By Radha Basu, Senior Correspondent, The Sunday Times, 25 Jan 2015
Coffee-shop assistant Wong Meng Lin, 55, shells out about a third of her $1,000 monthly take-home pay to send her 83-year-old mother to an eldercare centre while she is at work.
The older woman has dementia and cannot be left alone at home. The centre sends a van for her, but the daily commute can take 45 minutes each way, since other clients are picked up too.
So when Ms Wong chanced upon a new day-care centre for the elderly near her home, she immediately dropped in to inquire if it could accommodate her mum.
The Kallang Bahru centre has ample vacancies. But it is run by a private company, Goldencare Group, and its clients do not receive the government subsidies that apply at similar centres run by voluntary welfare organisations (VWOs).
While VWO-run centres receive subsidies for needy clients, they are also subject to regular checks by the Ministry of Health (MOH).
They must also meet some ministry requirements on safe and appropriate care, staffing qualifications and so forth.
Goldencare gets no subsidies, does not need to meet these requirements and is also not audited for its quality of care.
The centre is the brainchild of Ms Sim Kah Cheng, 47, a nurse with nearly two decades of experience at restructured hospitals and polyclinics.
Aware that Singapore has one of the fastest rates of ageing in the world - and eldercare infrastructure may well fall short - she decided to set up the centre with help from private investors.
She points out that Singaporean children who attend private childcare centres are eligible for state subsidies. "In many ways, the need for subsidies may be greater in eldercare, since we are essentially a fast-ageing nation with very low fertility rates," she says.
She thinks centres such as hers can keep frail, elderly people active and engaged while their caregivers are at work.
An MOH spokesman told The Sunday Times the ministry welcomes the involvement of private-sector players in the provision of eldercare services.
Upcoming eldercare centres that are co-located with nursing homes will receive subsidies, irrespective of whether they are run by private groups or VWOs.
The ministry is looking into how to extend these "portable" means-tested subsidies.
However, such a scheme must include a framework to manage price increases and a quality-assurance system to better ensure quality care at affordable prices, the spokesman said. Such safeguards are indeed important.
After public consultations, the ministry is finalising a set of guidelines to define good care in day-care and day-rehabilitation centres for seniors. The spokesman said these guidelines will provide a basis to study the extension of eldercare subsidies more widely among existing centres.
With Singapore ageing faster than most other nations, I hope such decisions can be made soon.
As of last June, there were already more than 430,000 people here aged 65 and above, up by nearly 100,000 from just four years earlier.
While people are living longer, not everyone is living well.
Estimates from the latest National Health Survey made public in late 2011 showed that Singapore had around 210,000 people who were looking after elderly, sick or disabled folk at home.
I have spoken to many caregivers who have had to quit their jobs to look after loved ones at home.
The Government is ramping up eldercare services - the latest subsidised eldercare centre was officially opened by Prime Minister Lee Hsien Loong last weekend.
There are around 2,700 subsidised eldercare places islandwide and the capacity is likely to expand to 6,200 places by 2020. Given the rapid ageing, these numbers may need to be raised further.
The average waiting time islandwide for a subsidised day-care centre service is less than three weeks, says MOH.
But such statistics are of little comfort to people like Mr S. Das, 60. The marketing executive has decided to hire a maid to look after his 80-year-old mother, Madam S. Mary, after a two-month search for subsidised day care yielded no results.
Madam Mary lives with one of her daughters, who is out working during the day.
With a host of age-related illnesses, the elderly woman cannot be left alone at home. "There is no point having vacancies in Jurong if I need a place in Whampoa," says Mr Das.
A VWO-run day-care centre at the foot of Madam Mary's block told her family that, after subsidies, she would need to spend less than $350 per month.
"But there are seven people in the queue before her and many day-care clients are there for life, so we may well face an endless wait," says Mr Das.
He, too, turned up at Goldencare, but its fees - at $55 a day - are too expensive. "It's cheaper to hire a domestic helper, who can look after my mother, cook and clean the flat," says Mr Das.
For those who can afford them, maids have been the default mode of care for many families living with older folk in their last leg of life.
But relying on them may not be a sustainable solution.
With the economy improving in source countries such as the Philippines and Indonesia, the supply of good-quality maids is depleting rapidly.
New regulations may soon make hiring foreign maids costlier too.
The Philippine government is looking to introduce a quota on Filipino maids in Singapore, which could see supply dropping by as much as 20 per cent. The Indonesian government has also raised the minimum monthly salary of Indonesian maids here to $500, from $450 previously.
We need other options for eldercare, and some families prefer not to leave their old folk with maids.
Madam Y.M. Toh pays $1,680 a month to send her mother from Bukit Panjang to Goldencare in Kallang, simply because she hopes the centre will keep her mother active, engaged and social.
"Ordering a maid around at home will only make her more sedentary," she says.
She hopes the authorities will not only consider extending subsidies to private centres but also do quality checks on them.
"Buyer beware" cannot be the default mode for private care services.
Unlike eldercare centres, private childcare centres must be licensed and submit to regular checks by the Early Childhood Development Agency.
Older folk who are left at day-care centres require the same quality care as children. Given the shortage of space in non-profit centres, they need means-tested subsidies too.
In the 50th year of independence, it's the least we can do for the generation that built modern Singapore.
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