The future of healthcare for Singapore's ageing populationBy Dr Wai Chiong Loke
Singapore’s ageing population is rising rapidly and elderly healthcare support is top of the government’s agenda with several major steps already taken over the years to minimise the impact on the economy, society and national healthcare expenditure.
Globally, the “medicalised” model is shifting to become more social and rehabilitative. Singapore is similarly shifting focus and is placing emphasis on community-based care - delivering value at lower cost, and promoting an individual’s personal responsibility for his own health. In this year’s Budget speech, the Finance Minister announced two measures that lean towards this focus – expanding the Community Network of Seniors to provide social and healthcare support within the community setting, and consolidating social- and health-related services to streamline and improve delivery of services for the elderly.
These moves make a lot of sense and are laudable – people are living longer with more complex diseases that require coordinated health and social care, and sometimes social determinants of health are even more important. Other innovative solutions can also be considered.
Moving into the future, seniors will become increasingly digitally savvy and will be able to enjoy the conveniences afforded by technology. This will give rise to more elderly preferring to live independently and age-in-place within a supportive community.
Co-living arrangements are seeing success in other parts of the world. For example, in the US, start-ups like Common and WeLive have set up full-fledged co-living spaces offering housekeeping services and an instant community of friends for less than US$1,500 a month. Established player Property Markets Group has developed small, but highly customisable integrated private spaces that prioritise common areas built to foster interaction.
There is potential to develop similar living spaces in Singapore that offer not only amenities like the Internet and housekeeping services, but also an integrated medical service and facility on-site, a robust elderly support community, and easy access to family members.
However, co-living may not be for everyone. Some would choose to live alone or with family members. For such cases, home-based care should be made more viable and sustainable, with solutions that are customisable and enhanced using innovative technology. Already, there are different organisations that have initiatives to provide these solutions and encouragement from the government is crucial for further developments in this space.
One solution is to build an elderly-friendly, smart IoT-enabled infrastructure. A good example is SHINESeniors, a project by the SMU-TCS iCity Lab, that aims to deliver more effective community care services through ICT to support ageing-in-place. It does so by developing sensor-enabled homes and personalised home care for the elderly. In such homes, the physical environment (such as air quality, noise level, temperature and humidity) and daily living patterns (such as their mobility patterns at home, medication adherence and sleep quality) can be monitored unobtrusively, without infringing on privacy and comfort.
By observing and analysing living patterns over time, changes in well-being can be detected before the senior’s condition deteriorates. Family and community caregivers can then be activated to intervene in a timely manner - especially in emergency situations such as falls or calls for help.
Another way is to apply the concept of the sharing economy to senior care solutions by creating digitalised shared services and developing digitally-enabled living arrangements. A shared service currently available in Singapore is Homage – a web and mobile platform that provides on-demand elderly caregiving services. It combines curated and trained caregivers with smart technology, making the entire caregiving management process hassle-free.
Communications services are also important to create a meaningful feedback loop. There are services available worldwide that allow healthcare providers and life science companies to harness emerging technology and big data to create meaningful patient dialogue. For instance, through connected and regulated applications and devices, the care provider is able to conduct digital therapy, improve patient outcomes, and support healthcare professionals in managing patient care. Also, internal and external data can be analysed to gather unique insights into patient treatment and interactions while demonstrating real-world evidence. Lastly, care-team coordination can be enabled to effectively support care coordination across practitioners, caregivers and other team members. Good examples can be found in the UK such as Patients Know Best and Health Fabric; and in integrated health and social systems like the Canterbury district in New Zealand.
Future healthcare technologies cannot work in silos. Solutions must be designed to sync with and work alongside the human elements fundamental to the health and well-being of the elderly – relationships with family and loved ones. Building a healthcare infrastructure to facilitate this, just like combining health and social care, requires collaboration and foresight of policymakers and planners. The future model of healthcare for the elderly will be a decentralised and disseminated model that is both customisable for each individual, and fully integrated and seamlessly coordinated between all the stakeholders – patients, caregivers, healthcare providers and the government alike.