马善高国会陈述：新加坡未来十年将至少投入35亿新元，支持社区养老

社会及家庭发展部长兼卫生部第二部长马善高：

主席，我感谢各位议员提出的问题和建议，我将从如何建设一个国人可以茁壮成长的新加坡开始陈述。一个强大的家庭是我们社区关怀生态系统的基石。它有助于确保孩子的健康，并且对支持我们的老年人健康老去至关重要。

老年人健康老去始于家庭，家庭应始终是关怀的第一堡垒。研究显示，大多数老年人更倾向于在社区中与家人和朋友在一起老去。同样，许多家庭都希望在家中照顾他们的亲人。

为了支持这些愿望，政府将在未来十年内至少投入35亿新元，用于支持实施“乐龄SG”计划，其中19亿新元将用于卫生部的各项倡议。

“乐龄SG”是由卫生部、新加坡国家发展部、交通部，与人民协会、社会及家庭发展部等合作伙伴机构以及其他志愿组织共同参与，旨在让老年人与家人在社区一起过上充满活力和富有意义的生活。

整个社区将共同努力实现“乐龄SG”计划。

首先，我们将投资活跃乐龄站，让老年人可以在社区安享晚年。

最终，我们希望老年人能够与他们的朋友和家人保持联系和交流，这对于保持健康至关重要。我们希望老年人和他们的家人可以更容易地获取社区提供的护理服务和资源。

活跃乐龄站正在扩展项目的质量和范围，并调整其服务以满足居住在附近的老年人的喜好。为了让老年人更容易参与，大多的活跃乐龄站还将这些项目扩展到社区空间，例如人民协会的居民联系网（Residents' Network）。

我被告知老年人可以参加各种课程和活动，此外政府也推出能够帮助老年人身心健康的项目。

以学习为例子。全国乐龄学苑在约60个活跃乐龄站提供多样化的课程，涵盖健康与保健、金融知识、资讯科技和科学等主题。还有一些课程是让老年人掌握实用技能的，比如学习专业摄影或花艺。这些在活跃乐龄站举办的课程价格合理，其中约四分之三的课程符合技能创前程培训补助。

叶汉荣先生询问了我们在推出活跃乐龄站、外展工作，特别是针对可能处于社交孤立状态的人，以及我们的倡议如何帮助促进代际交流的计划。我将会解答这些问题。

我们正在扩大活跃乐龄站的“人脉”。自从实施了活跃乐龄站，我们的中心数量增长到157个，并且每年参与的老年人数量稳步增加——从2021年的17,000人增加到2022年的49,000人以上。我们将继续努力，到2025年底将活跃乐龄站扩展到220个。这意味着到2025年，每十位老年人中就有八位将能够在家附近参加活跃乐龄站的活动。不论老年人的房屋类型如何，活跃乐龄站将为他们提供服务。因此，如果你身边有老年人，尤其是独居的老年人，请鼓励他们加入附近的活跃乐龄站。

其次，在“乐龄SG”计划下，我们设想所有老年人都能在社区得到支持，无论他们是独居还是与家人同住。社区的作用至关重要。我们已经在这项目开始了努力。关爱乐龄办事处与志愿者大使一起，通过家访与过去四年中超过33万名老年人进行了接触，包括那些独居或可能没有家人的老年人。他们帮助老年人参与活跃乐龄站的社区活动，比如在社区一起堂食。

因此，除了参与活跃乐龄站的活动外，我们还希望老年人与他们的家人和朋友一起加入我们的行列，接触社区的其他老年人。

让我分享一下谢女士的故事。通过家访和电话交流，谢女士在过去的八年里积极地接触社区的其他老年人。谢女士表示，与她接触这些人，现在这已经成为了她的朋友。她感到很不可思议，毕竟她自己已经是72岁的高龄了。

她的精神影响了周围的人，现在她的女儿、孙女和女婿也加入了她的“团队”。我们很高兴看到谢女士在她的晚年做到了如此有意义的事情，而且他们的志愿工作已经促进和加强了家人之间的联系。

我们希望我们的社区成为老年人与朋友聚集、保持活跃和健康的地方，从活跃乐龄站开始。

第三，我们希望老年人能够轻松地在他们的社区周围活动。

我们将加强我们的基础设施。国家发展部和交通部将通过乐龄易计划（EASE 2.0）、对选定的老旧街区进行升级以及交通部的“安行街道”，使我们的公寓、社区和街道更加适合老年人。我相信各位成员已经看到乐龄安全区和人行天桥的电梯为我们的老年人带来了很多方便。

