Long-term eldercare: More options now, but more data also needed

With 100,000 people now aged 80 and older, does Singapore have enough places for the frail elderly? More transparency in information would help families make better decisions.

Madam Chew Eng Huay, 71, suffered a stroke 17 years ago and has been in hospitals and nursing homes ever since. Home for most of the past decade was a cavernous 30-bed ward at the Ren Ci Nursing Home in Moulmein.

The retired coffee-and-ice kacang seller, who is single, is well enough to go home, but having sold her flat years ago, is considered a permanent resident at Ren Ci.

On the eve of National Day, Madam Chew was among the first batch of residents from the home to be transferred to a new nursing home run by the same operator.

The 470-bed Ren Ci Ang Mo Kio is the biggest departure yet from the medicalised dormitory-style accommodation, which has long been the norm for nursing homes here. Instead of wards, the new Ren Ci has "households", each comprising 16 residents, who share bright and airy four-bedded rooms.

Each household has its own living and dining areas, kitchenette and bedrooms, resembling a Housing Board flat. There are bright and breezy corners filled with bougainvillea. Fixtures include bookcases, welcome mats, mirrors at the height of wheelchairs and condo-style floor-to-ceiling windows.

Now Madam Chew doesn't have to wait for a nurse to wheel her 50m to the nearest toilet. She does not have to eat by her bed any more. And she does not have to hear the groans of severely ill residents all night.

Newly built nursing homes like Ren Ci Ang Mo Kio, offering more humane ways of living, are examples of the winds of change sweeping through Singapore's nursing home and long-term care sector.

Such developments have been heartening to those rooting for change in the sector. However, while the Republic has a much-lauded acute-care system, long-term care here is largely underdeveloped, compared with what's available in other advanced, ageing nations such as Japan, Germany and the Netherlands.

In recent years, the Government has been working hard to ramp up supply of senior-care facilities in Singapore. According to figures released last year by the Ministry of Health (MOH), there will be a cumulative 40,000 nursing home, home care and community care places by 2020. But the numbers may prove insufficient, given that there will be more than 600,000 people aged 65 and above by then.

It also does not help that enrolment and vacancy rates at senior-care centres are not easily available. It is not clear whether long-term care infrastructure has kept up with rising demand, given the rapid pace of ageing.

REASONS TO CHEER

The same week that Madam Chew moved to her new home, the first residents collected their keys at Kampung Admiralty, an 11-storey HDB complex being billed as the country's first "retirement kampung".


The interior of one of Ren Ci Ang Mo Kio's "households", which has its own living and dining areas, kitchenette and bedrooms, and resembles a Housing Board flat. Newly built nursing homes like Ren Ci Ang Mo Kio, offering more humane ways of living, are examples of the winds of change sweeping through Singapore's nursing home and long-term care sector. ST PHOTO: JONATHAN CHOO

The project combines 100 studio flats for the elderly with medical and senior-care centres, a foodcourt, shops and community gardens, among other amenities. It hopes to empower seniors - particularly those who live alone or with an elderly spouse - to function independently in the community for as long as they can.

New "active-ageing hubs", where seniors can join wellness programmes or get help with care, rehabilitation and even grocery shopping, are also being opened islandwide.

Other examples of new developments on the long-term care scene include the announcement in July that Peacehaven Nursing Home was reviving its Jade Circle project. A 22-bed extension to the current nursing home, Jade Circle will offer en suite single-or twin-bed rooms for people with dementia, including those who receive government subsidies.

The project, funded by the Lien Foundation and the Khoo Chwee Neo Foundation, was scrapped in 2015 after it failed to secure MOH subsidies for its residents. Traditionally, subsidised residents have been housed in only multi-bed wards.

At the end of last year, after further discussions with MOH, Peacehaven agreed to add four-bedded rooms, funded by MOH, in its existing building as part of the overall development of the nursing home. Based on these revised plans, MOH considered Jade Circle and Peacehaven as one entity and agreed to provide subvention to all eligible residents, irrespective of whether they stayed in one-room or multi-bed wards.

