# 馬善高陳述：未來十年將至少投入35億新元，支持社區養老

URL: https://www.shicheng.news/zh-hant/v/RZVEm
Published: 2024-04-06
Source: 獅城新聞

2024年3月6日，新加坡社會及家庭發展部長兼衛生部第二部長馬善高在國會答覆議員關於新加坡實施「樂齡SG」計劃，支持社區養老的舉措。

**以下內容為新加坡眼根據國會英文資料翻譯整理：**

社會及家庭發展部長兼衛生部第二部長馬善高：

主席，我感謝各位議員提出的問題和建議，我將從如何建設一個國人可以茁壯成長的新加坡開始陳述。一個強大的家庭是我們社區關懷生態系統的基石。它有助於確保孩子的健康，並且對支持我們的老年人健康老去至關重要。

老年人健康老去始於家庭，家庭應始終是關懷的第一堡壘。研究顯示，大多數老年人更傾向於在社區中與家人和朋友在一起老去。同樣，許多家庭都希望在家中照顧他們的親人。

為了支持這些願望，政府將在未來十年內至少投入35億新元，用於支持實施「樂齡SG」計劃，其中19億新元將用於衛生部的各項倡議。

「樂齡SG」是由衛生部、新加坡國家發展部、交通部，與人民協會、社會及家庭發展部等合作夥伴機構以及其他志願組織共同參與，旨在讓老年人與家人在社區一起過上充滿活力和富有意義的生活。

整個社區將共同努力實現「樂齡SG」計劃。

首先，我們將投資活躍樂齡站，讓老年人可以在社區安享晚年。

最終，我們希望老年人能夠與他們的朋友和家人保持聯繫和交流，這對於保持健康至關重要。我們希望老年人和他們的家人可以更容易地獲取社區提供的護理服務和資源。

活躍樂齡站正在擴展項目的質量和範圍，並調整其服務以滿足居住在附近的老年人的喜好。為了讓老年人更容易參與，大多的活躍樂齡站還將這些項目擴展到社區空間，例如人民協會的居民聯繫網（Residents' Network）。

我被告知老年人可以參加各種課程和活動，此外政府也推出能夠幫助老年人身心健康的項目。

以學習為例子。全國樂齡學苑在約60個活躍樂齡站提供多樣化的課程，涵蓋健康與保健、金融知識、資訊科技和科學等主題。還有一些課程是讓老年人掌握實用技能的，比如學習專業攝影或花藝。這些在活躍樂齡站舉辦的課程價格合理，其中約四分之三的課程符合技能創前程培訓補助。

葉漢榮先生詢問了我們在推出活躍樂齡站、外展工作，特別是針對可能處於社交孤立狀態的人，以及我們的倡議如何幫助促進代際交流的計劃。我將會解答這些問題。

我們正在擴大活躍樂齡站的「人脈」。自從實施了活躍樂齡站，我們的中心數量增長到157個，並且每年參與的老年人數量穩步增加——從2021年的17,000人增加到2022年的49,000人以上。我們將繼續努力，到2025年底將活躍樂齡站擴展到220個。這意味著到2025年，每十位老年人中就有八位將能夠在家附近參加活躍樂齡站的活動。不論老年人的房屋類型如何，活躍樂齡站將為他們提供服務。因此，如果你身邊有老年人，尤其是獨居的老年人，請鼓勵他們加入附近的活躍樂齡站。

其次，在「樂齡SG」計劃下，我們設想所有老年人都能在社區得到支持，無論他們是獨居還是與家人同住。社區的作用至關重要。我們已經在這項目開始了努力。關愛樂齡辦事處與志願者大使一起，通過家訪與過去四年中超過33萬名老年人進行了接觸，包括那些獨居或可能沒有家人的老年人。他們幫助老年人參與活躍樂齡站的社區活動，比如在社區一起堂食。

因此，除了參與活躍樂齡站的活動外，我們還希望老年人與他們的家人和朋友一起加入我們的行列，接觸社區的其他老年人。

讓我分享一下謝女士的故事。通過家訪和電話交流，謝女士在過去的八年里積極地接觸社區的其他老年人。謝女士表示，與她接觸這些人，現在這已經成為了她的朋友。她感到很不可思議，畢竟她自己已經是72歲的高齡了。

她的精神影響了周圍的人，現在她的女兒、孫女和女婿也加入了她的「團隊」。我們很高興看到謝女士在她的晚年做到了如此有意義的事情，而且他們的志願工作已經促進和加強了家人之間的聯繫。

我們希望我們的社區成為老年人與朋友聚集、保持活躍和健康的地方，從活躍樂齡站開始。

第三，我們希望老年人能夠輕鬆地在他們的社區周圍活動。

我們將加強我們的基礎設施。國家發展部和交通部將通過樂齡易計劃（EASE 2.0）、對選定的老舊街區進行升級以及交通部的「安行街道」，使我們的公寓、社區和街道更加適合老年人。我相信各位成員已經看到樂齡安全區和人行天橋的電梯為我們的老年人帶來了很多方便。

