Vignette for the collection of standardised qualitative data on the ability of Long Term Care (LTC) systems to meet the needs of older persons across countries

Aspects in orange represent substitutable elements that allow tailoring of vignettes to different countries, cultures and settings. Descriptions used here are tailored to Singapore.

1. A common surname of ethnic majority persons in the country

2. Life expectancy of women at 60 in the country minus 15

3. The most common living arrangement for this profile in the country

4. The most common housing type for the median income group in the country

5. The most common state / town / neighbourhood for the median income group in the country

6. Country for data collection

7. The most common form of financial support for older persons. In Singapore, it is a financial transfer from family members under the Many Helping Hands policy. Another example is the state providing pension / social security

8. Public health financing schemes which are available to the median income group in the country

Stage 1

I’d now like to tell you the story of Mrs Tan, an older woman who is starting to have declines in her physical and cognitive functions. Then I will ask you some questions. Please answer these questions based on Mrs Tan’s perspectives and your understanding of the country’s long-term care system.

Mrs Tan (1) is 72 years old (2). She lives with family (3) in a 2-bedroom flat (4) she owns, located in Hougang (5), Singapore (6). Her husband passed away five years ago. She has some savings and financial support from her children (7). She has been living in the same home for about 40 years and has good relationships in the community. She can manage her daily tasks independently and attend social activities with her friends and family. She has high blood pressure and pain in the joints in the past two years. Currently, she is unable to walk for long, requiring a walking stick for longer distances. She is also getting more forgetful, taking more time to recall important events and frequently misplacing her valuables. Mrs Tan (1) is feeling anxious about losing her ability to manage her tasks on her own. She is eager to maintain her current lifestyle.

Stage 2

OK, now we fast forward to see what happens to Mrs Tan in another three years. The same questions from Stage 1 apply here.

Mrs Tan’s (1) health has become worse. She has fallen three times at home in the last one year. It has become much more difficult to get up from the chair, bed and toilet. She is still able to walk around but moves slowly and feels unsteady. She frequently has to be reminded to take her meals and showers. She also forgets important personal details like her own address and sometimes gets the days wrong. She has since stopped going out for her daily tasks and social activities. Mrs Tan’s (1) children (7) are uncertain about her care arrangement and worried about the cost. Thus far, they have been relying on CPF schemes (8) for health expenses. Mrs Tan (1) prefers to stay home and does not wish to burden her children (7).

Stage 3

I will now tell you the last part of the story. Again, the same questions apply.

It has been eight years and Mrs Tan’s (1) functions and memory have further deteriorated. She needs help in most of her daily activities including bathing, toileting, and dressing. She is starting to have difficulty eating as she constantly needs reminders on when to eat and she spills food and drinks. She is also occasionally quarrelsome and agitated in the evenings and refuses to bathe. Her children (7) are stressed out and in need of more help.