen family bonds, and reduce the need for elderly parents to resort to legal recourse for maintenance. In addition, in instances where the children cannot maintain their parents, for example, they themselves are on social support or are incarcerated, the Tribunal and the Commissioner would refer such elderly to the SSOs. The aim is to ensure that the elderly's basic needs are met, but it does also reduce the number of cases officially filed.

Source: Hansard (Parliament of Singapore)

Louis delivered his budget cut on Extending ElderShield Payouts at Committee of Supply 2017.

Louis: ElderShield is meant to be a Severe Disability Insurance scheme. However, payouts are only for 72 months, and I understand that the quarter of claimants outlive this and still need care.

Would the Ministry consider making payouts for life? In addition, premiums are also higher for women than it is for men. Insurance is supposed to pool risk across different life expectancies. As such, will the Ministry making the premiums equal for men and women?

Mr Chee Hong Tat (The Minister of State for Health): Madam, I thank Dr Chia Shi-Lu, Dr Lily Neo and Mr Louis Ng for their comments on ElderShield. We have formed the ElderShield Review Committee chaired by Mr Chaly Mah in October last year. The Committee has engaged different groups of stakeholders, such as care-givers, service providers, insurers and members of the public, through focus group discussions. The consultation process is still on-going.

In doing its review, the Committee is looking at ways to enhance the benefits and payout period, while balancing the need to keep premiums affordable for all Singaporeans. It will continue to consult widely to gather further views and feedback.

Madam, ElderShield is an important risk-pooling scheme to prepare ourselves for an ageing society, as some of us will require extra help if we become seriously disabled when we grow old.

Source: Hansard (Parliament of Singapore)

Recurrent Costs of Government's Healthcare and Long-term Care Expenditure

Louis asked the Minister for Health (a) what percentage of the Government's healthcare expenditure and long-term care expenditure are recurrent costs respectively; and (b) what percentage of the Government's healthcare expenditure and long-term care expenditure are capital costs respectively.

Mr Gan Kim Yong (MOH): Based on latest available data in 2016, the Government's Healthcare Expenditure was $9.3 billion, of which about 80% and 20% were on recurrent cost and capital costs respectively. Government expenditure in long term care was $830 million, of which about 70% and 30% were on recurrent and capital costs respectively.

Source: Hansard (Parliament of Singapore)

Total Cost of Providing Long-term Care in Singapore in Latest Available Financial Year

Louis asked the Minister for Health (a) what is the total cost of providing long-term care in Singapore in FY2017/18 or the latest year available including nursing homes, daycare centres and formal homecare services; and (b) what percentage of this cost has been borne by (i) individuals (ii) the Government (iii) insurance (ElderShield) and (iv) charities respectively.

Mr Gan Kim Yong: The 2017 data will only be available later in 2019, as the data collection and compilation process spans across many government and non-government data sources.

Based on the latest available data in 2016, Singapore's National Health Expenditure on long-term care, including both formal care and informal care-giving, was about $1.3 billion. About two-thirds of this was borne by the Government, and the remaining one-third was paid by private financing sources, which include insurance, charities and individual out-of-pocket payments. Due to constraints in the data, we are unable to provide further breakdown of these sources.

Source: Hansard (Parliament of Singapore)

Louis asked the Minister for Health how does the Ministry calculate norm costs, defined as the Ministry's observed average costs of running Long Term Care services, which tend to be considerably lower than what Voluntary Welfare Organisations (VWOs) claim are the real costs of service delivery, as reported in Lien Foundation's 2018 "Care Where You Are" report.

Mr Gan Kim Yong (MOH): MOH partners Voluntary Welfare Organisations (VWOs) as well as private and public sector service providers in delivering long-term care services (LTC) for Singaporeans.

To estimate the costs of providing different LTC services, MOH works with the service providers to conduct regular costing exercises. The costs are determined based on service requirements set out for each care service. The average of the costs across the long term care provided by different service providers, the "Norm Cost", is then used as a reference to determine the funding for the services.

