INTERMEDIATE AND LONG-TERM CARE IN SINGAPORE

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1 MOH Information Paper: 2006/ 014 INTERMEDIATE AND LONG-TERM CARE IN SINGAPORE By Integrated Health Services Division and Healthcare Finance Division ABSTRACT This paper outlines the different types of intermediate and long-term care (ILTC) residential facilities in Singapore, and provides information on the bed situation and charges in these facilities. This would allow Singaporeans to make more informed decisions on where to seek care when they require it. It would also provide the ILTC industry with comparative benchmarks and clearer market signals so as to facilitate the provision of services to meet the needs of Singaporeans. INTRODUCTION 2 Singapore has an ageing population. It is projected that the number of residents aged 65 years or older will increase threefold from the current 300,000 to 900,000 by The majority of older people lead healthy and independent lives. However, there are some who require skilled nursing or rehabilitation services after they are discharged from acute hospitals. Residential ILTC facilities serve this need. based and community-based services such as home nursing and day rehabilitation centres are also part of ILTC services. These services help the older person to agein-place in his home for as long as appropriate. ILTC RESIDENTIAL FACILITIES 4 There are three different types of residential ILTC facilities available Community Hospitals, Chronic Sick Hospitals and Nursing s for the Elderly. These facilities are either managed privately or by Voluntary Welfare Organisations (VWOs). MOH provides subsidies to needy persons who require ILTC services at these facilities. To ensure that subsidies benefit those who require it most, all persons who wish to receive MOH subsidies have to undergo means testing 1. 1 There are currently three levels of subsidy - 75%, 50% or 25%. The subsidy will be paid directly to the ILTC providers, and this amount will be reflected in the patients bills.

2 Community Hospitals 5 Community Hospitals are intermediate care facilities. They cater to patients who are fit for discharge from acute hospitals but require inpatient convalescent and rehabilitative care. Chronic Sick Hospitals 6 Chronic Sick Hospitals provide skilled nursing and medical care on a longterm basis to older persons with advanced, complicated medical conditions. Nursing s for the Elderly 7 Nursing s for the Elderly provide long-term skilled nursing care for older persons. These older persons do not have families or caregivers to look after them at home, or the caregiver is unable to provide the level of nursing care required. 8 Table 1 below provides a breakdown of VWO and private sector Nursing s and the numbers receiving MOH subsidies. Table 1: Number of Nursing s by Operator and MOH Subsidy Status Nursing Operator Total number of nursing homes No. of nursing homes receiving MOH subsidies / MOH portable subsidies VWO Nursing s Private Nursing s 31 8 a. VWO Nursing s receiving MOH subsidies Patients who meet the means test criteria are referred by Integrated Care Services 2 (ICS) to VWO Nursing s which receive MOH subsidies. The VWOs provide additional support if the patient requires further financial and social assistance. b. VWO Nursing s that do not receive MOH subsidies Some VWO-operated Nursing s are self-funded through their own fundraising and do not receive MOH subsidies. Although patients here are not subsidised by MOH, these VWOs are able to provide the necessary financial and social assistance to patients who are unable to afford the Nursing fees. c. Private Nursing s which are under MOH portable subsidy scheme Since April 2003, MOH has extended subsidies to patients who meet the means test criteria and are admitted to accredited Private Nursing s. These homes have set aside a certain proportion of their beds for patients who are eligible for MOH subsidies and referred by ICS. This allows for greater private sector participation in the provision of MOH-subsidised care. d. Private Nursing s which are not under the MOH portable subsidy scheme These are Private Nursing s, which cater to full-paying patients. 2 Integrated Care Services (ICS) is the coordinating agency which facilitates referrals to Nursing s receiving subsidies from MOH. 2

3 9 A summary of the characteristics of the various residential ILTC services are summarised in Table 2 below: Table 2: Characteristics of ILTC Institutions Type of ILTC Institution Placement by ICS Long-term care (> 1 month) Additional financial aid by ILTC institution Medisave Claimable Institutions receiving MOH subsidies Community Hospital Chronic Sick Hospital VWO Nursing Private Nursing (under portable subsidies scheme) Institutions that do not receive MOH subsidies Chronic Sick Hospital VWO Nursing Private Nursing ILTC BED SITUATION 10 Table 3 below shows the number of licensed beds and residents in the various residential ILTC institutions: Table 3: Bed Situation in ILTC institutions Type of ILTC Institution Number Licensed Beds Residents Community Hospitals Chronic Sick Hospitals* VWO Nursing s (receiving MOH subsidies) VWO Nursing s (without MOH subsidies) Private Nursing s (receiving MOH portable subsidies) Private Nursing s * Inclusive of the VWO which is not receiving MOH subsidies. 11 Annexes A, B and C provide detailed information on the bed situation at each of the various institutions. ILTC CHARGES 12 The following section features a comparison of charges for ILTC institutions 3. To ensure a like-for-like comparison, the charges compared are for nonsubsidised patients in VWO and private sector establishments. Patients who are subsidised (either by MOH and/or VWOs) can expect to pay significantly less than the charges tabulated. Community Hospitals and Chronic Sick Hospitals 3 The charges were obtained through a survey of ILTC institutions. Institutions that are not featured did not respond to the survey. 3

