If any of my loved ones or I ever wish to make a long-term care insurance claim, we’d need to be deemed severely disabled. However, many people don’t know that this involves undergoing a severe disability assessment – or what the latter entails for that matter. So, I decided to get some answers.

Here's an outline of this article:

• More seniors could mean more severe disability claims
• How having long-term care insurance helps
• Who is eligible for severe disability payouts?
• When would you or your loved one need a Severe Disability Assessment (SDA)?
• What to note about Severe Disability Assessments (SDA)
• What to expect during a Severe Disability Assessment (SDA)
• Closing notes on severe disability

More seniors could mean more severe disability claims

I can’t get into the details about a severe disability assessment (SDA) without addressing Singapore’s ageing situation. Seeing more seniors today compared to a decade ago reminds me that Singapore is racing towards super-aged status, i.e. at least 21 percent of the population is aged 65 and above. By 2026 (yes, it’s just around the corner!), our country will officially become super-aged, and by 2030, one in four citizens will be aged 65 or older, up from one in six now¹.

While it’s a blessing that so many people are now living to a ripe old age, this changing demographic will also drive up the number of severely disabled people in Singapore.

Generally, majority of severe disability cases are a result of progressive illnesses or conditions such as severe arthritis, diabetes or dementia, which tend to affect elderly folk more. So, as Singapore society becomes more aged, we can expect more people to file long-term care insurance claims.

Severe disability could also result from sudden events like a stroke, or spinal cord or traumatic brain or musculoskeletal injuries, which could affect even younger working-age adults. It’s not unheard of for people in their 30s to receive long-term care insurance benefits.

How having long-term care insurance helps

Severe disability can cause income loss and it increases financial burden. Thankfully, our national long-term care insurance schemes CareShield Life and ElderShield, along with supplements by private insurers like Singlife, offer a financial lifeline. They give monthly cash payouts for severe disability which can help cover the cost of things like:

• hiring a live-in caregiver,
• staying in a nursing home, 
• physiotherapy, 
• home modifications like wheelchair ramps, and
• assistive devices like walking aids.

Long-term care payouts not only mean a better quality of life thanks to access to support needed for managing severe disability; they can also protect savings intended for other purposes.

For an idea of what it’s like to look after a family member in need of long-term care, read about two caregivers’ experiences.  

Who is eligible for severe disability payouts?

I’ve mentioned “severe disability” about 10 times up till now, but what exactly does it mean? You can test your wits about the subject in my one-minute severe disability quiz.

For CareShield Life and ElderShield insurance purposes, a person is considered severely disabled when he or she is unable to perform at least three of these six Activities of Daily Living (ADLs) on their own:

The six Activities of Daily Living (ADLs)

• Feeding themselves
• Dressing themselves
• Washing themselves
• Using the toilet
• Walking or moving around
• Transferring between a bed and wheelchair and vice-versa

You can’t just tell the CPF Board (which administers CareShield Life and ElderShield) or your private supplement insurer that you’re unable to dress, feed and move around by yourself and expect to get a payout, however. In order for long-term care insurance payouts to be given fairly, everyone has to follow a proper claims process.

That’s where the SDA comes in. It’s essentially a test that evaluates an individual’s level of cognitive and physical functions.

When would you or your loved one need a severe disability assessment (SDA)?

 

An SDA is compulsory for determining an individual’s eligibility in several scenarios:

 

• financial payouts under CareShield Life, ElderShield, as well as supplements from private insurers like Singlife
• financial support under the Interim Disability Assistance Programme for the Elderly, which is for disabled seniors who are not covered under ElderShield
• making MediSave withdrawals for long-term care needs under the MediSave Care scheme (Medisave Care | Agency for Integrated Care (aic.sg))

 

 

While there are similar tests, like the Functional Assessment Report, note that you can only use the SDA to make a CareShield Life or ElderShield claim.

 

 

What to note about a severe disability assessment (SDA)

Here are three things to note about an SDA:

• Who can perform an SDA?
  It needs to be conducted by an MOH-accredited severe disability assessor, such as Homage. This is always a doctor, nurse or therapist who has undergone rigorous training to learn how to assess disability accurately. You must book an appointment beforehand.

• Where is it performed?
  It can be performed in a clinic or the assessor’s premises or wherever the patient is based (house call), be it at home, a nursing home or a hospital. There are more than 500 assessors islandwide, mostly GP clinics, eldercare hospitals and centres, nursing homes and community hospitals. Of these, 300-plus are clinic-based assessors, and over 200 are house call assessors.
  

• How much does an SDA cost?

