Rapid Ageing
We have one of the fastest ageing populations in the world. Today, there are about 300,000 persons aged 65 years and above. In 20 years’ time, we will see a three-fold increase to about 900,000. That is why we are preparing for an ageing society and that’s why it is important and urgent to do so.
2. We have taken steps to enhance the financial adequacy of our seniors: better returns on CPF savings, CPF LIFE for a stream of income until they pass on, enabling people to work longer and to monetize their homes. And we are working on financing of long-term care.
Active Ageing
3. We have promoted active ageing, so that seniors lead a full and meaningful life. Dr Teo Ho Pin and Mr Ong Ah Heng have asked what the Government is doing to promote healthy lifestyles and enhance the quality of life of our elderly as part of our long-term strategy to deal with an ageing population. We are encouraging them to take charge of their ageing, and be in control of their health and wellbeing.
4. To enable seniors to move easily out of their homes to places they wish to go to, we have been creating a barrier-free environment: lift upgrading for lifts to stop at every floor, barrier-free walkways, retrofitting buses to take wheelchairs, and ramps and lifts at MRT stations. We require new developments to be designed to the Code on Barrier-Free Accessibility in Buildings. There is also the Universal Design Guide, which recommends to the industry how to design to meet the needs for all people, including the elderly. We will assess the effectiveness of these measures.
5. Dr Lily Neo discussed active ageing, particularly lifelong learning and the employability of our seniors, while Dr Teo suggests the setting up of an Active Ageing Endowment Fund. The Council for the Third Age, or C3A, promotes active ageing through the annual Active Ageing Festivals, and works with partners to promote lifelong learning, enhancing seniors’ ability to contribute to society. And this is not just one event in a year but there are five other events organized by our CDCs, and funded by C3A. As the $20m GO! Fund is for the fiscal year 2006 to 2010, there is no need as yet for an endowment fund. C3A will continue to use the GO! Fund to fund lifelong learning opportunities for seniors. Importantly, as employability depends on the attitude of employers and older workers, C3A will also encourage a mindset shift of both seniors and employers. C3A is one of AARP’s international partners for the International Innovative Employer Award, which recognises employers that have implemented age-friendly practices in their organisations. Five Singapore companies have won the award in the last two years. So I think as we do more of this, as we showcase what some of the progressive companies do, I hope that others will also follow. With respect to employment, there is a tripartite group that is working on this. But reports throughout the world show that there will be a skills shortage that’s been faced in the US, in Europe, because the baby boomer generation is retiring. The employers are beginning to realize the assets that they have. They are now keen to employ such older workers. We should learn from this. C3A will be organizing the International Consortium for Intergenerational Programmes Conference in late April 2010, focusing on intergenerational relations at the family, workplace, and the community. We also have to learn how to manage a more diverse group of employees, with ages ranging from 20-plus to maybe even 70.
6. We have introduced a Wellness Programme, to help people take charge of their own health, and join social interest groups. The pilot project has been successful. The 12 sites reached out to 17,000 seniors aged 50 years and above, of whom 12,000 took part in health screening. Residents who are Wellness Club members have been able to better manage their health. 58% of the 8,857 at risk seniors identified during the Wellness Programme health screenings have seen doctors or nurse educators for medical follow-up. Research has shown that whatever the state of one’s health, we can improve our quality of life if we are active physically, mentally and socially. And as Dr Lily Neo requests, when we promote active ageing, we should promote these three points of importance of being active physically, socially and mentally.
7. We have examples from the Wellness Programme. Let me share one. Mr Quah Boon Hwee, a 65 year old retiree, led a sedentary life before joining the Radin Mas Wellness Programme. He had diabetes and an irregular heart beat. After attending health education workshops through the programme, he realized he had to exercise and watch his diet in order to enjoy good health. Mr Quah’s medical condition is now under control. He joined the herb garden interest group and made firm friends with other members. Their group has transformed a small plot of land in the Bukit Merah Community Club into a beautiful herb garden.
8. Dr Lily Neo asks whether we will extend the Wellness Programme to more constituencies. Yes. We will expand the Wellness Programme progressively. The budget is $77 million over the next 5 years. In fiscal year 2010, 25 new Wellness sites will be launched. The target is to reach out to 50% of seniors over the next 5 years.
9. We are implementing physical exercise programmes under Seniors for Physical Activities or SPA for short, which complements the Wellness Programme. MOS Heng Chee How, who chairs the SPA committee, will respond to Dr Teo and Mr Ang Mong Seng’s queries on the plans to support physical activities for our seniors.
10. I will now speak on two important issues: preventing social isolation and developing our capability to care for frail seniors.
Preventing Social Isolation
11. Mr Ong Ah Heng, Dr Ong Seh Hong, Ms Ellen Lee and Mr Laurence Wee have noted that social isolation and the plight of our lonely elderly are serious issues that we must pay attention to. Social isolation for seniors is an emerging concern among ageing societies. When seniors are socially isolated, they become disconnected from society. They withdraw into their own world, often literally into their own homes. They are apathetic to all that goes on around them, not caring for others, and not caring for themselves. They lose hope.
