Dr Ow Chee Chung, Advisor, Society for the Physically Disabled

Dr Chan Kin Ming, Chairman of Board of Directors for Ang Mo Kio-Thye Hua Kwan Hospital Ltd

Colleagues, Ladies and Gentlemen,

Good morning. It gives me great pleasure to join you today at the opening ceremony of the inaugural conference on Community-based Geriatric Rehabilitation.

1. Let me begin by extending a warm welcome to all our guests. To our overseas guest speaker a special welcome and let me add that your contributions will be invaluable in guiding us in this journey to reinvent community based geriatric rehabilitation.

The impending Silver tsunami
Singapore’s population is ageing rapidly. We expect to see a doubling of the number of elderly persons in Singapore by 2020 and tripling to almost a million by 2030.

As the population begins to age, the numbers seeking healthcare will increase significantly. We will need to be able to continue to deliver healthcare in an effective and efficient manner so that our population can access good healthcare and continue to add life to years.

2. The healthcare needs of the elderly after a bout of illness are different from those of a younger person. Younger patients generally have significant reserves and have little or no difficulty returning to normal active lives.

3. However, frail elderly patients often have little reserves. They will need more rehabilitation sustained over a longer period of time to help them improve their function and regain their pre-morbid quality of life.

The intensity of effort required is similar to that necessary to help a sportsman recover to his peak performance after an injury.

4. It will also be necessary to attend to co-existing conditions, such as malnutrition, sensory disturbance or incontinence that could have contributed to the illness, so that a recurrence can be prevented.

5. Considerable effort needs to be put in, by the patient, his carers and us, the healthcare professionals, if we wish to add life to years.

As the numbers of our elderly increase, we will need to plan and prepare to address their healthcare needs. At MOH we have been working with our partners to make these changes.

Changing the way we deliver healthcare
6. What changes must we pursue? First, we should have the necessary human capital to attend to this need. In addition to geriatricians we will need more physiotherapists, occupational therapists and speech therapists.

We have been working to attract students to pursue a career in these areas and have also been aggressively recruiting international graduates so that we will have enough healthcare professionals to take care of our elderly.
7. Even as we make efforts to support more training and increase recruitment we recognise that therapists will remain in short supply, be they physiotherapists, occupational or speech therapists. It will be all the more important therefore that we use them effectively.

They should work in teams, leveraging on therapy assistants and nursing aides. Therapists can then focus on the complex tasks such as patient assessment, planning the rehabilitation programme, initiating the therapy and evaluating the outcome.

The therapy assistants could be trained to assist the elderly carry out their rehabilitation routine, with supervision by therapists. Engaging therapy assistants in this manner will increase the effectiveness of our therapists and extend their reach to benefit more patients.

8. Second we should right site our patients and right site facilities to optimise the delivery of care and patient recovery. After the acute episode of illness, patients who need intensive rehabilitation should be right sited in community hospitals so that we can optimise their recovery.

9. MOH is encouraging and actively fostering partnerships between restructured hospitals and community hospitals with the larger aim of enabling more intensive and varied rehabilitation in community hospitals.

While rehabilitation already takes place today at community hospitals, the focus is mainly on patients with stroke and fractures. As we expand the numbers, we can also expand the scope to cover areas such as chest and cardiac rehabilitation for patients with COPD and cardiac failure.

The upstream and downstream links between RHs, CHs and community healthcare providers will enable patients to move seamlessly from one setting to the next and enjoy holistic care.

For patients who are fit enough to return to their homes further rehabilitation should be done in day rehabilitation facilities in the community.

Today, the most sophisticated rehabilitation facilities are sited in the acute hospital. For a younger person the duration of rehabilitation is often short and it is not a major inconvenience for him to return regularly to the acute care setting for rehabilitation.

But for an elderly patient, where the rehabilitation usually needs to be over longer periods and requires many sessions for recovery, this process of having to return to hospitals at regular intervals , sustained over long periods, can be very taxing.

The effort needed to travel to the hospital, wait for her turn, receive therapy for 1 hour and finally travel home might be difficult for a frail elderly person and her family.

Patients and their families who are unable to cope with this added strain often abandon therapy and as a result some elderly persons remain inadequately treated and dependent on their caregivers.

10. There are benefits to be gained by moving the site of rehabilitation into the Community Hospitals, day rehabilitation centres in the community, and even into the home.

The locus of rehabilitation should shift from the acute hospital into the community as our population ages.

11. For those who still have difficulty travelling even to the day rehabilitation centres, home rehabilitation programmes must be made available. Home therapy programmes have enabled many to live independent lives again.

There are now various caregiver training programmes that teach family members how to maintain exercise programmes for the elderly at home.

12. Third if we are able to right site rehabilitation facilities in the community, there is scope to move rehab services upstream to allow earlier preventive interventions to take place. Let me explain:

13. We now have evidence that rehabilitation programmes can be used to prevent further disability in certain disease conditions like osteoporosis and in other areas like prevention of falls.

With regards to osteoporosis, studies have shown that exercise programmes can help to prevent or reverse the almost 1% of the bone loss per year in both the lumbar spine and femoral neck in premenopausal women. Fall prevention programmes have also been successful in reducing falls and the resulting fractures. We need to do more to develop prevention strategies for the elderly.

Fostering Partnerships and Integrating Rehabilitation services appropriately into this continuum
14. Fourth we will need to encourage innovation. To support this, additional sources of funding has been made available for training of long-term care providers through the HMDP-ILTC programme.

We also provide seed funding for new and innovative community programmes through the ToteBoard Community Healthcare Fund.

15. One example of a new and innovative programme that we have supported with this Community Health Fund is the Dysphagia Management Programme by the Society for the Physically Disabled. This programme has been admitting patients since last month.

16. With this programme, elderly patients who risk aspiration because of swallowing difficulty need not be referred to the acute hospital setting, but can be assessed and managed in the community. We are eagerly anticipating the positive results of this innovation.

Conclusion
17. Before I end, let me say that my Ministry will work with you to reinvent community geriatric rehabilitation.

We will invest in medical care in the community.

We will develop the necessary manpower.

We will right site facilities and appropriately skill the care teams so that we can provide optimal care for our patients.

We will promote prevention strategies and we will encourage innovation.

On this note, I wish you fruitful deliberations and a successful symposium.

Thank you.