- S$100 for SDAs performed at a clinic or the assessor’s premises

- S$250 for a house call

Payment – cash only – must be made to the assessor. If the patient is assessed to be severely disabled, the above will be reimbursed together with the first insurance payout. According to the Agency for Integrated Care (AIC) website, the fee will be waived for the first SDA for CareShield Life claims regardless of the claim outcome.

What to expect during a severe disability assessment (SDA)

Here’s how the SDA journey looks and how to prepare for it…

Before – what to prepare:

• Medical reports and documentation, including hospital discharge letters
• The medication that the patient is taking
• Doctor’s memo on the care recipient’s condition, diagnosis or health status (optional)
• Periodic review letter (only for reassessments – more about this below)
• Completed claim forms for supplements, which can be filled up by the caregiver

During – what to note:

How long does an SDA take?

An assessment typically takes 30 to 45 minutes, depending on the patient’s condition. The assessor will review the patient’s medical history before carrying out the physical assessment.

If the patient is alert and communicative, the assessor will ask them to perform a few tasks in order to evaluate their strength and ability for each of the six ADLs. If the patient has difficulty communicating, the primary caregiver will be asked to assist with this part.

How is an SDA performed?

Most assessors won’t reveal exact details on how the assessment is done to avoid skewing the results, but there’s a framework to guide them.

From what I’ve read and heard, patients are assessed and scored based on what they actually do during the assessment and not what they have the potential to do.

The degree of disability is categorised based on the level of assistance the patient needs i.e. between the two extremes of independence (no caregiver or assistance needed) and total dependence (patient does less than 25% of the ADL).

Both cognitive and mental impairments are factored for each ADL.

Here are some examples of how assessments are scored.

Example 1: A dementia patient may be able to put on clothes independently before an assessor, which means he has the capacity to perform the dressing ADL, however, he may be completely unable to do this at home due to memory impairment, which means his performance is affected. In this case, the patient would likely be scored as needing maximal or total assistance (performance).

Example 2: What if a stroke patient can put on a shirt on her own but not her pants? Since she needs only minimal assistance with upper body dressing but requires moderate assistance in dressing of the lower body, she’d likely be scored as needing moderate assistance in dressing.

After – what comes next?

After the SDA, the assessor will submit the SDA report via the AIC website. Processing time can be up to six weeks depending on the volume of applications and you’ll be notified of the outcome via mail. For successful claims, payouts into your bank account will start the following month and may include payouts backdating to the month you submitted the application.

If you or a loved one has a Singlife CareShield or ElderShield supplement, which also gives payouts if you can’t perform only one or two ADLs (depending on the plan), follow these steps. With the Singlife Care Collab initiative, policyholders and their loved ones enjoy a hassle-free claims process. You can get your SDA done with Homage at 20% off the usual cost and they will help to submit your documents to Singlife for processing. You’ll hear from Singlife within 14 days and if your claim is approved, you’ll be notified of the start date of for your payouts.

There’s no expiry date for an SDA, however, according to the AIC website, an annual periodic assessment may be necessary to continue receiving payouts or making withdrawals for severe disability. This is on a case-by-case basis and re-assessment fees will be waived regardless of the SDA outcome. Care recipients who are permanently severely disabled will be exempted from re-assessments unless the AIC receives new information suggesting the care recipient’s condition has improved.  

Closing notes on severe disability

As Singapore learns to live with the demands of an ageing population, it takes a whole-of-society effort to champion the Age Well SG programme that Prime Minister Lee Hsien Loong spoke of in his National Day Rally 2023. This not only means encouraging seniors to stay active, which can help prolong their healthy years, but also knowing where to get help should you or your loved one become severely disabled. Understanding how an SDA is done and how it can help disabled individuals and their loved ones access much-needed financial support is also a crucial part of that equation.  

^Notes

^{1. Source: The Straits Times© Singapore Press Holdings. Extracted with permission. “Initiatives in place to tackle ageing issues as S’pore hits ‘super-aged’ status in 2026: Health minister”, 20 April 2023.}

^{As this product has no savings or investment feature, there is no cash value if the policy ends or if the policy is terminated prematurely. Buying a health insurance policy that is not suitable for you may impact your ability to finance your future healthcare needs.}

^{You will need to have a basic CareShield Life (CSHL) or ElderShield (ESH) policy before purchasing Singlife CareShield Standard or Singlife CareShield Plus (“Supplements”). Supplements purchased by CSHL policyholders are regulated under the CareShield Life and Long-term Care Act. Supplements purchased by ESH policyholders before the transfer of ESH to Government administration are considered ESH Supplements, which are regulated under the Central Provident Fund (Withdrawals for ElderShield Scheme) Regulations. After the transfer, they are considered CSHL Supplements, regulated under the CareShield Life and Long-term Care Act.}