Agency for Integrated Care (AIC)
The pilot programme provided integrated and community-based medical, nursing and social services for frail elderly who required a high level of medical and nursing care usually provided in a nursing home. By providing such services within the community, SPICE enabled elderly to age at home surrounded by their loved ones.
An existing day rehabilitation centre was modified and enhanced to run the programme. A multi-disciplinary team looked after the care needs of the elderly and worked closely with the patients' primary physicians. A case manager also worked with various providers to ensure delivery of the individualised care plans and helped to coordinate services that were not available in-house.
Under the programme, frail elderly were able to receive medical, nursing and social care within the community during the day and were still able to stay at home with their families during the evenings and on weekends. Caregivers could also continue to work and get respite during the day.