我们还将对家庭环境进行改进。陈有明医生和叶汉荣先生可能会高兴地注意到，我们还将引入室内摔倒探测器，为有老年人的家庭提供安心。

虽然我们希望老年人能够在社区、与家人和朋友一起安享晚年，但我们也认识到，照顾有护理需求的老年人的家庭可能面临额外的压力。因此，我们将采取更多措施来支持这些家庭照顾老年人。

我们已经增加家庭医疗护理的途径，并提高可负担性。

如今，政府向家庭护理服务的受益者提供高达8成的家庭护理服务补贴，包括家庭医疗、家庭护理和家庭治疗等服务。自2023年10月起，MediSave500/700和灵活保健储蓄计划已扩展至接受卫生部资助提供商提供的家庭医疗护理服务的居家患者。

陈有明医生和佳馥梅女士询问了超出医疗费用的议题。卫生部的主要重点是确保所有人都能够负担得起医疗服务。因此，我们的主流医疗补贴、终身健保、保健储蓄、保健基金（S+3Ms）框架主要关注覆盖急性护理、初级护理以及长期护理服务。

尽管如此，我们认识到照料护理所涉及的附加费用，以及健康和社会护理密切相关。因此，卫生部已针对性地设立了拨款计划，以更好地支持家庭支付其他照料费用，特别是针对低收入人群。这包括医疗护送服务，帮助虚弱的老年人载到医院接受治疗，或到医疗老年护理中心、居家护理津贴计划和乐龄助行基金。我们将继续监督和审查。我们尽力帮助，但能够覆盖的范围是有限的。扩大范围将会进一步推高国家医疗支出，最终会给人民带来更大的负担。为了更好地支持社区的家庭和照料者，我们将改进现有的服务并试点新的护理模式，正如陈有明医生、叶汉荣先生和郭献川先生所建议的那样。

我们正通过一项正在进行中的试点项目研究更多家庭护理选择。在“HPC+”计划下，老年人将得到日常活动的帮助，包括家务管理服务。

截至2024年1月，已有328名客户参加了HPC+试点项目。我们将在2024年底评估该试点项目，然后确定是否将其扩展到全国范围。

我们感谢郭献川先生对共用看护沙盒计划”（Shared Stay-in Senior Care Services Sandbox）的询问，该计划旨在减轻家庭规模缩小对家庭照料的影响。在这个计划下，一个共享照料者将协助一组生活在公共或私人住宅区的老年人进行日常生活活动。这个沙盒计划将至少持续一年，直到2025年第一季度。

卫生部将审查其结果，并在确定下一步行动时考虑郭献川先生的反馈意见。我们将在确定后宣布下一步行动。

卫生部将引入标准化的护理评估，并逐步委任捆绑式服务提供者，以便老年人能够享受护理服务。这将减少由不同的护理提供者进行多次评估和不必要的转诊的需要。

对于需要在养老院接受进一步护理的老年人，养老院安置的中位等待时间大约为一个月。在此期间，护联中心会与老年人及其看护者密切合作，根据需要制定替代性的临时护理安排。

这些努力将在一定程度上支持家庭和看护者。我们希望让他们更容易地管理在家照料长辈所带来的认知和身体负担。这包括可能正在照料年迈家庭成员的老年看护者。

此外，我们将为看护者提供资源，以便他们在照料家人时得到支持。

自2023年11月以来，看护者也可以使用他们的技能创前程培训补助参加符合资格的照看护者培训课程。今年，我们将把现行的每年200新元的看护者培训补助提高至每位受护者每年最高400新元，以补助由批准的培训提供者开展的看护者培训费用。通过这些计划，看护者可以获得更负担得起、更易获得的看护者培训，帮助他们在社区中照料老年人。

我想向陈浍敏女士保证，看护者可以在社区中找到支持。

如今，看护者可以通过护联中心的热线和网站上提供的在线资源，以及Support-Go-Where门户上的护理服务推荐器来获取支持。

这些努力将在一定程度上支持家庭和看护者。我们希望让他们更容易地应对在家照料长辈所带来的认知和身体负担。这包括可能正在照料年迈家庭成员的老年照看护者。

护联中心还运营着为有心理健康需求的老年人和看护者提供支援的社区外展团队和社区辅助小组。对于社会情感支持，看护者还可以利用由人民协会提供的看护者支援网络和WIN看护者联系网。

主席，我们有一个雄心勃勃的愿景，即将新加坡建设成一个老年人能够安享晚年的社会。我们在社区推出计划，使老年人能够积极地过生活。我们正在各个社区投资基础设施以及支援家庭照顾他们的老年人。但最终，关键在于“心”，每个人都要互相关心，帮助我们的老年人在社区过上充满活力和充实的生活。

(Building a caring and inclusive society together)

Head O (cont) –Resumption of debate on Question [6 March 2024],

"That the total sum to be allocated for Head O of the Estimates be reduced by $100." – [Dr Tan Wu Meng].