4 13 Annexes D and E provide a comparison of the following charges for nonsubsidised patients at Community Hospitals and Chronic Sick Hospitals: a) Ward Charges b) Treatment Fees c) Average Bill 4 d) Refundable Deposit e) Administrative Charges 14 Charges vary not only across different institutions, but also for different bedtypes within individual institutions. There is also a tendency for charges to be higher for the more private bed-types. II. Nursing s for the Elderly 15 Annex F provides a comparison of the following charges for non-subsidised patients at Nursing s: a) Ward Charges b) Deposits c) Administrative Charges 16 Unlike Community Hospitals and Chronic Sick Hospitals, charges for Nursing s vary not only according to bed type, but also according to patients nursing care 'Category' (i.e. Categories I-IV). The nursing care category provides an indicator of the skilled nursing care required by individual patients, with Category IV needing the most care, and Category I, the least care. 17 In addition, the items included under Ward Charges vary from institution to institution. Annex G features a comparison of items included under Ward Charges for each institution. FUTURE PLANS FOR RESIDENTIAL ILTC FACILITIES 18 An additional 124 Community Hospital beds will be available when the new Ren Ci Community Hospital is ready in The private sector has the flexibility to develop ILTC services based on their assessment of the market demand. Two new stand-alone and purpose-built Private Nursing s are in their construction stages. They will add more than 500 extra Private Nursing beds when completed. REGULAR UPDATES 20 ILTC services will continue to evolve in response to the changing needs of Singaporeans. MOH will regularly update the information on the ILTC bed situation 4 Average Bill is inclusive of Ward Charges and Treatment Fees. 4

5 and charges to ensure that patients and the industry will be able to continue to benefit from this information. NB: Please refer to MOH website for latest version 5

6 Annex A Information on Community Hospitals (as at 30 Sep 06) Number of Number of Licensed Beds Patients 1 ANG MO KIO - THYE HUA KWAN HOSPITAL LTD BRIGHT VISION HOSPITAL ST ANDREW S COMMUNITY HOSPITAL ST LUKE'S HOSPITAL LTD* *Footnotes St. Luke's Hospital Ltd closed 8 beds for upgrading work. 6

7 Annex B Information on Chronic Sick Hospitals (as at 30 Sep 06) Number of Number of Licensed Beds Patients 1 BRIGHT VISION HOSPITAL KWONG WAI SHIU HOSPITAL AND NURSING HOME (KWSH)* 3 REN CI HOSPITAL & MEDICARE CENTRE (JALAN TAN TOCK SENG) 4 REN CI HOSPITAL & MEDICARE CENTRE (HOUGANG) 5 ST LUKE'S HOSPITAL LTD* 18 9 *Footnotes Kwong Wai Shiu Hospital and Nursing o Does not receive MOH subsidies o Uses 50 beds flexibly as community hospital, chronic sick hospital and hospice beds St Luke's Hospital Ltd closed 3 beds due to upgrading work. 7

8 Information on VWO Nursing s Receiving MOH Subsidies (as at 4 Sep 2006) Number of Licensed Beds Annex C -1 Number of Residents 1 ALL SAINTS HOME (TAMPINES) APEX HARMONY LODGE ASSISI HOME & HOSPICE BETHANY METHODIST NURSING HOME BRIGHT HILL EVERGREEN HOME* BRIGHT VISION HOSPITAL GRACE LODGE JAMIYAH NURSING HOME (DARUL SYIFAA) JU ENG HOME FOR SENIOR CITIZENS LING KWANG HOME FOR SENIOR CITIZENS LIONS HOME FOR THE ELDERS (BEDOK) LIONS HOME FOR THE ELDERS (TOA PAYOH) MAN FUT TONG NURSING HOME PEACEHAVEN NURSING HOME* REN CI HOSPITAL & MEDICARE CENTRE (JALAN TOCK SENG) SINGAPORE CHRISTIAN HOME FOR THE AGED SOCIETY FOR THE AGED SICK SREE NARAYANA MISSION HOME FOR THE AGED SICK ST JOSEPH'S HOME ST THERESA'S HOME SWAMI HOME THONG TECK HOME FOR SENIOR CITIZENS VILLA FRANCIS HOME FOR THE AGED * Footnotes Bright Hill Evergreen closed 46 beds for renovation works. Peacehaven Nursing 's 34-bedded dementia hostel ward opened in May

9 Information on VWO Nursing s Not Receiving MOH Subsidies (as at 4 Sep 2006) Annex C -2 Number of Licensed Beds Number of Residents 1 ALL SAINTS HOME (HOUGANG) KWONG WAI SHIU HOSPITAL AND NURSING HOME MORAL HOME FOR THE AGED SICK TAI PEI OLD PEOPLE'S HOME THIAN LENG OLD FOLKS HOME Information on Private Nursing s under MOH portable subsidy scheme (as at 4 Sep 2006) Number of Licensed Beds Number of Residents 1 EAST COAST MEDICARE CENTRE PTE LTD ECON MEDICARE CENTRE PTE LTD (UPPER EAST COAST) 3 NIGHTINGALE NURSING HOME PTE LTD ORANGE VALLEY NURSING HOME (CLEMENTI) ORANGE VALLEY NURSING HOME (SIMEI)* PACIFIC HEALTHCARE NURSING HOME PTE LTD THE LENTOR RESIDENCE UNITED MEDICARE CENTRE * Footnotes Orange Valley Nursing (Simei) is a new nursing home which was licensed in April

