Sunday, 12 January 2014

Ageing in comfort and with dignity

Three seniors who work with seniors dream up their ideal retirement home: Cosy units with common lounge areas to encourage interaction, which come packaged with health care and social activities.
By Chiang Hai Ding, Rosemary Khoo And Philbert Chin, Published The Straits Times, 10 Jan 2014

FOR 16 years, "home" to Annie has been in the heartland of Henderson Housing Board estate. The Henderson Senior Citizens' Home is also home to 20 other residents who are long retired and whose meagre Central Provident Fund savings have long run out.

These men and women, mostly single, are independently mobile. Two or three residents share a converted one-room HDB flat, with an attached toilet and shower, and basic cooking facilities. They share a small lounge with a television set and laundry. They can also go to the hawker centre nearby for food or join the day centre on the first floor for activities, should they wish to do so.

These elderly residents appear to be happy with what they have. They receive basic care from a few live-in foreign workers, and are mostly free to do their own thing. Volunteer health professionals look in on them periodically, and other volunteers organise weekly meals and periodic outings.

The home Annie lives in was run for several decades by the Chinese Women's Association led by its president, Mrs Betty Chen. This organisation handed the baton to the NTUC Eldercare Cooperative in 2008.

Today, there are 300,000 seniors over 65 years in Singapore. By 2020, there will be 600,000, and by 2030, 900,000. In fact, there are already 200,000 singles over the age of 35. The majority of Singapore seniors are found in HDB estates, which house over 80 per cent of our population.

Requirements of seniors

WHAT do seniors need?

As active volunteers working with seniors, we believe they need the four basics - health, housing, dignity and meaning. We were heartened by Prime Minister Lee Hsien Loong's National Day Rally speech in August. "Whatever happens to you," he assured Singaporeans, "you can get the essential social services that you need, especially health care." And to provide "peace of mind", especially to "the pioneer generation", he announced the new MediShield Life.

The health insurance scheme will embody three striking features. First, it is lifelong; second, it is universal and covers everyone, newborn and old alike, as well as pre-existing illnesses; and third, it will help cover large hospital bills.

With health care for the aged now getting more official attention at the national level, we would like to dwell on housing. Where will seniors retire to?

The gold standard in senior housing is "ageing in place". This concept refers to seniors continuing to live wherever they are now, such as in existing HDB estates. It would be an ideal solution if every senior had someone - a spouse, a family member or friend - to provide care and companionship as they became less able.

But our population is declining, and caregivers are scarce. Can two young people with two children cope with four ageing parents? What if the young persons are working abroad? Who will care for the growing number of aged singles like Annie?

The most popular of the various HDB solutions has been the "studio apartment". They come in two sizes, 35 sq m and 45 sq m, and are on a 30-year lease.

New-style retirement homes

HOWEVER, they do not provide for health care. We envision a new type of retirement home in our HDB estates. It is an extension of the studio apartment concept, but incorporates health care and social care in a holistic manner, bringing a range of health care, eldercare and voluntary groups together.

These would be high-rise blocks with smaller "housing units" of 18 sq m each. They would be equipped with bath, toilet and kitchenette, as well as elder-friendly features like non-slip floors, grab rails to assist mobility and a personal emergency response system, or Pers, in case of need. They would also incorporate some IT features to enable seniors to live more safely at home.

If you think 18 sq m, or about 200 sq ft - equal to the size of a lounge in a HDB flat - is too small, think again. A friend of ours, retired architect Andrew Tan, came up with a design for the units. In addition, each floor and block will incorporate common user-spaces like a laundry, lounge and a "sky garden" to bring in light and air. Such features would entice seniors to come out of their housing units to interact with other seniors.

The units, like standard HDB studio apartments, would be on short-leases.

These housing units would also be of modular design and scaleable, so that those who can afford them can purchase two or three adjoining units to create a bigger one. Thus, there could also be two-unit and three-unit designs, of 36 sq m and 54 sq m respectively, for singles and senior couples.