Question again proposed.

The Second Minister for Health (Mr Masagos Zulkifli B M M): Chairman, I thank Members for their questions and suggestions, and I will start on how we can build a Singapore where our families and seniors can flourish. Strong families are the building blocks for an ecosystem of care within our communities. They help to ensure the health of their children and are pivotal to supporting our seniors to age well.

Ageing well starts from home and families should always be the first bastion of care. Studies show that most seniors prefer to age in the community, close to their families and friends. Likewise, many families have a desire to care for their loved ones at home. 

To support these aspirations, the Government will dedicate at least S$3.5 billion over the next decade, to support the implementation of Age Well SG, of which S$1.9 billion will be dedicated to the Ministry of Health's (MOH's) initiatives.

Age Well SG is led by MOH, the Ministry of National Development (MND), the Ministry of Transport (MOT), with other partner agencies like the People's Association (PA), the Ministry of Social and family Development (MSF) and other volunteer organisations, to enable seniors to lead vibrant and fulfilling lives in the community with their families. 

The whole village will work together to realise the Age Well SG plans.

First, we will invest in Active Ageing Centres (AACs), which will be a key enabler for seniors to Age Well within the community.

Ultimately, we want seniors to be engaged and connected with their friends and families, which is key to keeping healthy. We would like to make it easier for seniors and families to access available care services and resources in the community.

The AACs are expanding the quality and range of their programmes and adapting their offerings to suit the preferences of seniors living in the vicinity. To make it easier for seniors to join in, most AACs also extend these programmes at community spaces, like PA's Residents' Network.

I am told that seniors can participate in classes and activities, and there are also programs which have been proven to help seniors to age well physically and cognitively. 

Take learning as an example. The National Silver Academy (NSA) offers a diverse range of courses at about 60 AACs, ranging from topics like health and wellness, financial literacy, to information technology and science. There are also courses for seniors to pick up practical skills, like taking professional photos or floral arrangements. Most of these courses held at the AACs are affordable and around three-quarters of them are eligible for SkillsFuture credits.

Mr Yip Hon Weng asked about our plans for the roll-out of AACs, our outreach efforts, especially for those who might be socially isolated and how our initiatives can help to foster intergenerational bonding. I will address these points below.

We are scaling up our network of AACs. Since the implementation of the AAC service, we have grown to 157 AAC centres and have seen a steady increase in seniors engaged yearly – from 17,000 in 2021 to more than 49,000 seniors in 2022. We will do more and expand the network of AACs to 220 by the end of 2025. This means that by 2025, eight in 10 seniors will have access to AAC activities near their homes. AACs serve all seniors regardless of housing type. Therefore, if you have seniors among your loved ones, especially those living on their own, please encourage them to join a nearby AAC.

Secondly, under Age Well, we envision all seniors to be supported within the community, regardless of whether they live alone or with family. This is where the community is key. We have started this community effort. Together with volunteer ambassadors, the Silver Generation Office has engaged more than 330,000 seniors in the past fours years through house visits, including those who live alone or may have no family. They help to connect the seniors to community events or activities organised by AACs, such as communal dining.

As such, in addition to participating in activities at the AACs, we also hope for our seniors to join in our efforts in reaching out to other seniors in the community, together with their family and friends.

Let me share about Mdm Yuling Siah. For about eight years now, Mdm Siah has been actively reaching out to fellow seniors in the community through home visits and telephone engagements. Mdm Siah says that she finds it especially meaningful when she has good conversations with the people she reaches out to, who have now become her friends. And Mdm Siah is 72 years old!

Her spirit has caught on and now her daughter, granddaughter and son-in-law, have also joined in. We are happy that Mdm Siah is finding such meaning in her senior years and their volunteering has fostered and strengthened inter-generational bonds across the family.

Ultimately, we want our communities to be places where seniors gather with friends, keep active and stay healthy, starting with AACs.

Thirdly, we will enable seniors to be active and move around their neighbourhoods with ease.

We will enhance our infrastructure. The Ministry of National Development (MND) and the Ministry of Transport (MOT) will be making our flats, neighbourhoods and streets more senior-friendly through EASE 2.0, the upgrading of selected older precincts and MOT's Friendly Streets initiative. I am sure Members have seen how Silver Zones and the lifts at Pedestrian Overhead Bridges bring much joy to our seniors.