10 Annex C -3 Information on Private Nursing s Not under MOH portable subsidy scheme (as at 4 Sep 2006) Number of Licensed Beds Number of Residents 1 CHERRY NURSING HOME PTE LTD EAST SHORE RESIDENCE ECON MEDICARE CENTRE PTE LTD (BRADDELL) ECON MEDICARE CENTRE PTE LTD (CHAI CHEE) ECON MEDICARE CENTRE PTE LTD (CHOA CHU KANG) ECON NURSING HOME SERVICES (1987) PTE LTD (BUKIT TIMAH) 7 ECON NURSING HOME SERVICES (1987) PTE LTD (BUANGKOK)* GREENVIEW NURSING HOME (S) PTE LTD IRENE NURSING HOME PTE LTD LEE AH MOOI OLD AGE HOME MARGARET CHIO NURSING HOME PTE LTD MIN CHONG COMFORT HOME PTE LTD MOONLIGHT HOME FOR THE AGED AND HANDICAPPED ORANGE VALLEY NURSING HOME (BIGGIN HILL) ORANGE VALLEY NURSING HOME (BUKIT MERAH) ORANGE VALLEY NURSING HOME (THOMSON)* OUR LADY OF LOURDES NURSING HOME PTE LTD PAEAN NURSING HOME PTE LTD SERENE NURSING HOME PTE LTD SOO'S NURSING HOME PTE LTD SUNNYVILLE NURSING HOME (1996) PTE LTD WINDSOR CONVALESCENT HOME PTE LTD WINDSOR NURSING HOME PTE LTD * Footnotes Econ Nursing Services Pte Ltd (Buangkok) is a new nursing home which was licensed in May Orange Valley Nursing (Thomson) is a new nursing home which was licensed in August

11 Information on Community Hospital Charges [Charges quoted are for unsubsidised patients and are inclusive of Goods & Services Tax (GST)] Note: Ward Charges, Treatment Fees and Average Bills are monthly figures Annex D Charge Category Ward Charges Treatment Fees Average Bill Institution Wards (By Bed Type) 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8 bedded Others Air-con Air-con Air-con Air-con w/o Air-con w/o Air-con w/o Air-con Ang Mo Kio - Thye $7,500 $4,950 $1,890 $1,290 $840 $2,370 1 Hua Kwan Hospital Ltd Kwong Wai Shiu $1,800 Hospital and Nursing St Andrew's Community Hospital $1,512 (Ward charges and Treatment fees) 2 St Luke's Hospital Ltd $4,725 $4,095 $3,465 $2,520 $1,890 Ang Mo - Thye Hua $1,590 $1,590 $870 $660 $540 $990 1 Kwan Hospital Ltd Kwong Wai Shiu $1,131 Hospital and Nursing St Andrew's Community Hospital Included in ward charges 2 St Luke's Hospital Ltd $1,575 $1,575 $1,575 $1,575 $1,575 Ang Mo Kio-Thye Hua $10,740 $8,640 $3,900 $2,850 $2,040 $4,710 1 Kwan Hospital Ltd 3 Kwong Wai Shiu $2,100 Hospital and Nursing St Andrew's Community Hospital 3 $2, St Luke's Hospital Ltd $7,781 $7,151 $6,521 $2,772 $2,079 4

12 Charge Category Refundable Deposit Institution Wards (By Bed Type) 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8 bedded Others Air-con Air-con Air-con Air-con w/o Air-con w/o Air-con w/o Air-con Ang Mo Kio-Thye Hua $7,240 $5,140 $410 $100 $100 $1,210 1 Kwan Hospital Ltd 5 Kwong Wai Shiu Hospital and Nursing $100 (with Medisave) $300 (without Medisave) St Andrew's $100 Community Hospital 6 St Luke's Hospital Ltd $2,500 $2,000 $1,700 $1,000 $500 Administration Fees Ang Mo Kio-Thye Hua Kwan Hospital Ltd Kwong Wai Shiu Hospital and Nursing St Andrew's Community Hospital* $13.65 (per admission for CPF transmission fee) St Luke's Hospital Ltd 1 5-bedded (Air con) 2 Ward charges are combined with treatment Fees 3 Average Bill for that particular ward (bed type) includes both and treatment fees. 4 Average Bill size includes ward charge, treatment fees- therapy treatment, medications both standard and non-standard, laboratory and diapers. 5 Deposit for patients with Medisave. Figures differ for patients without Medisave. 6 Deposit is for Administrative and Ambulance charges : Not applicable 12

