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Give Incentives to Keep Elderly at Home

By Salma Khalik, The Straits Times


June 14, 2004 

MORE elderly people are ending up in nursing homes. There are about 6,600 now, compared to 6,000 last year and just 4,500 in 2000.

Many do not need such care, and can be looked after at home. 

The Government is worried about this trend, but the reality is that the financial incentives it offers actually encourage such behaviour.

Hence, Singapore can expect to see demand for nursing homes go up.
There are those who would argue that money is not the main factor for most when it comes to deciding what to do with a dependent elderly parent.

Others will argue, correctly, that for some people, a nursing home is the only choice, monetary incentives or not.

But a closer look at the incentives points out part of the problem.

Take a parent whose children are working, for example. To look after an aged parent, such children will probably require a maid, and the ballpark figure to hire one - including the levy, salary and upkeep - would be about $800 a month.

If the family's income is at the national halfway mark of $1,000 per family member, or less, the Government provides a subsidy - anything from 25 to 75 per cent of the cost - for putting the elderly parent in a home.

The cost of putting an elderly person in a nursing home ranges from $500 to $1,800 a month, depending on how sick the person is. 

The irony is that the less ill the elderly person, the cheaper it is to deposit him or her in a nursing home.

Throw in the subsidy, and it is no wonder that some would opt for a nursing home.

A poor family with an elderly person who is not very sick can leave the person at a nursing home for just $125 a month. The bottom line is obvious.

Then, there are the tax breaks.

To encourage married women to return to the workforce, they are allowed to offset double the amount of the maid levy against their taxable income. 

Mothers also get tax allowances for underaged or school-going children.

Those who support an elderly parent or grandparent in the same household get $5,000 tax relief. They get $8,000 if the parent is disabled. 

But those who leave the parent at a nursing home are still entitled to tax relief of $3,500 and $6,500, respectively - a difference of just $1,500.

How, then, to get around the problem?

Building more and more nursing homes to meet the higher demand is not the answer. 

Doing so will be a heavy drain on the nation, with the need for more infrastructure and people to do the job.

One solution is day care centres.

In 1996, Dr Aline Wong, the then-Senior Minister of State for Health, announced that the Government was committing $126 million for 15 nursing homes and only $3 million for nine day rehabilitation centres.

It's a pity money was not set aside for day care centres as well.

Just as working parents keep clamouring for more childcare facilities, those with sick or weak elderly parents need similar help.

To work, such places need to be priced attractively and provide cheap transport for the elderly, as not everyone here owns a car. At the upper end, paying for day care and transportation can set a family back by as much as $70 a day.

Couple this with subsidies for working people looking after elderly parents or grandparents, and they might be encouraged to keep the dependent elderly with the family.

In addition, more respite care services - where the elderly can be placed in homes for short periods of a few weeks - would help too.

The reason? Even the most devoted care giver needs time for himself, and should not be deprived of holidays simply because he has to look after elderly parents.

Finetuning such services would promote the 1999 recommendation by the Inter-Ministerial Committee on Health Care for the Elderly, which concluded that 'institutionalisation should only be a last resort'.

Finally, though many do not view financial incentives as the deciding factor, there is no doubt that they count.

So these incentives should be tailored to encourage families to keep their elderly members at home, where they are most comfortable, unlike the case now. 

Just as they are used to attract more married women back to the workforce as well as raise the birth rate, subsidies can help keep elderly parents at home.

Why expect people to be less financially motivated when it comes to the elderly than they are with child bearing?

After all, the Government set up the Eldercare Fund in 2000, with a capital of $2.5 billion, because it foresaw the need to help the elderly.

Interest from the fund was meant to help the elderly in nursing homes, community hospitals, hospices, day rehabilitation, home medical and home nursing care.

It is simply a matter of channeling that money towards a more family-oriented outcome.

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