MERCENARY NURSING HOME OVERCHARGING ELDERLY PATIENTS FOR STANDARD CARE ITEMS

An Open Letter to the Prime Minister

Dear Mr Prime Minister

This open letter is a plea which, as an affected and concerned Singaporean, my following private attempts at lee_hsien_loong@pmo.gov.sg to surface issues of financial irregularities being experienced at one of the Private Nursing Homes under the Ministry of Health (MOH) portable subsidy scheme fell on deaf ears at the MOH:
- Subject: Mr Prime Minister, I did not manage to meet you on 30 April 2014 Meet-The-People session dated 6 May 2014; and
- Subject 1: MOH lied brazenly to the PMO QSM卫生部竟然对总理公署撒谎来掩盖包庇贪婪的受政府津贴安老院 and Subject 2: EM/14/May/00307 Feedback on UMC dated 29 June 2015.

I lost my beloved 88 year-old father on 23 March 2014 - four months after he was nursed at the Hospice in Bright Vision Hospital (BVH).
Between 28 January and 14 February 2013, my father was admitted to the acute hospital due to fever. Though he presented signs of weakening both physically and cognitively, my siblings and I did not want to give up hope of bringing him home with a foreign domestic helper to assist his daily living (as we had done between November 2009 and January 2013). Therefore we decided to transfer him to BVH on 14 February 2013 for slow stream rehabilitation…thinking hopefully that he may need more time to practice walking.

On 8 March 2013, during the family conference at BVH, my family was advised to accept the fact that professional nursing care at the nursing home was an optimal choice given my father’s gradually deteriorating medical conditions.

After the medical social worker at BVH submitted our application for a nursing home to the Agency for Integrated Care (AIC), I also explained (supported with my father’s specialist medical memo) the challenging situations we had undergone in my e-mail to the AIC on 8 April 2013. Barely two weeks later, the medical social worker at BVH informed me that the AIC had assigned my father to the United Medicare Centre (hereinafter referred to as “UMC” or “Home”) at Elizabeth Drive - a Private Nursing Home under MOH portable subsidy scheme.

Although it took me approximately three hours travelling to and fro visiting my father and UMC charged comparatively higher (which was beyond our budget) than the Voluntary Welfare Organisation (VWO) Nursing Homes receiving MOH subsidies, my siblings and I had no choice but to meticulously pool our resources and sent him to UMC because he truly needed proper medical care and attention. Plus, BVH needed to discharge him anytime. The medical social worker at BVH gave me the contact information of UMC and got me to liaise directly with the Home.

Between 24 April and 18 October 2013, my father was admitted to UMC. I paid S$180 per month for his diapers in addition to the fixed monthly maintenance fee of S$893. Later, the nursing director at UMC advised me that my father needed a reclining wheelchair. I immediately paid S$481.50 to acquire the prescribed wheelchair to ensure that he had the most effective therapy aid.

Between 10 and 26 August 2013 my father was admitted to the acute hospital due to high fever. According to UMC's Manager, I must pay for his fixed monthly maintenance fee during his hospitalisation leave because the Home reserved his bed! Ironically, MOH confirmed the same in its e-mail reply to me on 16 September 2013. Shortly thereafter, the following two sets of conventional MOH’s documents landed on my hands:

- The 65-page Provision of Subsidised Nursing Home Care Services (MH RFP 4 of 13); and
- Circular FCM 1-2013 “Funding for Bed Reservation for Home Leave” dated 4 February 2013 (3-page).

Having perused the 65-page MOH RFP and circular carefully, to my conundrum, my situation of predicament and anguish had been used to exploit me and others in the similar state, financially!

The contents of the four-page agreement I signed with UMC contradict the Clauses stipulated in the said two sets of MOH’s documents, particularly:
- the consumables such as diapers and therapy aid such as wheelchair I had paid in addition to the fixed monthly maintenance fee imposed by UMC actually come under LIST OF STANDARD SERVICES FOR NURSING HOMES per the MOH RFP ANNEX E-2 page 54 Clause B “Medical Equipment, Supplies and Medication”; and
- between 10 and 26 August 2013 and from 19 October to 13 November 2013 when my father was admitted to the acute hospital for emergency treatments, MOH’s funding shall take effect to defray a subsidised elderly’s fixed monthly maintenance fee. This means that my father should not have been charged for his fixed monthly maintenance fee at UMC because in page one, paragraph one of MOH circular FCM 1-2013, it states that “Nursing Homes typically reserve beds for the period that patients are hospitalised or on home leave. Since Jul 2010, MOH has been providing funding for bed reservation when patients go on hospitalisation leave”! This directive is in absolute congruence with MOH RFP page 62, Clause 18 (a) “Proposed patient charges on an average daily basis”.

In due compliance with the said conventional MOH’s documents, UMC had overcharged my father a sum of S$3,678.52 between 24 April and 18 October 2013!
Mr Prime Minister, following what have been outlined above together with my detailed justifications and all the concrete/factual supporting documents aggregate to more than 25 megabytes attached in my two e-mails to you, I like to think that you are just waiting for the right time to step in and step up, and show Singaporeans (especially the uninformed subsidised elderlies) and the world your zero tolerance for wrongdoing - in this instance, the financial lapses in the Private Nursing Homes under MOH portable subsidy scheme.

Although you did not elaborate to Singaporeans during the very difficult trying periods when you managed your elderly parents who were weakening gradually... from my personal experience with my father, I have no doubt that from the bottom of your heart, you truly apprehend every challenging circumstance facing the frail elderly Singaporeans and their family members/caregivers in that they have to cope with their emotional vulnerability of the apparently unpredictable medical conditions. In addition to their psychological stress, they also must ensure their continuous stable employments in order to make ends meet.

As Singaporeans and the world shared your grief on the passing of your late parents particularly on 23 March 2015 when you silently wept while announcing the passing of our founding Prime Minister, the late Mr Lee Kuan Yew - all we saw was a warm, affectionate and filial son who had just lost his loving Papa and not solely as a leader of Singapore... The emotive pictures captured along the way where you were connecting and interacting with the elderly Singaporeans that you posted to your Facebook further manifested your compassion and loving kindness towards the vulnerable Elderlies in our inclusive society... Based on these observations, I have every reasonable ground to believe that a man with such a caring heart will not just simply sit back and allow the unjust mercenary to continue concealing under the mask of a sympathetic nursing home operator in order to mislead our susceptible elderlies!

I must say that the Private Nursing Homes under MOH portable subsidy scheme is a commendable initiative by the government and I was impressed with the speed at which your government announced and implemented the national healthcare subsidy for our Senior Citizens. However, I cannot say that the implementation of the said subsidy scheme has indeed achieved its desired effects following my experience of various non-compliances committed by UMC as emphasised above. And, I earnestly reckon that we can restore the integrity of the said subsidy scheme that you have fastidiously implemented with a determined objective of benefiting our needy elderly Singaporeans.
Mr Prime Minister, I have due faith in the watch of your esteemed leadership in that all the uninformed subsidised elderlies who should be benefiting from what the state orginally intended to grant them will eventually receive their full entitlements. And, the investigative authority will bring all the Private Nursing Homes under MOH portable subsidy scheme that have violated the MOH RFP and circular (include but are not limited to), manipulated the trust of the state, ripped financial advantages off the uninformed subsidised elderlies and our country’s taxpayers’ money will be dealt with swiftly, transparently, objectively and appropriately in accordance with Clause 20 in page 63 of the MOH RFP.

Yours sincerely and respectfully
Kezia Tay