13 Annex E Information on Chronic Sick Hospital Charges [Charges quoted are for unsubsidised patients and are inclusive of Goods & Services Tax (GST)] Note: Ward Charges, Treatment Fees and Average Bills are monthly figures Charge Category Ward Charges Treatment Fees Institution Kwong Wai Shiu Hospital and Nursing Ren Ci Hospital and Medicare Centre St Luke's Hospital Ltd Kwong Wai Shiu Hospital and Nursing Ren Ci Hospital and Medicare Centre St Luke's Hospital Ltd Wards (By Bed Type) 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8 bedded Others Air-con Air-con Air-con Air-con w/o Air-con w/o Air-con w/o Air-con $1,200 $2,850 to $2,945 ($95 per day) $4,725 $4,095 $3,465 $2,520 $1,890 $339 $1,260 $1,260 $1,103 $1,103 $1,103 Average Bill Kwong Wai Shiu $1,539 Hospital and Nursing Ren Ci Hospital and $3,030 to Medicare Centre 1 $3,131 ($101 per day) St Luke's Hospital $6,395 $5,765 $4,977 $2,741 $1,922 Ltd 2 13

14 Charge Category Refundable Deposit Institution Kwong Wai Shiu Hospital and Nursing Ren Ci Hospital and Medicare Centre Wards (By Bed Type) 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8 bedded Others Air-con Air-con Air-con Air-con w/o Air-con w/o Air-con w/o Air-con $1,800 >$600 3 St Luke's Hospital Ltd $2,500 $2,000 $1,700 $1,000 $500 1 Average Bill for that particular ward (bed type) includes both and treatment fees and consumable items 2 Average Bill size includes ward charge, treatment fees- non standard medication, consumables, diapers and enteral feeds. 3 Based on estimated length of stay : Not applicable 14

15 Annex F Table 1 Information on Nursing Charges- Category 1 [Charges quoted are for unsubsidised patients and are inclusive of Goods & Services Tax (GST)] Note: Ward Charges are monthly figures and are inclusive of Bed, Laundry, Housekeeping, Meals, Nursing care & Activities of Daily Living (ADL) assistance. Institution Ward Charges (By Bed Type) Deposits 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8-bedded Others ^ Refundable Nonrefundable VWO Nursing s All Saints (Tampines) All Saints (Hougang) Apex Harmony Lodge Administrative Charges $2,100 $1,680 $2,200 1 $250 2 $2,415 $1,890 $1,575 $1,365 1 month ward charges and $300 3 $263 $3,600 $2,200 $1,500 (5 bedded) 2 months $500 Bright Hill Evergreen Jamiyah Nursing Ju Eng For Senior Citizens Kwong Wai Shiu Hospital and Nursing Lions for the Elders Man Fut Tong Nursing $200-$600 (23 bedded) 1 month $800 $800 2 months $2,500 $1,800 $1,500 $1,600 (3 bedded) 2 months $200 $300 $450 $1,300 $1,300 (6-8 bedded) 1 month and $200 4 $325 $2,500 $2,000 $1,500 $1,500 $

16 Institution Ward Charges (By Bed Type) Deposits 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8-bedded Others ^ Refundable Nonrefundable Moral for the Aged Sick Ren Ci Hospital and Medicare Centre Sree Narayana Mission for the Aged Sick St Joseph's Administrative Charges $1,500 $400 to $1,100 $400 to $1,100 $400 to $1,100 2 months $500 $1,950 >$600 6 to $2,015 ($65 per day) $1,500 $440 7 $50 8 $150 $700 $500 SWAMI $2,100 $1,890 $1,680 $1,575 1 month Tai Pei Old People's Thian Leng Old Folks Villa Francis for the Aged Private Nursing s Cherry Nursing Pte Ltd $650 $800 $800 $500 $700 1 month $950 $500 $500 East Coast Medicare Centre East Shore Residence The Lentor Residence Margaret Chio Nursing $3,200 $2,400 $1,650 $1,360 1 month $4,988 $3,413 $2,888 (5 bedded) 1 month $2,730 $1,680 $1,155 2 months $600 $525 $945 9 $700 $700 $700 $ $100-$

17 Institution Ward Charges (By Bed Type) Deposits 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8-bedded Others ^ Refundable Nonrefundable Moonlight for the Aged and Handicapped Our Lady of Lourdes Nursing Pacific Healthcare Nursing Paean Nursing Soo's Nursing Windsor Nursing Administrative Charges $1,000 $500 $1,200 $1,100 $900 $500 $250 $1,680 $1,365 $1,050 1 month $700 $700 $700 $ $100-$ $1,200 $1,100 $1,100 $1,500 $1,200 $1,000 $200 $ month and medical deposits 2 Nurse assessment & clerk charges 3 Medical Fees 4 For medication 5 To cover service costs incurred by the MSW, Business Office, Medical, Nursing, Rehab and Admin Depts from time of referral to assessment and admission. 6 Based on estimated length of stay 7 Medical $200, Bed $ st medical consultation 9 Effective for lifetime 10 In case of delayed payment and ambulance services 11 Doctor's consultation, blood & urine tests : Not applicable $630 17