In keeping with the national push to enable people to age in the community, rather than in institutions, Jade Circle will also feature a daycare centre, where 120 seniors can play arcade games that stimulate the mind, join interest groups and work out on senior-friendly exercise machines that can help fight ageing-related declines in muscle strength and mobility.

Days after the Jade Circle announcement came news of the ground-breaking ceremony of a new 129-bed private nursing home in Venus Drive that is being developed by Allium Healthcare, a subsidiary of investment company GK Goh Holdings. The home in the Upper Thomson area will have single-or twin-bed rooms, or "suites", and offer premium services and facilities .

And in late August, St Joseph's Nursing Home in Jurong unveiled an inter-generation playground and childcare within its premises. The first of its kind, it will facilitate inter-generational bonding.

DEMOGRAPHIC CHALLENGES

According to figures released last week, the number of citizens and residents aged 65 and above crossed the half-a-million mark this year. A fifth - or more than 100,000 people - have already crossed 80. The pace of ageing is expected to pick up, and by 2030, one in four Singaporeans - or nearly one million people - will be senior citizens.

The number of seniors who will live alone is expected to rise to 92,000 by 2030, up from 41,000 in 2015. Dementia figures are also expected to climb. According to the Well-being of the Singapore Elderly (Wise) study by the Institute of Mental Health, one in 10 people aged 60 and above is likely to have dementia. By those estimates, there are already nearly 78,000 people with dementia in Singapore today. Seniors with dementia and those who live alone are most likely to need institutional care.

Family has long been the first line of support in meeting Singapore's eldercare needs.

In the past, the vast majority of elderly had many children to share caregiving duties as they aged. But in the decade after independence, the Republic's total fertility rates fell rapidly from 4.7 births per woman in 1965 to two by 1975.

The number of elderly people with one or two children - or none at all - is likely to explode over the next decade. Singapore must better prepare for this caregiving crunch.

PLAN B ON DOMESTIC WORKERS

Many Singaporeans care for their elderly at home with the help of foreign domestic workers.

Unlike in the past, when even degree holders were willing to become domestic helpers here, many who come these days from countries such as Indonesia and Myanmar appear ill-equipped, untrained and unfamiliar with English. Besides, without proper training, domestic helpers might not always be equipped to handle caregiving responsibilities.

Last year, while researching for a report on nursing homes, I came across an octogenarian with dementia who was admitted to hospital after being stabbed in the hand by a frustrated helper who could not handle her employer's severe behavioural problems. The older woman had lived alone with the helper. The family had changed helpers six times over two years before the incident.

The human cost of caregiving by untrained domestic helpers also needs to be taken into account - media reports on abuse cases, for example, are common these days.

Another issue is that some Singaporean families tend to shun professionally devised primary care options - such as having regular rehabilitation, which can prove to be expensive over time - in favour of domestic workers.

DATA TRANSPARENCY

Unlike childcare figures such as enrolment numbers at centres, which are easily available online and regularly updated, there could be greater transparency in eldercare statistics.

Not only are capacity and enrolment numbers of senior care centres not released publicly by housing estate, it is not known how many senior-care or dementia daycare centres there are islandwide. These figures, traditionally available on the MOH website, have not been updated since 2014.

However, as at the end of last year, there were 7,500 home care places and 4,000 daycare places overall, MOH said when I asked recently.

Unlike hospitals, occupancy rates and waiting times at nursing homes and other community care facilities are not made public. And while there will be close to a million people aged above 65 by 2030, it is unclear how many will be aged 80-plus by then - the group that is most likely to need care.

Other useful information - routinely made public by other advanced countries - that is not in the public domain includes the average length of stay at residential care facilities such as nursing homes, and projected demand and costs of long-term care over the next 10 to 20 years.

Making such data public would better inform the conversations Singaporeans need to have on the eldercare they would like for their parents and themselves - and how much they are willing to pay for it.


  • The writer, a former senior correspondent with this newspaper, is director of research and advocacy at the Lien Foundation.
A version of this article appeared in the print edition of The Straits Times on October 05, 2017, with the headline 'Long-term eldercare: More options now, but more data also needed'. Print Edition | Subscribe