12. In 2000, the number of elderly aged 65 and above living alone was about 15,000. This increased to 22,000 in 2005. Living alone is the highest risk factor for social isolation. Preliminary results from an MCYS-commissioned study indicate that 26% of seniors who live alone have symptoms of depression compared to only 9% who live with their spouse or family. Further, 16% of seniors with weak social networks outside the household also show such symptoms as compared to only 8% who have strong social networks outside of the household.
13. Based on the survey findings, an estimated 35,000 older persons aged 60 and above live alone in 2009. Even if we do not consider the increase in singles and smaller families, this number is expected to rise further, to 61,000 in 2020 and 83,000 in 2030.
14. Given the increase in seniors living alone, it would become increasingly difficult to identify and reach out to those who are isolated, by the means we have adopted up to now. Thus, there is an urgency in addressing the issue of social isolation.
15. In the past 2 years, as Dr Ong Seh Hong has referred to, there have been several reports in the media of people dying alone, detected only when neighbours complained about the smell. Naturally, we are upset that this should happen.
16. What has gone wrong? Almost all the cases I read about happened in rental flats. There are Seniors Activity Centres serving the rental flats, run by VWOs, with each centre staffed by 2 or 3 persons. In addition, the poor who are at risk of social isolation have been placed on a befriending scheme, where the volunteer contacts the senior at least once a week. The befriending scheme is operated by VWOs. The Seniors Activity Centres and the befriending scheme receive funding from the government. Have the VWOs failed in their service?
17. How do other societies take care of their elderly, prevent social isolation, and prevent sad cases of people dying alone?
18. I remember reading a story of how seniors in a small village in Japan put up yellow flags at their doors each day, to let their neighbours or the postman know that they are all right. No flag, well, maybe something’s wrong. Yellow flag up, the person is all right. In Japan, many of the young people move to big cities for employment, leaving behind the very aged in the villages. In such a situation, the seniors have to organize themselves for mutual help. When old neighbours look out for old neighbours, help will come quickly if something should happen.
19. Another example is “The Village” concept in the USA. Older residents living in a neighbourhood collectively pay annual membership fees that support a small office of 2 staff or so. This office would coordinate services for the seniors. But more importantly, the seniors will organize themselves, volunteer their talents and skills to one another, and the old-old can leverage on the young-old so that they can age in their own homes. And they call such villages also ‘Naturally Occurring Retirement Communities’.
20. Typically, we live in high-density HDB flats. And because there are so many people around, we have not realized that we, too, have to organize ourselves for mutual support. As Dr Ong Seh Hong notes, the community must help these lonely seniors. If we depend on SACs and befrienders, then we will need many more staff and many more volunteers, to know what is happening to our seniors everyday. This is impossible. So, like the old villages in Japan, we too must organize ourselves, so that neighbours look out for neighbours.
21. Incidentally, both stories refer to “villages”. This reminds me of the “kampongs” of old-time Singapore. And I am glad that some of this “kampong spirit” lives on today. Tampines Changkat CCC has a Silver Connect Scheme. Ms Tan Lay Hua, a 47 year-old home-maker, has taken care of four elderly in her neighbourhood since 2005. The elderly trust her and are very open in sharing their problems with her. They call her whenever they need help. Through her, one of the elderly, who could not afford medical bills, successfully applied for the Neighbourhood Medical Assistance Scheme. Ms Tan even accompanies the elderly for their medical check-ups. She helps them read their bills in English, and patiently explains the contents to them. To encourage the elderly to be more active, she often buys tickets for them to participate in community activities for the elderly.
22. Mutual support is possible only when the community recognizes the need, and each resident is willing to participate. So our grassroots groups, especially the Residents’ Committees, have a key role to facilitate the formation of mutual help groups. That is why the People’s Association is encouraging pot-luck floor parties for people to get to know their neighbours better. That is why the PA is encouraging the formation of social interest groups, so that neighbours come together regularly and deepen friendships. This is building social capital. We need to accumulate a lot more social capital that will manifest in neighbours readily helping neighbours. It’s a lot of hard work doing floor parties. I’ve done a hundred in the past year in my own constituency. The person who initiate this, Dr Lim Wee Kiak, has already done his first hundred and is embarking on his next one hundred. But we have been gratified by the response of the residents. And so I look forward to all our advisors to support our grassroots organizations in this effort of building social capital.
23. Next, developing capability in eldercare. As the number of seniors grow, some will need care. The vast majority of seniors will be cared for at home by family care-givers. A majority of the old will be cared for by family caregivers, at home. In Minnesota, USA, in 2005, 92% of the elderly were cared for in this way. In Europe, the shift is towards home and community care. So, we should keep as many as possible of our seniors at home. Our policies and programmes should be framed around supporting families in the care of the elderly at home.
24. Our approach is to enable people to take care of themselves for as long as possible. And for those who need support, to enable them to do as much as possible themselves. The Australians call this the “Active Service Model”. Let me illustrate. A senior lady asked for home help services, as she felt she was no longer able to clean her home. When the service officer arrived, she found that the lady had an old heavy vacuum cleaner which this lady now could not pull around. So she proposed replacing it with a new light vacuum cleaner. This lady could then continue to clean her home herself, and benefit from the exercise as well.