18 Table 2 Information on Nursing Charges- Category 2 [[Charges quoted are for unsubsidised patients and are inclusive of Goods & Services Tax (GST)] Note: Ward Charges are monthly figures and are inclusive of Bed, Laundry, Housekeeping, Meals, Nursing care & Activities of Daily Living (ADL) assistance. Institution VWO Nursing s All Saints (Tampines) All Saints (Hougang) Apex Harmony Lodge Bethany Methodist Nursing Bright Hill Evergreen Jamiyah Nursing Ju Eng For Senior Citizens Kwong Wai Shiu Hospital and Nursing Ling Kwang for Senior Citizens Ward Charges (By Bed Type) Deposits 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8-bedded Others Refundable Nonrefundable Administrative Charges $2,205 $1,785 $2,300 1 $250 2 $2,415 $1,890 $1,575 $1,365 1 month and $300 3 $3,600 $2,200 $1,500 (5 bedded) $797 (Dormitory) $200 to $600 (20 bedded open ward) 2 months $263 $500 $1,594 $ month $1,000 $1,000 2 months $2,500 $1,800 $1,500 $1,600 2 months (3 bedded) $200 $300 $600 $1,200 $1,000 $1,000 5 $

19 Institution Lions for the Elders Man Fut Tong Nursing Moral for the Aged Sick Peacehaven Nursing Ren Ci Hospital and Medicare Centre Society For The Aged Sick Sree Narayana Mission for the Aged Sick St Joseph's SWAMI Tai Pei Old People's Thian Leng Old Folks Ward Charges (By Bed Type) Deposits Administrative 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8-bedded Others Refundable Nonrefundable Charges $350 $1400 $1400 (6-8 bedded ward) 1 month and $200 7 $2,500 $2,000 $1,500 $1,500 $300 8 $1,500 $400 to $1,100 $400 to $1,100 $400 to $1,100 2 months $1,617 1 month and $100 9 $1950 to $2015 ($65 per day) $500 >$ $636 $636 $1,500 $ $50 12 $150 $900 $500 $2,100 $1,890 $1,680 $1,575 1 month $650 $850 to $900 $850 to $900 $500 19

20 Institution Thong Teck for Senior Citizens Villa Francis for the Aged Private Nursing Cherry Nursing East Coast Medicare Centre East Shore Residence The Lentor Residence Margaret Chio Nursing Moonlight for the Aged and Handicapped Our Lady of Lourdes Nursing Pacific Healthcare Nursing Paean Nursing Soo's Nursing Ward Charges (By Bed Type) Deposits 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8-bedded Others Refundable Nonrefundable $1,200 Half month ward charges $900 1 month Administrative Charges $1,000 $500 $500 $3,200 $2,400 $1,650 $1,360 1 month $4,988 $3,413 $2,888 (5 bedded) 1 month $2,730 $1,680 $1,155 2 months $600 $525 $ $800 $800 $800 $ $100-$ $1,000 $500 $1,200 $1,100 $950 $500 $250 $2,100 $1,575 $1,344 1 month $630 $800 $800 $800 $ $100 to $ $1,200 $1,100 $1,100 20

21 Institution Windsor Convalescent Windsor Nursing Ward Charges (By Bed Type) Deposits Administrative 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8-bedded Others Refundable Nonrefundable Charges $1,500 $1,200 $1,000 $900 $200 $400 (Open ward) $1,500 $1,200 $1,000 $200 $400 1 One month and medical deposits 2 Nurse assessment & clerk charges 3 Doctor s fee 4 Payable if patient is discharged within 1 month; waived for stays over 1 month. 5 Excluding respite care 6 Uniforms, various professional assessments 7 For medication 8 To cover service costs incurred by MSW, Business Office, Medical, Nursing, Rehab and Admin Depts from time of referral to assessment and admission. 9 For Medical apt 10 Based on estimated length of stay 11 Medical $200, Bed $ st medical consultation 13 Effective for lifetime 14 In case of delayed payment and ambulance services 15 Doctor's consultation, blood & urine tests : Not applicable 21

22 Table 3 Information on Nursing Charges- Category 3 [Charges quoted are for unsubsidised patients and are inclusive of Goods & Services Tax (GST)] Note: Ward Charges are monthly figures and are inclusive of Bed, Laundry, Housekeeping, Meals, Nursing care & Activities of Daily Living (ADL) assistance. Institution VWO Nursing s All Saints (Tampines) All Saints (Hougang) Apex Harmony Lodge Ward Charges (By Bed Type) 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8- bedded Deposits Others ^ Refundable Nonrefundable Administrative Charges $2,310 $1,890 $2,400 1 $250 2 $2,415 $1,890 $1,575 $1,365 1 month and $300 3 $3,600 $2,200 $1,500 (5 bedded) 2 months $263 $500 Bethany Methodist Nursing Bright Hill Evergreen Jamiyah Nursing Ju Eng For Senior Citizens Kwong Wai Shiu Ling Kwang For Senior Citizens $1070 (Dormitory) $200-$600 (23 bedded open ward) 2 months 1 month $1,200 $1,200 2 months $2,500 $1,800 $1,500 $1,600 2 months ward (3 bedded) charges $32 4 $200 $300 $750 $1,500 $1,100 $1,100 5 $

