The opening of the first state-run nursing home recently, in Pearl's Hill Road, is significant in shaping the course of eldercare over coming decades. Barely 15 minutes away at Clarke Quay, the focus is understandably on today's happy hour rather than on tomorrow's moment of truth - when the number of seniors almost doubles between now and 2030. But that needs attention as the grace period will run out and the nation should not be caught short, especially after having pondered its ageing challenge over half of its existence.
By the time SG65 is celebrated, Singapore would already be a "super-aged" country, where at least one in five are aged 65 or older. Japan heads that growing club and is already feeling the strain of social welfare as its population greys and declines. The "demographic dividend" from the bulge of baby boomers, who once drove growth, is turning into a "demographic tax", as rating agency Moody's noted in a 2014 global report. That could slow the world economy by 0.9 per cent annually between 2020 and 2025.
Such realities should temper expectations of ever larger state support for the aged, as the tax burden will be on fewer shoulders - the ratio of working-age citizens to seniors will halve to 2.3 in 2030. How the Pearl's Hill facility can help is to give the authorities a better understanding of ground issues, and to pioneer solutions and innovations. On a larger scale, it takes a sound ecosystem to deliver adequate eldercare, involving the private, people and public sectors working in tandem. The 900,000 seniors here by 2030 will have different needs, financial capabilities and expectations which no single player or model can possibly cater to, and a wider range of options will be called for.
At the primary healthcare level, for example, polyclinics would be overwhelmed if these are the first stop for an army of elders. Instead, state services ought to be integrated with those provided by private family physicians. Similarly, the convalescent sick and aged who do not need to be in a general hospital can be cared for in community hospitals, some of which are run by voluntary welfare organisations like Ren Ci and St Andrew's .
Daily care arrangements will vary as seniors might be ambulant, wheelchair-using or bedridden. When rehabilitative, therapeutic, end-of-life or assistive care is required, it could be offered in an institution, centre, "village" or home. The preference here is to facilitate "ageing in place" which would permit elders to be with their families or friends in familiar environments. Given their numbers, not all will fit within a desired paradigm of care. How Singaporeans reach out to help those who slip between the cracks will define them as a society. Outsourcing the task to vast state nursing homes, as a convenient catch-all for the needy aged, would spell a dystopian future indeed.