Thursday 23 February 2012

'Yes, we need retirement villages'

Few housing options for the old in Singapore, says senior-living consultant
By Radha Basu, The Straits Times, 22 Feb 2012

LAST Friday's Budget bestowed a hamper full of goodies on older Singaporeans.

Families caring for the frail elderly are in for a windfall, with more state subsidies for care in community hospitals, nursing homes and even at home. For the first time, even the richest can get state subsidies for stays in community hospitals.

In this 'season of plenty', it may seem politically incorrect to talk about some seniors who feel short-changed about retirement options.

But international senior-living consultant Tan Kee Hian, 57, believes this is as good a time as any to discuss the relative shortage of living choices for Singapore's growing group of more affluent, older folk.

He says many seniors in the top fifth to 20th percentile of the income scale would gladly part with their savings to live in retirement villages (RVs) which offer professional care and support services such as an on-site round-the-clock emergency response system.

While such communities are common in most developed countries, there are none in space-starved Singapore. Both the public and policymakers seem to prefer 'ageing in place' - where people live out their last years in the community rather than in institutions.

But Mr Tan says that while boosting community resources to enable the majority to age in place is a 'basic necessity' here, no one solution can fit the needs of all seniors.

'Ageing in place assumes that everyone has similar needs - and that's a very big assumption. Given the diversity of our First World society, we deserve more choices.'

The veteran management consultant is convinced there is a need and even a demand for Western-style retirement villages, and hopes to develop Singapore's first such project.

He says those who argue that there is absolutely no demand for retirement villages here are divorced from reality.

'If you repeat a myth often enough, it gets mistaken for a fact.'

Over the past two years, he has rigorously researched and written a proposal for a $70 million to $80 million retirement living project in Jalan Jurong Kechil, a site the Government has earmarked for the purpose.

All he needs is an investor who is willing to put in up to $25 million. The rest will be made up by bank loans and he is willing to put his cost calculations up for thorough scrutiny.

The Harvard Business School-trained expert says he has done his homework and pulls out a consultant's most handy tool: statistics.

A survey of 3,000 baby boomers, commissioned by the Ministry of Community Development, Youth and Sports (MCYS) and released in 2009, showed that one in four would not mind living in a retirement village.

Significantly, that is far higher than the 12 per cent of older folk who actually live in such communities in countries like the United States.

There are nearly a million baby boomers here, born between 1947 and 1964. The first cohort turns 65 this year, which Mr Tan sees as an 'inflection point' in this nation's history.

Singapore's population of those aged 65 and above is set to double to 600,000 over the next decade and triple to nearly one million by 2030 - that's a faster rate of ageing than in virtually every other nation in the world.

He says some demographic micro-trends have reinforced the need for RVs.
- The number of older folk here who live alone or with their elderly spouse doubled to nearly 100,000 between 2000 and 2010.
- The number of those who have mobility problems and are 'semi-ambulant' has also doubled to around 36,000.
- The exploding numbers of these two groups - which have traditionally formed the core client base of retirement communities overseas - have far outstripped the overall growth in the senior population, which increased by around 50 per cent to 344,000 over the past decade.
The exploding numbers of semi-ambulant seniors are a particular concern for Mr Tan, who is a baby boomer himself.

Although they are in relatively good health, they may end up living in expensive nursing homes simply because they are immobile.

'Most such patients overseas would be living in retirement communities, saving their health-care institutions taxpayer dollars.'

Mr Tan, who returned to Asia in 2006 to be near his ageing parents after 35 years in Europe and the US, points out that he is often asked why he wants to 'break up families and hurt inter-generational ties' by advocating RVs.

'Just look at the statistics,' he says. 'The number of older folks who want to live by themselves may well explode. And as things stand now, many may not be getting the services they need.'

Indeed, growing groups of seniors either do not have children or do not want to depend on them as they age. Many - like Mr Tan himself - have children who live and work overseas.

Small wonder then that, according to the baby boomers survey, nearly 75 per cent of all respondents - and 85 per cent of university graduates - said they wanted to live on their own during their golden years.

About a third of those aged 65 and above already do so now.

But even if the demand is there, will older people have enough savings to pay for such resources?

Mr Tan reckons they will. Singapore, after all, has the highest proportion of millionaires in the world, with one in six households on that rich list. The number of those who earn above $10,000 a month has increased by nearly three-fold to 140,000 in a decade.

According to the MCYS survey, 12 per cent of baby boomers - or potentially 120,000 people - have gross monthly incomes of $7,500 and above.

Interestingly, the father of two acknowledges that it is not the Government but the private investors who should test the market by setting up Singapore's first retirement village.

To be fair, the Government has already taken the initiative to inject some variety in elder-living options, particularly those that cater to middle- to lower-income Singaporeans.

On Sunday, it launched Singapore's first group home for low-income elderly, where small groups of older folk who have little or no family support can share rental flats.

The Housing Board (HDB) has ramped up the supply of studio apartments for the elderly - and latest take-up rates are above 90 per cent.