23 Institution Lions For The Elders Man Fut Tong Nursing Moral for the Aged Sick Peacehaven Nursing Ren Ci Hospital and Medicare Centre Singapore Christian for the Aged Society For The Aged Sick Sree Narayana Mission For The Aged Sick St Joseph's Ward Charges (By Bed Type) 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8- bedded $1500 $1500 (6-8 bedded ward) Deposits Others ^ Refundable Nonrefundable 1 month and $200 7 Administrative Charges $375 $2,500 $2,000 $1,500 $1,500 $300 8 $1,500 $400 to $1,100 $400 to $1,100 $400 to $1,100 2 months $500 $1,848 1 month and $100 9 $1950 >$ to $2015 ($65 per day) $1,200 (Open ward) 1 month $836 $836 $1,500 $ $50 12 $150 $1,200 $500 St Theresa s * months SWAMI $2,100 $1,890 $1,680 $1,575 1 month Tai Pei Old People s $800 23

24 Institution Thian Leng Old Folks Thong Teck For Senior Citizens Villa Francis For The Aged Private Nursing s Cherry Nursing Ward Charges (By Bed Type) 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8- bedded $950 to $1,000 Deposits Others ^ Refundable Nonrefundable $950 to $1,000 $1,400 Half month's (Estimated at $700) $1,200 1 month Administrative Charges $500 $1,000 $500 $500 East Coast Medicare Centre East Shore Residence The Lentor Residence Margaret Chio Nursing Moonlight for the Aged and Handicapped Our Lady of Lourdes Nursing Pacific Healthcare Nursing Paean Nursing $3,200 $2,400 $1,650 $1,360 1 month $600 $4,988 $3,413 $2,888 (5 bedded) 1 month $525 $2,730 $1,680 $1,155 2 months $ $900 $900 $900 $ $100 to $ $1,000 $500 $1,200 $1,100 $1,000 $500 $250 $2,940 $1,974 $1,470 1 month $630 $900 $900 $900 $ $100 to $

25 Institution Soo's Nursing Pte Ltd United Medicare Centre Windsor Convalescent Windsor Nursing Ward Charges (By Bed Type) 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8- bedded Deposits Others ^ Refundable Nonrefundable Administrative Charges $1,400 $1,200 $1,200 $1,890 $1,785 $1,900 $840 $1,500 $1,200 $1,000 $900 (Open ward) $200 $400 $1,500 $1,200 $1,000 $200 $400 1 One month charges and medical deposits 2 Nurse assessment & clerk charges 3 Doctors fees 4 Payable when patient discharged within 1 month stay; waived for stays over 1 month 5 Excluding respite care 6 Uniforms, various professional assessments 7 Medication 8 To cover service costs incurred by MSW, Business Office, Medical, Nursing, Rehab and Admin Depts from time of referral to assessment and admission. 9 For Medical apt 10 Based on estimated length of stay 11 Medical $200, Bed $ st medical consultation 13 Effective for lifetime 14 In case of delayed payment and ambulance services 15 Doctor's consultation, blood & urine tests : Not applicable 25

26 Table 4 Information on Nursing Charges- Category 4 [Charges quoted are for unsubsidised patients and are inclusive of Goods & Services Tax (GST)] Note: Ward Charges are monthly figures and are inclusive of Bed, Laundry, Housekeeping, Meals, Nursing care & Activities of Daily Living (ADL) assistance. Institution Ward Charges (By Bed Type) Deposits 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8-bedded Others ^ Refundable Nonrefundable VWO Nursing s All Saints (Tampines) All Saints (Hougang) Apex Harmony Lodge Administrative Charges $2,415 $1,995 $2,500 1 $250 2 $2,415 $1,890 $1,575 $1,365 1 month and $300 3 $3,600 $2,200 $1,500 (5 bedded) 2 months $263 $500 Bethany Methodist Nursing Bright Hill Evergreen Jamiyah Nursing Ju Eng For Senior Citizens Kwong Wai Shiu Hospital and Nursing Ling Kwang For Senior Citizens Lions for the Elders $1,581 (Dormitory) $200-$600 (23 bedded open ward) 2 months 1 month $1,600 $1,600 2 months $2,500 $1,800 $1,500 $1,600 (3 bedded) 2 months $32 4 $200 $300 $900 $1,800 $1,300 $1,300 5 $300 6 $2000 $2000 (6-8 bedded ward) 1 month and $200 7 $500 26

27 Institution Ward Charges (By Bed Type) Deposits 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8-bedded Others ^ Refundable Nonrefundable Man Fut Tong Nursing Administrative Charges $2,500 $2,000 $1,500 $1,500 $300 8 Moral For The Aged Sick $1,500 $400 to $1,100 $400 to $1,100 $400 to $1,100 2 months $500 Peacehaven Nursing Ren Ci Hospital and Medicare Centre Singapore Christian for the Aged Society For Aged Sick Sree Narayana Mission For The Aged Sick St Joseph's $2,079 1 month plus $100 9 $1950 to $2015 ($65 per day) $1,000 (Open ward) >$ month $1,200 $1,200 $1,500 $ $50 12 $150 $1,650 $500 St Theresa s $0 - $ months SWAMI $2,100 $1,890 $1,680 $1,575 1 month Tai Pei Old People s Thian Leng Old Folks Thong Teck for Senior Citizens $900 $1050 to $1200 $1,050 to $,1200 $1,600 Half month's (Estimated at $800) $500 27

