Whampoa's way: Residents live out their golden years in their own homes

Singapore is one of the fastest-ageing societies, with nearly 100,000 people turning 65 over the past four years alone. Over the next 15 years, the number of older folk will double to close to a million. In the first of a series on ageing well, our correspondent describes an ambitious experiment under way to let Whampoa residents live out their golden years in their own homes. This story was first published in The Straits Times on April 5, 2015

She has already finished a morning workout, sat through a health talk, played ball games and shared a simple lunch of century-egg porridge with friends.

But even as the last rays of the late afternoon sun stream into Madam Tan Kim Yoke's bright and cheery three-room flat, the 86-year-old is not done for the day.

The phone rings.

It is a friend from a neighbouring block. "Sure, I would love to go karaoke," she says into her iPhone with a chuckle.

Its red plastic case, decorated with multicoloured hearts, matches her red-and-gold manicure.

"See you later."

The widowed mother of eight has a large, loving family, but chooses to live alone in Whampoa, in the same neighbourhood she has called home for well over 50 years.

She raised her children - who are now in their 50s and 60s - in the flat which she still lives in.

"I have many memories here, my friends are here and there is so much to do," she says. "My children come to see me. There is no reason to move."

She does not know it, but older residents in Whampoa are part of an experiment to enable older people to age in their own flats and familiar neighbourhoods, with the help of a coordinated community-wide system of health and social support programmes and services.

Called the Community for Successful Ageing (ComSA), the $5 million initiative is spearheaded by the Tsao Foundation, a non-profit group that specialises in ageing issues.

The Tote Board has committed $4 million. The foundation is paying for the rest.

It will be launched officially on Saturday, nearly three years after the foundation first began working with seniors in the neighbourhood.

More than a third of Whampoa's 33,000 residents are over 50. Around 3,600 have crossed 65.

The foundation works closely with Whampoa grassroots groups and more than 20 government, healthcare and community agencies to better serve Whampoa's seniors. Its chairman, Dr Mary Ann Tsao, says that ComSA hopes to enable all seniors - rich or poor - to "live well".

For those like Madam Tan who are financially better off and in fine fettle, "living well" means keeping them active, engaged and happy.

For others who are frail, lonely or poor, it means connecting them to the right services at the right time, so that they do not have to leave home or land in institutionalised care.

"Singaporeans are living long, but we're not really living well," says Dr Tsao. "This is what we're hoping to change."

Energetic, independent and full of good cheer, Madam Tan is in many ways the perfect poster child for active ageing.

Every Sunday morning, she is the oldest resident to join song-and-dance sessions conducted by cardiologist Tan Yong Seng, 55, a local grassroots leader. (See box.)

On Tuesdays and Wednesdays, the garrulous great-grandmother of eight plays mahjong and other games with her kakis at the Whampoa Gardens Residents' Committee (RC) office, a stone's throw from her block.

Thursdays are special, with Madam Tan joining about 20 friends for "self-care" sessions.

They first got together last year for 24 sessions with trained volunteers from the Tsao Foundation who taught them how to deal with chronic diseases, manage stress and take better care of themselves.

Although men are welcome, the group is made up entirely of women. "Men are shy, lah," she says.

The formal sessions ended long ago, but the women meet every Thursday afternoon to chat, exercise and play ball games.

They also share a meal - usually something simple and healthy like porridge or soup - sing and swop stories.

One recent Thursday, the conversation centred on Whampoa, and how long some of them have been living there.

Madam Tan, who looks and acts far younger than her age, says she moved to the area as a young mother in the early 1950s.

Some of her friends who live alone like her - widows Tan Ah Moy, 80, Oh Siew Lian, 76, and Lam Ah Won, 79 - have called the area home since childhood.

"Just imagine," Madam Tan marvels. "We've lived here almost all our lives but did not meet when we were young."

Why Whampoa is special

There are many groups islandwide running active ageing programmes, but several factors make the Whampoa project special.

First, the Tsao Foundation and grassroots volunteers polled nearly 2,000 senior residents to assess their needs and vulnerabilities, before drawing up services to meet those needs.

For instance, the elderly residents found it hard to travel long distances for frequent medical appointments.

So the foundation started a mobile clinic in the same RC office that Madam Tan and her friends hang out in.

The survey also found that many seniors had "small social networks" and may feel lonely as a result, says Whampoa MP Heng Chee How, a key ComSA partner.

The grassroots groups are now working with Tsao Foundation on ways to include these seniors in various community activities to forge new friendships.

While many agencies conduct surveys, the information collected is often not put to use, says Dr Tsao. "We follow through and help connect the dots."

The aim is not merely to provide a "care service", but build an entire system of care.

A spokesman for the Ministry of Health, which oversees ageing issues, says another noteworthy aspect of the Whampoa project is that it brings together various groups working in the area to "act in concert to meet the diverse needs".

Around once a month, representatives of partner organisations - including the local grassroots, social service and health agencies, and community eldercare groups - meet to discuss challenges that seniors face and devise solutions.

