The elderly in Singapore have hardly any housing options besides nursing homes if they grow frail and need someone to take care of them.
With the number of elderly people living alone estimated to jump three times from 29,000 in 2011 to 92,000 by 2030, this issue needs to be addressed urgently, said a rare study on nursing homes here.
In countries such as the United States, Australia and Finland, about 5 per cent of the elderly population live in some form of residential aged care facility. Going by this estimate, about 50,000 seniors in Singapore will need such facilities by 2030. But there are only about 12,000 nursing home beds now.
"Although Singapore's residential property market is awash with choice, there are hardly any affordable types of residential care for the elderly. Assisted living facilities are almost non-existent," said Ms Radha Basu, a former journalist of 15 years who wrote the report.
The 130-page report, commissioned by the Lien Foundation and Khoo Chwee Neo Foundation, is believed to be a rare comprehensive study on local nursing homes.
NURSING HOMES STUDY: KEY FINDINGS
Despite a 30 per cent increase in capacity since 2010, Singapore still had fewer nursing home beds per 1,000 people aged 65 and above last year - 26.1 beds - than it had in 2000 when the figure was 27.9 beds.
Many live in these homes for years as there is no one to care for them at home. One study of six homes showed that 15 per cent of residents lived at the homes for a decade or more.
In some homes, a single care worker must look after 20 to 30 residents at night. Up to 85 per cent of staff are foreigners. Their starting pay, excluding food and accommodation, can be as low as $350 to $400.
Some residents still live in dormitory-style accommodation where more than 20 people share a room, although newer homes have six- to eight-bed dorms. Japan, which has the highest proportion of older folk in the world, stopped building such dorms 40 years ago.
Singapore has roughly the same number of hospital and nursing home beds. Despite a significant increase in spending in recent years, nursing homes still account for less than 4 per cent of the Ministry of Health's budget. It is not known how much is spent on hospitals.]
Ms Basu, a former Straits Times journalist, interviewed 50 sector experts, including operators who run 40 of the 72 nursing homes here, and long-term care experts.
Assisted living facilities are common and popular in Australia, Britain and the US. They provide a more home-like environment, such as private rooms, for more independent seniors who need help with personal care. In comparison, nursing homes, which tend to be like wards, focus on providing 24/7 medical care such as tube feeding and wound dressing.
They may look quite different and be located within blocks of Housing Board flats. This could be the future of nursing homes in Singapore, as the authorities look into offering more options for the elderly who need care. These could include assisted living facilities.
The Ministry of Health (MOH) said it has been working with the Urban Redevelopment Authority over the last few months to plan for and design future nursing homes. It will call for proposals soon to "develop and research innovative solutions... while ensuring both quality and affordability of care".
Last year, The Straits Times broke the news about how plans for a different model of nursing home were aborted after these failed to secure government subsidies. The project had hoped to replace the six- to eight-bed layout common in nursing homes here with single or twin rooms that come with en suite toilets.
These rooms are the norm in countries such as Japan as they may offer residents more privacy, autonomy and better well-being.
The Lien Foundation later commissioned a study by a consultancy firm which found that it would cost just $8 more a day for someone who opts for a nursing home with single- or double-bedded rooms instead of one with a ward- or dormitory-style facility.
Yesterday, MOH said it has assessed that the additional cost of building and operating homes with only single- or double-bedded rooms will be significant. "MOH will continue to provide a mix of nursing home designs and room types to meet the different needs of seniors," it said.
There are 14 senior group homes here but they do not count as assisted living facilities as residents do not get help with daily activities.
“Fiscally speaking, Singapore is in a position of strength and the time is ripe to consider new models of funding better quality care,” said Mr Christopher Gee, a senior research fellow at the Institute of Policy Studies, where he leads the demography and family research cluster.
Dr Ow Chee Chung, chief executive of Kwong Wai Shiu Hospital and Nursing Home, which is being redeveloped into Singapore's largest nursing home, said assisted living options could mean a cluster of seven to 10 seniors sharing a common living room and kitchen within a floor in HDB blocks. "Assisted living is a social construct, not a medical construct, so these units should be right within the housing blocks that the majority of Singaporeans call home," he said.
The study also suggested raising the pay of foreign workers to address manpower shortages and developing a rating system - similar to Trip Advisor's ranking of hotels - to help people decide which nursing homes to send their loved ones to.
The Ministry of Health told The Straits Times that assisted living is a service worth studying. "We are currently supporting a few nursing homes to pilot services that help more abled seniors to continue to live independently," it said.
For instance, St Joseph's Home will start a small-scale pilot at the year end to offer assisted living services at its new nursing home for seniors who may need some support but not full nursing home services.
Correction note: This story has been updated for clarity.