Meanwhile, MCYS recently piloted 'seniors service centres' for residents in these apartments, providing information and referral services, organising social services and responding to emergencies.

But what these facilities do not cater to yet is more 'sophisticated needs', says the professional, who would love to live in such a facility one day.

For instance, there are no provisions for on-site nursing care.

There are older folk, for example, who may want care facilities within their condominiums - rather than in the neighbourhood. Some might not want to - or be able to - walk even 400m to the nearest polyclinic.

'A retirement village combines elder-friendly housing with care and community engagement services, together with professional management,' says Mr Tan. 'And no facility in Singapore currently provides all three.'

While senior activity centres might provide referral services, they certainly don't have a 'village manager' whose primary duty is to ensure the well-being of seniors living in his village.

So given that there seems to be a market demand, why has no developer bitten the bullet so far?

Mr Tan believes there is a 'fundamental mismatch' between what property developers traditionally do and what seniors want.

Developers want to sell houses, but seniors want to buy care; developers want to build, sell and move on; seniors want a provider who will stay and ensure a specified quality of care and services for the rest of their years - for many, many years.

'Developers love more of the same, but a retirement community is really a new market space,' says Mr Tan. 'We need a new breed of champion investors - and I hope we find them fast.'

Senior-living specialist 
MR TAN Kee Hian, 57, is a senior-living consultant who has worked on retirement and community living projects in Singapore, Malaysia and China.
In Singapore, he has been adviser to a proposed state- sponsored communal living project, to be run by a voluntary welfare organisation. He has drawn up detailed plans for what could be the island's first retirement village and is looking for private investors.
Mr Tan is also on the advisory committee of the non-profit group RSVP Singapore (The Organisation of Senior Volunteers).
Before moving to Singapore in 2006, he spent three decades as a management consultant working out of London and Boston in senior positions in companies like Gemini Consulting (Cap Gemini), A.T. Kearney and Shell International Group. He was the global leader for Gemini's health-care and life sciences practice. Since 1996, he has headed his own consulting firm, KHT and Co, which has had 40 clients in 15 countries.
The Malaysia-born Singapore permanent resident was an Asean scholar at National Junior College and went on to study engineering at Imperial College, London. Later, he received an MBA from Harvard Business School, where he was in the top 5 per cent of his cohort.
Mr Tan is married to Madam Chia Swee Tuen, 55, a Singaporean piano teacher. They have two grown-up children.

Q&A: What baby boomers want

People have been talking about retirement communities here for 20 years. So why has nothing materialised yet?

A: Twenty years ago, the retirement community idea was clearly ahead of its time. The generation that grew old then had very different cultural values, needs and preferences. Older folk were less-educated, less-travelled, had limited means, and were quite happy sitting at home, chatting occasionally with or tending to grandchildren and family members.

Today's and future generations of seniors - the baby boomers - are very different. They are better-educated, are used to more sophisticated lifestyles, and have worked hard to squirrel away nest eggs. They have seen the kind of services seniors enjoy overseas and want such professional care services in Singapore. They don't want to depend on their children. They have hobbies, they want social engagement. Just interacting with - or depending on - family is not enough for them. So, yes, their needs and expectations have changed - and become more Western, if you will.

What would you say to potential investors who argue that there is no money to be made in retirement villages (RV)?

A: Whether you make money or not will depend on what you offer. Like any value-added product or service, people are willing to pay to get what they need and want. A cursory look at the success of HDB's studio apartments will confirm that customers will pay a premium for the right solution in the senior-living market in Singapore.

I believe that unlike younger home buyers, baby-boomer seniors who buy a unit in a retirement village are not as interested in the size of their home or in its investment value. They want the convenience of having services on-site - be it a shared nurse or a domestic helper or a manager who ensures your day-to-day well-being, a wide range of social activities and a vibrant community of like-minded people.

At the same time, there are frills that seniors don't want or care for, such as marble tiles, grand water features or large, expensively fitted kitchens.

According to my analysis and calculation, with the right business model based on a deep understanding of the baby-boomer seniors, an RV can deliver up to 20 per cent more profit than conventional condos in the Upper Bukit Timah area. Of course, this is not a one-off project, as success will provide a strong credibility to expand and gain a disproportionate share of the potential market, which I estimate to be well in excess of 10,000 by 2030.

Are retirement villages necessary in an urban setting where access to community medical and social services is just a stone's throw away?

A: To answer this, we must go back to how seniors define their needs and preferences. Experiences from more advanced countries show a strong preference for on-site provision of care services and convenience, even in urban settings such as London and New York.

For the record, being land-starved has nothing to do with the viability of a retirement village. Everyone has to live somewhere, whether it's in a traditional home like an HDB flat or condominium or an RV apartment. Who says RVs have to be sprawling complexes spread over 200 acres (80ha) like in Australia or rural USA?

Vertical retirement villages - which are basically elder-friendly condominiums with comprehensive on-site services - are also a viable option and there are many such complexes in both Europe and the US.