25. This active service approach is also applied to day care. Instead of prescribing what the seniors do, day care operators give them choices, so that they continue to decide what they want to do. We must not place them in a dependency mode, but in an active mode to take charge of their own lives. And it is important that we learn to do this.
26. If we take the approach that we will provide care, and we prescribe care, then inevitably the client will expect care, and everything will have to be provided for, or done by someone else. Now one of our Seniors Activity Centres reported that the seniors expect everything to be done for them, including carrying goodie bags to their flats. On the other hand, in another Seniors Activity Centre run by TOUCH Community Services, the seniors happily help in organizing activities at the centre. TOUCH SAC initiated a “Loving Your Neighbour Programme” in 2009. It aims to mobilize the seniors to show kindness and to keep a look out for one another in their neighbourhood. It is quite clear why the TOUCH SAC can do a lot more than the first SAC I mentioned. And I believe the seniors there find life more purposeful.
27. Next, we should take a client-centric approach to delivering services to the elderly. Currently our services are service-centric. A senior may have meals delivered daily by one service provider, the flat cleaned by another and a befriending visit by yet another. Not only is this approach not cost effective, sometimes there can be adverse outcomes if services are poorly coordinated. For example, one senior who died alone and was discovered only after neighbours complained of the smell, actually was receiving home delivery meals. Therefore, we need service providers who can provide en suite services, who can work with the local community, and who have systems that can flag significant gaps that may need attention.
28. Services for the elderly are dominated by VWOs, whose focus is on the poor. But it is not only the low-income elderly and the poor who need services. For example, the seniors living alone that I mentioned earlier are not only living in rental flats, but also in 3-room, 4-room, 5-room and even private property. So we need more service providers to cater to the needs of fee-paying clients.
29. I shall also be frank to say that most of our service providers are small, lacking in scale, unable to pay attractive wages, yet incur high costs. And most also provide little training. Mr Baey Yam Keng mentioned capability building in the VWO sector to provide adequate care for our seniors. Yes, there is much to be done regarding productivity in this sector. Much as we want many helping hands, we need to nurture a few large operators with en suite services and critical mass to bring unit costs down and to raise standards, and adopt the active service model.
30. This is the approach we are taking in developing capability for care of the elderly. Ms Ellen Lee asked about caregiver support and home and community care options. I would say that in addition to building hardware in terms of a barrier-free Singapore to facilitate ageing-in-place, we are working to improve the “software” of options and better support for those who need care.
31. The setting up of the Centre for Enabled Living or CEL is an important piece in the eldercare landscape. And as its name suggests, the care philosophy is to empower seniors and their families, and to enable seniors who need care to be as independent as possible.
32. First, CEL acts as a first-stop centre for seniors who need eldercare and supportive services. It is also a resource centre for information and referrals. Together with the Agency for Integrated Care, or AIC, we are working towards an integrated and seamless care delivery and referral pathway.
33. For seniors who are frail and may have multiple needs, CEL will launch its pilot Assessment and Coordination for Enabling service, or ACE. It aims to develop such care management expertise over the next two years so that families can be supported in caring for their seniors.
34. Second, CEL helps to empower informal caregivers with practical caregiving skills. CEL is working with key providers such as NTUC Eldercare and Touch Community Services to provide up to 1,000 training places for informal caregivers, including foreign domestic workers in the coming financial year.
35. Third, CEL is building up VWO capability in providing en suite home- and community-based care and supportive services, working closely with NTUC Eldercare, TOUCH Community Services and St Luke’s. For example, CEL is funding TOUCH to develop and scale up integrated home care covering home help, home therapy, and home modification. TOUCH will use RFID technology to enhance efficiency in home service delivery.
36. CEL is working with Thye Hua Kwan to pilot the “Rent-a-Care Helper” programme, targeted at lower income seniors. These seniors and their families cannot afford to hire foreign domestic workers, but they do need regular help and support from trained caregivers. With a VWO like Thye Hua Kwan maintaining the central pool of care workers, costs could be made affordable for low income families.
37. MCYS has set aside about $3 million in fiscal year 2010 to support these initiatives by CEL in collaboration with key VWO providers.
38. Mr Laurence Wee asked about abandonment of parents by children. The role of the family is vital. The government is committed to support families with the responsibility for their parents. Children who abandon their elderly parents in an irresponsible manner should be deterred. I understand that the Minister for Community Development, Youth and Sports will speak more on this as he discusses the Maintenance of Parents Act.
Conclusion
39. The Government has already laid the groundwork and will continue its plans to meet the challenges of an ageing population. It will take a long time, not just months but years, to change mindsets about what ageing means and to realize the opportunities to help our seniors be confident participants in society for as long as they are able. I am confident that we have taken the right steps towards enhancing the lives of our seniors, but it will be up to each individual to take control of his own old age, with the support of his family and community.