As care models, cost structures and productivity vary across service providers, some could have costs that are higher than the norm cost, while others could have costs that are lower.

MOH provides means-tested subsidies of up to 80% for long term care services. Singaporeans who require additional help after the subsidies can apply for financial assistance such as MediFund. Some VWOs provide additional assistance to their clients through charity dollars raised. Some may also choose to provide additional facilities and services using their charity funds. To support VWOs in their fundraising efforts and encourage Singaporeans to give generously, the Government funded Community Silver Trust provides dollar for dollar matching for donations raised in the long term care sector.

Source: Hansard (Parliament of Singapore)

Louis asked the Minister for Health (a) whether there are plans to tighten the regulation of private daycare and homecare services that do not receive Government subsidies as they currently do not have any mandatory minimum standards; and (b) whether daycare and formal homecare services should be licensed like childcare and nursing home services.

Mr Gan Kim Yong (MOH): As the home and community care sector grows over time, we will need to continually improve the quality and standards of home and day care services.

Healthcare professionals working in the sector, such as doctors, nurses and therapists, are already subject to licensing by their respective professional bodies. They are held to strict professional standards in areas such as code of conduct, practice standards and competencies. In 2015, MOH, in consultation with the sector, also introduced developmental service guidelines for home and day care providers covering areas such as care delivery, staff training and staff qualifications.

MOH will review the need for more formal regulation of the home and day care sector. We have provided for the future regulation of home and day care services within the scope of the upcoming Healthcare Services Act (HCSA). The specific timing, phasing and regulatory approach will need to be studied carefully as the sector is still nascent and evolving.

Source: Hansard (Parliament of Singapore)

Louis asked the Minister for Health for the senior care industry (a) what is the percentage of local workers; and (b) what are the plans to attract more locals.

Mr Gan Kim Yong (MOH): Based on data reported by MOH-subvented service providers in 2018, there were 12,000 workers working in the Long Term Care (LTC) sector1, of which about 40% are locals.

We have been enhancing the attractiveness of LTC jobs to locals by (a) raising awareness and interest in job opportunities within the sector, (b) providing training and development opportunities, and (c) increasing salary competitiveness. 

For example, the Agency for Integrated Care (AIC) works with LTC providers and recruitment partners like Workforce Singapore (WSG) and Employment and Employability Institute (e2i) to facilitate local employment and raise awareness of job opportunities in the LTC sector. In 2018, more than 1,000 locals have joined the LTC sector through various recruitment efforts. 

MOH and AIC also support LTC providers in staff training and development. For example, training for newly hired local support care staff2 can be funded under the Community Care Traineeship Programme (CCTP) so they can be equipped with requisite skills to perform in their new roles. Providers are also eligible for on-the-job training support of up to $10,000 per local support staff recruited to facilitate mentoring, supervision and development of new hires. Local staff may apply for sponsorship through the Community Care Manpower Development Award (CCMDA) to pursue advance training in skills relevant to their work. 

Lastly, to increase local salary competitiveness, MOH works with employers to review salaries of workers regularly to ensure that they are adequately recognised for their efforts. Between 2012 and 2017, MOH had provided funding support to raise wages of workers across participating providers which saw a 30% increase in aggregate over this period.

Going forward, we will continue to step up our efforts to attract locals to this sector.

Source: Hansard (Parliament of Singapore)

(Supplementary Question) Louis: Can I just ask the Senior Parliamentary Secretary whether we can consider providing some subsidies for Household Services Scheme (HSS). I understand the cost is quite high. In a similar way that we provide subsidies for the foreign worker levy, can we consider such subsidies also for HSS?

Ms Low Yen Ling (for the Minister for Manpower): I want to thank the Member Mr Louis Ng for the question. Currently, the FDW concession is meant to support families with young kids and also families with elderly. And as we review how we can improve HSS, we need to bear in mind how we are designing it to provide the support for sandwiched families where they have younger kids and elderly.

Source: Hansard (Parliament of Singapore)