Harness the Power of One to help the old
Individuals can be agents of change and come up with senior-living options
By Radha Basu, The Straits Times, 26 Feb 2012

In the mid-1950s, World War II veteran Richard Carr-Gomm used his gratuity from the British Army to buy a terrace house in a derelict part of London.

He threw open his new home's doors to lonely vagrants whom he had seen wandering around the neighbourhood. Four old men with no family or friends soon moved in with him.

In class-conscious Britain, cynics began scoffing. But this private citizen persevered - sparking a movement that thrives half a century later.

Today, Abbeyfield Society, the charity Major Carr-Gomm set up, oversees more than 700 group homes for the elderly across Britain. Clients pay for their stay and volunteers are the charity's lifeblood.

Anyone can start a home in any part of the country and become an Abbeyfield member by adhering to a set of common principles: primarily that the elderly 'feel the warmth of community care' as they live out their last years.

Meanwhile, in Singapore, the first group home for the lonely elderly was officially launched last weekend in a block of rental flats on Pipit Road. In true Singapore style, it was a project conceived, initiated and partly funded by the Government.

In fact, civil servants had visited group homes in the Netherlands and Britain, including some run by Abbeyfield Society, before deciding to emulate them here.

Well-known voluntary welfare group Thye Hua Kwan has been roped in to help run the project and bear part of the costs.

As Singapore hurtles on the course to being among the oldest nations in the world, the Government has significantly increased spending on older Singaporeans.

This year's Budget includes new wage subsidies to help them remain employable and more health-care subsidies for care at home, and in community hospitals and nursing homes. There is even a cash bonus for lower-income folk who downgrade to smaller homes.

As the Budget announcements show, the well-being of the old is firmly on the Government's radar. But with the number of those aged 65 and above set to double to 600,000 in less than a decade, and treble to nearly a million by 2030, the Government cannot go it alone. More ordinary Singaporeans need to step forward as elder-care champions to ensure that our elderly lead prosperous, healthy and socially engaged lives.

During a recent visit to the United Kingdom and the United States to study senior-living options that could work here, I was struck by the number of prescient, private individuals who anticipated the ageing challenge, stepped in early and helped change their own lives - and those of countless others.

Many of them are affluent, educated senior citizens themselves who believe in the 'Power of One' - that when it comes to overcoming major national challenges like ageing, it is not just governments but even individuals who can be powerful and positive agents of change.

For instance, retirees Michael and Norma Milner, both 81, spent the past two decades running an Abbeyfield group home in London before handing over the reins to younger volunteers recently.

'Did they believe that today's baby boomers would have time for such altruism?' I asked when I met the couple in the bright yellow living room of the place they once ran and still consider their 'second home'. Won't older folk these days want to travel? Pursue hobbies?

'Oh come on, you can't travel all days of the year,' said Mrs Milner with a laugh. 'Everyone needs a home and a community to belong to.'

In New York, I met Mr Nat Yalowitz, a spritely, straight-talking 82-year-old who is regarded as the founding father of 'naturally occurring retirement communities' (Norcs) in the United States.

As a resident of the Penn South cooperative housing estate in midtown Manhattan in the early 1970s, he noticed groups of lonely old men wandering aimlessly in his housing block. Many were unable to take care of themselves.

Realising that the problem could grow as residents aged, the trained social worker surveyed elderly residents on their needs and drew up a proposal for health, social welfare and recreational programmes within their housing block.

After initial funding from a charity, by the mid-1990s, he was able to convince the New York government to help fund the programme which involves hiring nurses and social workers to help look after residents living in the housing block.

Today, more than half of the programme's US$600,000 (S$760,000) annual budget comes from state funds. Such 'Norc programmes' have mushroomed across the US and more than three million older Americans receive help and care from them.

Not too far from Manhattan, in affluent neighbourhoods in upstate New York and New Jersey, I met Mr John Corry, 80, and Mr Richard Bergman, 77, and his wife, Victoria, 67. Mr Corry and the Bergmans don't know each other, but they're kindred spirits.

They helped conduct local surveys on elder-care needs and organised neighbours in their communities to form non-profit groups for seniors, where members help one another in times of need.

Mr Corry's outfit, Gramatan Village, also connects seniors to home help and other services so they don't need to live out their last years in nursing homes or retirement villages. The community also sources for grants to help poorer neighbours access such services.

After a recent Saturday Special Report in The Straits Times highlighting the big variety of senior-living options in the US, Britain and the Netherlands, I was inundated by responses from readers lamenting the relative lack of such options here.

Some wrote in yearning for retirement villages. Others wanted more intimate group homes like the ones run by Abbeyfield Society in Britain. Many complained that the Government had 'not done enough'. Yet others expressed outrage at how some residents at Toh Yi and Woodlands had protested against government plans to set up elder-friendly centres in their neighbourhood.

I'm sure there must be people or groups doing their part to help with senior-living options here. We need to hear from them and celebrate their successes - and hope that they will inspire a new generation of champion change-makers who believe in the Power of One.

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