28 Institution Ward Charges (By Bed Type) Deposits 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8-bedded Others ^ Refundable Nonrefundable Villa Francis for the Aged Private Nursing s Cherry Nursing East Coast Medicare Centre East Shore Residence The Lentor Residence Margaret Chio Nursing Moonlight For The Aged and Handicapped Our Lady of Lourdes Nursing Pacific Healthcare Nursing Paean Nursing Soo's Nursing United Medicare Centre $1,650 1 month Administrative Charges $1,000 $500 $500 $3,200 $2,400 $1,650 $1,360 1 month $4,988 $3,413 $2,888 1 month 5 bedded $2,730 $1,680 $1,155 2 months $600 $525 $ $1,000 $1,000 $1,000 $ $100 to $ $1,000 $500 $1,200 $1,100 $950 $500 $250 $2,100 $1,575 $1,344 1 month $630 $1,000 $1,000 $1,000 $ $100 to $ $1,200 $1,100 $1,100 $1,995 $1,890 $2,000 $840 Windsor Convalescent Windsor Nursing $1,500 $1,200 $1,000 $900 (Open ward) $200 $400 $1,500 $1,200 $1,000 $200 $400 28

29 Institution Ward Charges (By Bed Type) Deposits 1-bedded 2-bedded 4-bedded 6-bedded 8-bedded > 8-bedded Others ^ Refundable Nonrefundable 1 One month charges and medical deposits 2 Nurse assessment & clerk charges 3 Doctors fees 4 Payable when patient discharged within 1 month stay; waived for stays over 1 month 5 Excluding respite care 6 Uniforms, various professional assessments 7 Medication 8 To cover service costs incurred by MSW, Business Office, Medical, Nursing, Rehab and Admin Depts from time of referral to assessment and admission. 9 For Medical apt 10 Based on estimated length of stay 11 Medical $200, Bed $ st medical consultation 13 Effective for lifetime 14 In case of delayed payment and ambulance services 15 Doctor's consultation, blood & urine tests : Not applicable Administrative Charges 29

30 ANNEX G Items included/not included under Ward Charges in Nursing s (Notes: Yes: Item include; No: Item not included; n/a: Item not available.) Institution ITEMS INCLUDED UNDER WARD CHARGES Therapy Services - Physiotherapy Therapy Services- Occupational therapy Therapy Services - Speech therapy Therapy Services - Podiatry Medical Social Work Services Standard Medical & Surgical Supplies Ambulance transport to hospitals Death Certificate during office hours Dental/ Dentures Diapers Escort service to hospital Lab tests Medical consultation by in-house doctor (GP) Medical consultation by in-house doctor (specialist) Medication Nutritional Supplements/ NG Tube Feeds Outpatient Specialist Outpatient Clinic consultation Oxygen Therapy X-rays Others VWO Nursing s All Saints (Tampines) All Saints (Hougang) Apex Harmony Lodge Bethany Methodist Nursing Bright Hill Evergreen Jamiyah Nursing Ju Eng For Senior Citizens Yes Yes No No Yes Yes No No No No No No No No No No No n/a No No Yes Yes No No No No No No No No No No No No No No No No No n/a Yes Yes Yes Yes Yes Yes No Yes No Yes Yes No Yes Yes No Yes No Yes No n/a Yes Yes Yes Yes Yes Yes No Yes Yes No No No No Yes Yes Yes No No No n/a Yes Yes Yes Yes n/a Yes Yes No No Yes Yes No No No Yes Yes Yes Yes n/a n/a Yes Yes No No Yes No No Yes (office hours) Yes Yes Yes Yes Yes Yes No No Yes (no dentures) Yes No Yes No Yes No No No No No No n/a No No Yes Yes Yes No No Yes Yes Yes n/a 30

31 ITEMS INCLUDED UNDER WARD CHARGES Therapy Services - Physiotherapy Therapy Services- Occupational therapy Therapy Services - Speech therapy Therapy Services - Podiatry Medical Social Work Services Standard Medical & Surgical Supplies Ambulance transport to hospitals Death Certificate during office hours Dental/ Dentures Diapers Escort service to hospital Lab tests Medical consultation by in-house doctor (GP) Medical consultation by in-house doctor (specialist) Medication Nutritional Supplements/ NG Tube Feeds Outpatient Specialist Outpatient Clinic consultation Oxygen Therapy X-rays Others Institution Kwong Wai Shiu Hospital and Nursing Ling Kwang For Senior Citizens Lions For The Elders Man Fat Tong Nursing Moral for the Aged Sick Peacehaven Nursing Ren Ci Hospital and Medicare Centre Singapore Christian For The Aged Society For Aged Sick Yes Yes n/a n/a Yes Yes No Yes No No Yes No Yes Yes Yes No No No No No Yes Yes Yes n/a Yes No No Yes Yes No No No Yes n/a No No No No No n/a Yes Yes No No Yes Yes No No No No No No Yes Yes Yes Yes (stan dard) No Yes No n/a Yes Yes No No Yes Yes No No No No No No- Yes No No No No No No Yes Yes No No No No No No No No No No No No No No No No No No No Yes Yes Yes Yes Yes Yes No No No No No No Yes Yes No No n/a n/a n/a n/a Yes Yes Yes Yes Yes Yes Yes - During office hrs only No No No Yes No Yes Yes No No No No No No Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes No Yes Yes NA Yes Yes n/a n/a n/a No No No n/a No Yes No No n/a No No n/a n/a n/a n/a 31