We will also make enhancements to the home environment. Dr Tan Wu Meng and Mr Yip Hon Weng would be happy to note that we will also introduce in-flat fall detectors to provide a peace of mind for families with seniors.

While we want seniors to be able to age in the community, with their families and friends, we recognise that families caring for seniors with care needs may face additional stresses. Therefore, we will do more to support these families in caring for their loved ones.

We have increased access to home medical care and improved affordability.

Today, the Government provides up to 80% means-tested subsidies to patients for home care services such as Home Medical, Home Nursing and Home Therapy. Since October 2023, MediSave500/700 and Flexi-MediSave schemes have been extended to homebound patients receiving home medical care from MOH-funded providers.

Dr Tan Wu Meng and Ms Mariam Jaafar asked about allaying costs beyond medical expenses. MOH's primary focus is to ensure healthcare services are affordable for all. Our mainstream financing Subsidies, MediShield Life, MediSave, MediFund (S+3Ms) framework, is thus focused on covering acute care, primary care, as well as long-term care services.

Nevertheless, we recognise that there are ancillary costs associated with caregiving and that health and social care are closely related. Hence, MOH has targeted grant schemes to better support families to defray other caregiving expenses, especially for the lower-income. This includes the Medical Escort and Transport (MET) services to help frail seniors attend medical appointments or travel to Senior Care Centres, the Home Caregiving Grant and Seniors' Mobility and Enabling Fund. We will continue to monitor and review. We try to help, but there is a limit to how much we can cover. Expanding scope of our financing will further push up national healthcare expenditure and ultimately result in a greater burden on people. To better support families and caregivers within the community, we will improve existing services and pilot new care models, as Dr Tan Wu Meng, Mr Yip Hong Weng and Mr Henry Kwek have suggested.

We are studying more options for home care, via an ongoing pilot. Under "HPC+", seniors are assisted in their daily activities, and this also includes housekeeping services.  

As of January 2024, there are 328 clients enrolled under the HPC+ pilot. We will evaluate the pilot by end-2024, before determining whether to expand it nationwide.

We thank Mr Henry Kwek for his query on the stay-in shared caregiving sandbox which was launched to mitigate the impact of shrinking family sizes on family caregiving. Under this sandbox, a shared caregiver assists a group of seniors living in public or private estates with their activities of daily living. This sandbox will be in place for at least a year until the first quarter of 2025.  

MOH will review its outcomes and take Mr Henry Kwek's feedback into consideration when determining next steps, which we will announce when finalised.

MOH will also introduce standardised care assessments and progressively appoint bundled-services providers, so that seniors can enjoy more seamless care delivery. This reduces the need for multiple assessments and unnecessary referrals by different care providers.

For seniors who require further care in Nursing Homes, the median wait time for nursing home placement is around one month. In the interim, the Agency for Integrated Care (AIC) works closely with the seniors and their caregivers to make alternative interim care arrangements as needed.

These efforts will go some way to support families and caregivers. We want to make it easier for them to manage the cognitive and physical load of providing care for their loved ones at home. This includes senior caregivers who may be caring for senior family members.

In addition, we will provide caregivers with resources so that they can be supported in caring for their loved ones.

Since November 2023, caregivers have also been able to use their SkillsFuture credits for eligible caregiver training courses. This year, we will be enhancing the Caregivers Training Grant from the current $200 per year to up to $400 per year per care recipient, to subsidise the cost of caregiving training conducted by approved training providers. With these schemes, caregivers can receive more affordable and accessible caregiver training to help them care for their loved ones in the community.

I would like to assure Ms Carrie Tan that support for caregivers can be found in the community.

Today, caregivers can access the AIC hotline and online resources available on AIC's website, as well as a Care Services Recommender on the Support-Go-Where portal.

We will also progressively level up all AACs as community touchpoints to provide information and referral services. For example, families and caregivers can visit an AAC to discuss how they can obtain the appropriate care for their seniors. There are also nine AIC links located in public hospitals to provide caregivers who are planning for the discharge of their loved ones from the hospital.

AIC also runs CREST and COMIT teams that provides support for seniors and caregivers with mental health needs. For socio-emotional support, caregivers can also tap on the Caregiver Support Networks (CSNs) and WIN Caregivers Network by PA. 

Chairman, we have an ambitious vision to be a society where we age well. We are rolling out plans in the community that enable seniors to live active lives. We are investing in infrastructure across neighbourhoods. We are supporting families in caring for their loved ones. But, ultimately, it is about the heartware, each of us looking out for one another, helping our seniors lead vibrant and fulfilling lives in the community.

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