As these new-type retirement homes would be built by the HDB, they could come with space set aside for new services such as health screening, basic medical care by the Home Nursing Foundation, physiotherapy and podiatry, and even for a "senior navigator". In this way, seniors would remain very much an integral part of the community.

Seniors often suffer from loneliness due to the loss of family and friends, and of their strength and faculties. This is where voluntary welfare organisations (VWOs) and faith groups can help seniors find companionship and meaning, helping others even as they themselves are helped.

In addition to VWOs, the new retirement residences can also count on support from the established citizen groups like the Citizens Consultative Committee, the Community Centre Management Committee, the Residents' Committee, Senior Activity Centre and wellness centres.

The housing units should be available initially to HDB owners, but can subsequently be offered to other seniors as well. Then, our HDB heartland would be even more integrated than they are now.

Health-care vision

WE SEE the HDB selling the new housing units together with a mandatory health-care package which covers periodic health screening with referral (if warranted) to medical services, as well as advice on health promotion and active ageing.

"Old" or "traded-in" HDB flats could also be refurbished and recycled to new buyers on shorter leases, priced accordingly.

The introduction of these clusters of housing units for seniors could be accompanied by the creation of a new position, of "senior navigator": A cheerful, friendly person to help seniors access the new housing units and government and social services already on offer, which many seniors may not be aware of.

Monetising assets

MANY seniors would be able to pay their own way if the Government enabled them to monetise their major asset, their HDB flats.

If we assume one housing unit of 18 sq m costs about $36,000 and a resale three-room HDB flat to be worth about $320,000, then in a sale-and-purchase transaction, the senior would acquire both a housing unit and residual cash of $284,000.

Obviously, the numbers for the housing unit, resale three-room flat and residual cash would vary according to the location, age and other factors, but the basic arithmetic would remain true.

This residual cash would be sufficient to pay for the senior's mandatory health-care package, MediShield Life premium as well as an annuity. He will then have a secure lifestyle, and may even leave a modest legacy.

We envision seniors retaining their dignity and sense of self-worth by cashing in their major asset, yet possessing an independent living space that comes with some health care and money in hand. Life is not much fun if one is asset-rich but cash-poor.

With our new-type retirement home, seniors can age in the HDB environment they are most comfortable in, with assurance of health care, dignity and meaning.

The authors are three doctors - of history, linguistics and medicine, respectively. Between them, they have more than 30 years of experience working with seniors in various non-profit organisations, including the NUS Senior Alumni, NTUC Eldercare, the Gerontological Society and RSVP (The Organisation of Senior Volunteers).

Programme to help seniors take charge of their health

I REFER to the article "Ageing in comfort and with dignity" by Dr Chiang Hai Ding, Dr Rosemary Khoo and Dr Philbert Chin (Jan 10) and three letters published on Jan 16 ("Start planning for 'retirement blocks'"; Forum Online, "'Working in place' approach to retirement housing" and "Key lies in integration, not separation").

I would like to share with readers the PA Wellness Programme, a community-based active-ageing initiative by the People's Association that helps our seniors take charge of their health - physically, mentally and socially.

Beyond regular health-screening sessions, we encourage seniors to follow through with the necessary corrective medical attention and also participate in community activities to keep physically and mentally healthy.

When our grassroots volunteers come across seniors who require assistance, they will also offer the necessary support, such as providing suitable financial assistance and working with the right partners to meet seniors' needs.

Since the programme started in 2010, we have also seen seniors forming and leading many interest groups.

These interest groups are made up of young and old. Because of their regular interactions, members tend to develop stronger friendships over time.

In fact, such interest groups often act as an informal roll call where members look out for one another, and even help one another during emergencies.

Our seniors also achieve a deep sense of fulfilment when they are able to impart their experience and knowledge to others, especially the younger generation.

I would like to encourage our seniors to embrace wellness, come forward and join us in staying active, healthy and happy.

To find out more about our programmes, please visit the nearest community club or

Tan Yong Seng (Dr)
PA Active Ageing Council
ST Forum, 27 Jan 2014

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