32 Institution ITEMS INCLUDED UNDER WARD CHARGES Therapy Services - Physiotherapy Therapy Services- Occupational therapy Therapy Services - Speech therapy Therapy Services - Podiatry Medical Social Work Services Standard Medical & Surgical Supplies Ambulance transport to hospitals Death Certificate during office hours Dental/ Dentures Diapers Escort service to hospital Lab tests Medical consultation by in-house doctor (GP) Medical consultation by in-house doctor (specialist) Medication Nutritional Supplements/ NG Tube Feeds Outpatient Specialist Outpatient Clinic consultation Oxygen Therapy X-rays Others Sree Narayana Mission for the Aged Sick St Joseph's Yes Yes No No No Yes No No No No No No No No No No No No No No Yes Yes Yes Yes Yes Yes No Yes No No Yes No Yes Yes Yes Yes No Yes No n/a St Theresa's Yes Yes n/a n/a Yes Yes No Yes Yes Yes No No Yes Yes No Yes No n/a No n/a SWAMI Tai Pei Old People's Thian Leng Old Folks Thong Teck for Senior Citizens Villa Francis for the Aged Private Nursing s Cherry Nursing Yes Yes Yes Yes Yes Yes No No No No Yes No Yes Yes No No No No No n/a Yes Yes n/a n/a n/a No No No No No No No No No No No No No No No Yes No No No No No No No No No No No No No No No No No No No Yes Yes No No Yes No No No No No No No No No No No No No No No. Yes Yes No No Yes Yes No Yes No No No No Yes No Yes Yes No Yes No No No No No No No No No No No No No No No No No No No No No n/a 32

33 ITEMS INCLUDED UNDER WARD CHARGES Therapy Services - Physiotherapy Therapy Services- Occupational therapy Therapy Services - Speech therapy Therapy Services - Podiatry Medical Social Work Services Standard Medical & Surgical Supplies Ambulance transport to hospitals Death Certificate during office hours Dental/ Dentures Diapers Escort service to hospital Lab tests Medical consultation by in-house doctor (GP) Medical consultation by in-house doctor (specialist) Medication Nutritional Supplements/ NG Tube Feeds Outpatient Specialist Outpatient Clinic consultation Oxygen Therapy X-rays Others Institution East Coast Medicare Centre East Shore Residence The Lentor Residence Margaret Chio Nursing Moonlight for the Aged and Handicapped Our Lady of Lourdes Nursing Pacific Healthcare Nursing Pte Ltd Paean Nursing Soo's Nursing United Medicare Centre Yes (group) Yes (group) n/a n/a n/a No No No n/a No No No No No No No No No No No No No No n/a n/a No No No n/a No n/a No No No No No n/a No No No No n/a n/a n/a n/a n/a No No n/a No No n/a No n/a No No n/a No n/a n/a No No No No No Yes No No No No No No Yes Yes Yes No Yes No No No Yes n/a n/a n/a n/a No No Yes No No No n/a No No No No No No No No No n/a n/a n/a n/a n/a No No n/a No n/a No No n/a No No n/a No n/a No Yes (Basic) Yes (Basic) No No No No No No No No No No No No No No No No No n/a No No No No No Yes No No No No No No Yes Yes Yes No Yes No No No No No No n/a No No No No No No No n/a No No No Yes No No No n/a Yes Yes No No No Yes No No No No No No No No Yes (Basic) No No Yes No n/a 33

34 ITEMS INCLUDED UNDER WARD CHARGES Therapy Services - Physiotherapy Therapy Services- Occupational therapy Therapy Services - Speech therapy Therapy Services - Podiatry Medical Social Work Services Standard Medical & Surgical Supplies Ambulance transport to hospitals Death Certificate during office hours Dental/ Dentures Diapers Escort service to hospital Lab tests Medical consultation by in-house doctor (GP) Medical consultation by in-house doctor (specialist) Medication Nutritional Supplements/ NG Tube Feeds Outpatient Specialist Outpatient Clinic consultation Oxygen Therapy X-rays Others Institution Windsor Convalescent Windsor Nursing No n/a n/a n/a n/a n/a No No n/a No No n/a No No No n/a n/a n/a n/a n/a No n/a n/a n/a n/a n/a No No n/a No No n/a No n/a No n/a n/a n/a n/a n/a 34