Who is looking after the elderly?

There's Hope for dementia patients

At Hope, the elderly residents, who have mild to moderate dementia, do not follow a regimented timetable.
At Hope, the elderly residents, who have mild to moderate dementia, do not follow a regimented timetable. ST PHOTO: ONG WEE JIN

It is only 11.20am but a lunch queue has already formed at an in-house cafe along Upper Changi Road North. In the line are old folk, leaning on walking sticks, waiting patiently for their turn.

They tell the servers the portions they are feeling up to that day. They then carry their plates to nearby tables and join whoever they want to dine with. When they are done, they empty the food waste in a bin and leave the plates and utensils in separate tubs.

These elderly folk, most of whom are in their 80s and 90s, have dementia. But the people who run the assisted living facility where they live believe that getting them to do little things and make decisions for themselves will empower them.

"This is not the kind of place where they just sit there and wait to be served. Giving them a say in simple things matters, because it keeps them engaged in life," says Ms Josephine Khai, senior staff nurse of Peacehaven nursing home.

The home is run by a charity, the Salvation Army, but these relatively independent seniors are housed next door in a separate five-storey building. Called Hope, the area where they live is modelled after an HDB block. There are about 60 senior citizens with mild to moderate dementia who live in single or four-bed rooms.

In the morning, they wake up whenever they want. They are expected to change out of their pyjamas. In contrast, at some nursing homes, it is common for residents to wear the same outfit all day.

"These are environmental cues and will put them in the frame of mind to get their day going," says Ms Khai.

When Insight visited two weeks ago, some were in the cafe, piecing together jigsaw puzzles. Others watched television or read the newspapers. Another group went into a room to belt out the classics tunes of Taiwanese pop singer Teresa Teng.

They do not need to follow a regimented timetable, but there is a list of specific activities available each day. If they prefer to rest in their rooms, they may do so.

Before going into their rooms to deliver fresh laundry or remind them to shower, nurses make it a point to knock on their doors first to ask for permission to enter, so as not to intrude on their personal space and privacy.

Though some of the seniors are prone to wander, they are not kept within their "HDB block". Every Wednesday, they go to a factory across the road for a morning snack at the canteen. Every Friday, they walk to the Japanese school next door to say hello to the children.

Hope was started in 2006 after the charity saw a need to provide care that helps relatively independent seniors with dementia. Since then, about 100 have lived there. They pay the same rates as the nursing home residents next door, between $2,800 and $4,500 before subsidies of up to 75 per cent.

Peacehaven is not alone in having the concept of assisted living facilities.

Over at Lentor Residence, two in three of its 208 beds are in single or twin-occupancy rooms with attached toilets. The floors of the common areas are carpeted and there is free Wi-Fi.

The home's chief executive Jonathan Koh says it was set up as a retirement village in 1997. "But there was no demand, so we ran it like a nursing home, taking in subsidised residents."

A room does not come cheap - $240 a day, or more than $7,000 a month. The price includes meals, laundry and housekeeping services.

Ms Khai says that living in a home-like environment has helped residents enhance their quality of life. Assessments show an average of a 30 per cent increase in the sense of well-being after living there.

Assisted living facilities: Govt integrating services for seniors within neighbourhoods

The elderly in Singapore have hardly any other housing options besides nursing homes if they grow frail and need someone to take care of them.

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.

Assisted living facilities provide a more home-like environment, such as private rooms, for more independent seniors who need help with personal care.

Standalone assisted living options are virtually non-existent in Singapore. The small pockets that exist are mostly nursing homes that have set aside separate spaces for assisted living.

While Singapore has 14 senior group homes, they do not count as assisted living facilities as residents do not get help with daily activities. Senior group homes are clusters of rental flats meant to let elderly folk with little or no family support live together with one another in an environment which they are familiar with.

The Ministry of Health (MOH) says assisted living is a service worth studying. "Many citizens own their own homes within public housing estates. Therefore, assisted living takes the form of injecting a range of services within such estates in Singapore," says its spokesman.

The Government seeks to integrate services within neighbourhoods in two ways. First, it has been retrofitting existing mature estates to create conducive environments for seniors. In Marine Terrace, Jalan Batu, Nee Soon Central and Beach Road, for instance, there is a range of services and facilities - including an active ageing centre, community kitchen, senior activity centre and day rehabilitation centre - within the same area.

Second, it is including senior services in new public housing developments. New Housing Board projects will have "Active Ageing Hubs", or larger spaces where various eldercare services such as daycare centres and rehabilitation are located.

The MOH is also encouraging private operators and voluntary welfare organisations to provide assisted living services, such as housekeeping and grocery-shopping, for seniors who require assistance. A senior activity centre at a new studio apartment development in Marsiling has been offering residents nearby health and dental check-ups, and taking grocery orders.

Nursing homes like Peacehaven have also taken the initiative to experiment and come up with assisted living spaces for more mobile and able seniors, who still get the usual nursing home subsidies of up to 75 per cent.

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A version of this article appeared in the print edition of The Sunday Times on November 06, 2016, with the headline There's Hope for dementia patients. Subscribe