我們還將對家庭環境進行改進。陳有明醫生和葉漢榮先生可能會高興地注意到，我們還將引入室內摔倒探測器，為有老年人的家庭提供安心。

雖然我們希望老年人能夠在社區、與家人和朋友一起安享晚年，但我們也認識到，照顧有護理需求的老年人的家庭可能面臨額外的壓力。因此，我們將採取更多措施來支持這些家庭照顧老年人。

我們已經增加家庭醫療護理的途徑，並提高可負擔性。

如今，政府向家庭護理服務的受益者提供高達8成的家庭護理服務補貼，包括家庭醫療、家庭護理和家庭治療等服務。自2023年10月起，MediSave500/700和靈活保健儲蓄計劃已擴展至接受衛生部資助提供商提供的家庭醫療護理服務的居家患者。

陳有明醫生和佳馥梅女士詢問了超出醫療費用的議題。衛生部的主要重點是確保所有人都能夠負擔得起醫療服務。因此，我們的主流醫療補貼、終身健保、保健儲蓄、保健基金（S+3Ms）框架主要關注覆蓋急性護理、初級護理以及長期護理服務。

儘管如此，我們認識到照料護理所涉及的附加費用，以及健康和社會護理密切相關。因此，衛生部已針對性地設立了撥款計劃，以更好地支持家庭支付其他照料費用，特別是針對低收入人群。這包括醫療護送服務，幫助虛弱的老年人載到醫院接受治療，或到醫療老年護理中心、居家護理津貼計劃和樂齡助行基金。我們將繼續監督和審查。我們盡力幫助，但能夠覆蓋的範圍是有限的。擴大範圍將會進一步推高國家醫療支出，最終會給人民帶來更大的負擔。為了更好地支持社區的家庭和照料者，我們將改進現有的服務並試點新的護理模式，正如陳有明醫生、葉漢榮先生和郭獻川先生所建議的那樣。

我們正通過一項正在進行中的試點項目研究更多家庭護理選擇。在「HPC+」計劃下，老年人將得到日常活動的幫助，包括家務管理服務。

截至2024年1月，已有328名客戶參加了HPC+試點項目。我們將在2024年底評估該試點項目，然後確定是否將其擴展到全國範圍。

我們感謝郭獻川先生對共用看護沙盒計劃」（Shared Stay-in Senior Care Services Sandbox）的詢問，該計劃旨在減輕家庭規模縮小對家庭照料的影響。在這個計劃下，一個共享照料者將協助一組生活在公共或私人住宅區的老年人進行日常生活活動。這個沙盒計劃將至少持續一年，直到2025年第一季度。

衛生部將審查其結果，並在確定下一步行動時考慮郭獻川先生的反饋意見。我們將在確定後宣布下一步行動。

衛生部將引入標準化的護理評估，並逐步委任捆綁式服務提供者，以便老年人能夠享受護理服務。這將減少由不同的護理提供者進行多次評估和不必要的轉診的需要。

對於需要在養老院接受進一步護理的老年人，養老院安置的中位等待時間大約為一個月。在此期間，護聯中心會與老年人及其看護者密切合作，根據需要制定替代性的臨時護理安排。

這些努力將在一定程度上支持家庭和看護者。我們希望讓他們更容易地管理在家照料長輩所帶來的認知和身體負擔。這包括可能正在照料年邁家庭成員的老年看護者。

此外，我們將為看護者提供資源，以便他們在照料家人時得到支持。

自2023年11月以來，看護者也可以使用他們的技能創前程培訓補助參加符合資格的照看護者培訓課程。今年，我們將把現行的每年200新元的看護者培訓補助提高至每位受護者每年最高400新元，以補助由批准的培訓提供者開展的看護者培訓費用。通過這些計劃，看護者可以獲得更負擔得起、更易獲得的看護者培訓，幫助他們在社區中照料老年人。

我想向陳澮敏女士保證，看護者可以在社區中找到支持。

如今，看護者可以通過護聯中心的熱線和網站上提供的在線資源，以及Support-Go-Where門戶上的護理服務推薦器來獲取支持。

這些努力將在一定程度上支持家庭和看護者。我們希望讓他們更容易地應對在家照料長輩所帶來的認知和身體負擔。這包括可能正在照料年邁家庭成員的老年照看護者。

護聯中心還運營著為有心理健康需求的老年人和看護者提供支援的社區外展團隊和社區輔助小組。對於社會情感支持，看護者還可以利用由人民協會提供的看護者支援網絡和WIN看護者聯繫網。

主席，我們有一個雄心勃勃的願景，即將新加坡建設成一個老年人能夠安享晚年的社會。我們在社區推出計劃，使老年人能夠積極地過生活。我們正在各個社區投資基礎設施以及支援家庭照顧他們的老年人。但最終，關鍵在於「心」，每個人都要互相關心，幫助我們的老年人在社區過上充滿活力和充實的生活。

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以下是英文質詢內容：

**(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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