MADAM Ong Ah Poo lies still, oblivious to the four adults fretting over her. The 81-year-old former construction worker has been bedridden since a stroke in May.
Home-care physician Tham Weng Yew is visiting this morning. Over the next two hours, he and a nurse check Madam Ong’s vital signs and cognitive functions and discuss her daily care, as well as that of her husband, Mr Ng Sin Guan, 87, who has Alzheimer’s. The youngest of the elderly couple’s seven children, Ms Irene Ng, 47, dutifully jots down notes.
Dr Tham recommends cutting down some medicine,
reminds Ms Ng not to force-feed her mother and warns against giving her too much water. “She could choke, the water could go into her lungs and she could end up in hospital,” he warns. “That’s something we must avoid.” Dr Tham is employed by a private firm, Code 4, which arranges home care for home-bound patients like Madam Ong.
Such a visit normally costs up to $220, but Ms Ng – her parents’ caregiver – pays only $72, thanks to a subsidy from a charitable foundation. The unmarried florist, who earns $1,150 a month, is thankful for these quarterly home visits by Dr Tham. “I would need to hire an ambulance to take them to see a doctor,” she says. “This way, they get medical care in the comfort of home.”
Even as clients like Ms Ng swear by their care, home-care providers like Code 4 – which has three doctors including Dr Tham – are struggling to stay afloat. On Dec 31 last year, Ren Ci Home Care, which funded Code 4’s work, ceased operations because of the “escalating operating deficits” of its home-care arm.
A Ren Ci spokesman told The Straits Times that the voluntary welfare organisation, which runs a community hospital, a chronic sick unit and a nursing home, wanted to optimise resources by focusing on in-patient services. Since then, Code 4 has been fighting an uphill battle to keep offering home-based treatment to its 190 or so clients. As a private company, Code 4 cannot raise funds and does not receive government subsidies. It has secured some funds from a private foundation to enable it to subsidise patients for two years or so, says Dr Tham, a senior home-care physician. “But there is no doubt that because of a lack of funds, this is a tough field to survive in.”
He and other home-care physicians believe that home-based medical care could stave off institutionalisation for the growing number of frail and immobile old folk in Singapore. But such care is expensive. According to Dr Ng Wai Chong of home medical provider Hua Mei Mobile Clinic, such care costs $8,000 per patient each year. “But the current government subsidies we receive are only about 5 per cent of that cost,” says Dr Ng, a home-care doctor who is assistant director of the clinic.
HOW MANY: Singapore is served by five home medical organisations run by voluntary welfare organisations, nine home nursing providers and seven home therapy providers.
TYPE OF PATIENTS: Home medical care is an expensive but attractive option for those who are very ill – such as patients with stroke, dementia or cancer – and yet are being cared for at home. Home care providers offer a variety of services, including home visits by doctors, nurses and physiotherapists.
SUBSIDIES: The Ministry of Health (MOH) subsidises doctors’ fees by between $30 and $100 per visit, depending on the family income of the patient, capped at two visits a month. MOH subsidies for nurses’ visits range from $15 to $40 per visit, capped at eight visits per month. There is no subsidy for consumables such
as feeding tubes or bandages that a patient might need.
FEES: According to home medical providers, each visit by a doctor could cost about $220. Home therapy costs
$80 to $130 per visit, depending on the type of service and frequency of needs.