Tan Tock Seng Hospital, which is close to Whampoa, is another key partner. Last year, it started a programme to pay closer attention to patients warded three or more times over the preceding year.

Dr Tan Kok Leong, deputy head of the hospital's continuing and community care department, says that once they are discharged, the patients are put under the charge of the ComSA team, which comprises doctors, nurses and social workers.

"The ComSA team provides multidisciplinary community care, looking after a patient's medical, functional and psycho-social needs," says Dr Tan.

"This helps to reduce the likelihood of re-admission."

Spotting seniors who need help

Their efforts are paying off, especially when it comes to helping frail and poor old folk with limited family support, such as cancer survivors Tan Siew Luan, 75, and her husband, retired labourer Lim Guan Thye, 82.

Madam Tan, a mother of five, had uncontrolled diabetes and often missed her daily insulin injections as she depended on her caregiver son, who was often not around.

After the Tsao Foundation medical team intervened, she has learnt to take the pills and her son has been giving her regular insulin injections. Her diabetes is now under control.

Instead of taking a 30-minute bus ride to the Toa Payoh Polyclinic, her husband, who has dementia, now goes to the aged-care mobile clinic at his doorstep, which is open twice a week.

The couple first came to the notice of ComSA care staff in 2013, when they attended a block party.

"While talking to them, we realised that the couple were missing appointments, not taking medicines and could not convince their children to accompany them for these appointments," says Ms Fiona Hon, a nurse-care manager from the Tsao Foundation who monitors the couple's health and well-being with teammate Chua Hui Keng.

There was a time when Madam Tan did not leave the flat for more than a year because she was too weak. Apart from ill health, the couple also had money woes.

Their eldest son gave them $100 a month. Other children chipped in with smaller amounts when they could.

The couple got by on free food and meal vouchers distributed by grassroots and welfare groups.

They say their children are poor and would "scold" them if they asked for money.

Mr Lim says he once tried approaching the local community development council for aid, but gave up when he was told to provide the payslips of all five children.

"There are children who often brush off their parents' requests for money or care," says ComSA care manager Ms Chua. "But they may listen to a third party."

She helped to rope in Jalan Besar's Social Service Office (SSO), under the Ministry of Social and Family Development, which gives financial aid.

The SSO chipped in with $400 in financial assistance a month and persuaded four of their children, who work in low-income jobs, to contribute $50 each.

Meanwhile, the Awwa Family Service Centre, another ComSA partner, is pitching in with counselling and job support for one of their sons, an odd-job worker who lives with them.

The medical director of Tsao Foundation's Hua Mei Centre for Successful Ageing, Dr Ng Wai Chong, points out that "psycho-social factors" such as the love and support of children have a huge impact on the physical health of older folk.

"If a person has money woes or feels neglected or depressed, medical intervention alone may not improve his health," says Dr Ng, who is one of the doctors at the aged-care clinic.

Trying to reach seniors outside the current care system is another key aim of ComSA, adds Dr Ng.

"We knock on doors to assess risks and find families that need help but never really asked for it," he says.

Last year, the team stumbled upon an elderly couple in a rental flat looking after six young grandchildren as the parents were in jail.

"They were old and frail but incredibly had never touched the healthcare system," says Dr Ng.

Like the Lims, they are now being helped by several agencies.

The foundation is also working with the Saw Swee Hock School of Public Health at the National University of Singapore to test a risk-assessment tool, a software formula which helps to identify older folk who are at risk of medical or cognitive decline, disability or loneliness, based on questions put to them.

Among those deemed at risk is Madam R. Letchmi, 83, though community support has enabled her to continue living at home rather than in an institution.

Her right leg has been amputated and her husband, her sole caregiver, died in 2011.

She does not see her older son very often; her younger son died of a sudden heart attack more than 30 years ago.

These days, she often feels breathless. Her joints ache. Her memory is fading.

She used to miss her doctors' appointments when the volunteers who accompanied her for visits were unavailable.

The Tsao case-management team has since arranged for free taxi rides from ComfortDelGro.

She does not mention it, but it is loneliness that seems to affect Madam Letchmi most keenly.

Sitting on the floor of her two-room rental flat, she shows The Sunday Times old photographs, faded and torn payslips and old medical records of her husband, younger brother and son, some dating back 40 years ago.

"So many memories I have here," the articulate former canteen helper whispers, in tears as she gently caresses the old cloth bag in which she keeps these priceless possessions from her past.

A native Tamil speaker, she picked up Hokkien and Malay when she was growing up in a kampung. She later learnt English by paying a small sum to one of her son's teachers.

"They are gone now," she says, pointing to the flower-bedecked photos of her husband and younger son.

The pain of losing loved ones still lingers. But she has new friends now.

Smiling through her tears, she turns and gives Ms Hon a big hug.

"And this is my best friend," she says.

radhab@sph.com.sg

This story was first published in The Straits Times on April 5, 2015