Wednesday 8 April 2015

Community for Successful Ageing @ Whampoa

Whampoa's way
Singapore is one of the fastest-ageing societies, with nearly 100,000 people turning 65 over the past four years alone. Over the next 15 years, the number of older folk will double to close to a million. In the first of a series on ageing well, our correspondent describes an ambitious experiment under way to let Whampoa residents live out their golden years in their own homes.
By Radha Basu, Senior Correspondent, The Sunday Times, 5 Apr 2015

She has already finished a morning workout, sat through a health talk, played ball games and shared a simple lunch of century-egg porridge with friends.

But even as the last rays of the late afternoon sun stream into Madam Tan Kim Yoke's bright and cheery three-room flat, the 86-year-old is not done for the day.

The phone rings.

It is a friend from a neighbouring block. "Sure, I would love to go karaoke," she says into her iPhone with a chuckle.

Its red plastic case, decorated with multicoloured hearts, matches her red-and-gold manicure.

"See you later."

The widowed mother of eight has a large, loving family, but chooses to live alone in Whampoa, in the same neighbourhood she has called home for well over 50 years.

She raised her children - who are now in their 50s and 60s - in the flat which she still lives in.

"I have many memories here, my friends are here and there is so much to do," she says. "My children come to see me. There is no reason to move."

She does not know it, but older residents in Whampoa are part of an experiment to enable older people to age in their own flats and familiar neighbourhoods, with the help of a coordinated community-wide system of health and social support programmes and services.

Called the Community for Successful Ageing (ComSA), the $5 million initiative is spearheaded by the Tsao Foundation, a non-profit group that specialises in ageing issues.

The Tote Board has committed $4 million. The foundation is paying for the rest.

It will be launched officially on Saturday, nearly three years after the foundation first began working with seniors in the neighbourhood.

More than a third of Whampoa's 33,000 residents are over 50. Around 3,600 have crossed 65.

The foundation works closely with Whampoa grassroots groups and more than 20 government, healthcare and community agencies to better serve Whampoa's seniors. Its chairman, Dr Mary Ann Tsao, says that ComSA hopes to enable all seniors - rich or poor - to "live well".

For those like Madam Tan who are financially better off and in fine fettle, "living well" means keeping them active, engaged and happy.

For others who are frail, lonely or poor, it means connecting them to the right services at the right time, so that they do not have to leave home or land in institutionalised care.

"Singaporeans are living long, but we're not really living well," says Dr Tsao. "This is what we're hoping to change."

Energetic, independent and full of good cheer, Madam Tan is in many ways the perfect poster child for active ageing.

Every Sunday morning, she is the oldest resident to join song-and-dance sessions conducted by cardiologist Tan Yong Seng, 55, a local grassroots leader.

On Tuesdays and Wednesdays, the garrulous great-grandmother of eight plays mahjong and other games with her kakis at the Whampoa Gardens Residents' Committee (RC) office, a stone's throw from her block.

Thursdays are special, with Madam Tan joining about 20 friends for "self-care" sessions.

They first got together last year for 24 sessions with trained volunteers from the Tsao Foundation who taught them how to deal with chronic diseases, manage stress and take better care of themselves.

Although men are welcome, the group is made up entirely of women. "Men are shy, lah," she says.

The formal sessions ended long ago, but the women meet every Thursday afternoon to chat, exercise and play ball games.

They also share a meal - usually something simple and healthy like porridge or soup - sing and swop stories.

One recent Thursday, the conversation centred on Whampoa, and how long some of them have been living there.

Madam Tan, who looks and acts far younger than her age, says she moved to the area as a young mother in the early 1950s.

Some of her friends who live alone like her - widows Tan Ah Moy, 80, Oh Siew Lian, 76, and Lam Ah Won, 79 - have called the area home since childhood.

"Just imagine," Madam Tan marvels. "We've lived here almost all our lives but did not meet when we were young."

Why Whampoa is special

There are many groups islandwide running active ageing programmes, but several factors make the Whampoa project special.

First, the Tsao Foundation and grassroots volunteers polled nearly 2,000 senior residents to assess their needs and vulnerabilities, before drawing up services to meet those needs.

For instance, the elderly residents found it hard to travel long distances for frequent medical appointments.

So the foundation started a mobile clinic in the same RC office that Madam Tan and her friends hang out in.

The survey also found that many seniors had "small social networks" and may feel lonely as a result, says Whampoa MP Heng Chee How, a key ComSA partner.

The grassroots groups are now working with Tsao Foundation on ways to include these seniors in various community activities to forge new friendships.

While many agencies conduct surveys, the information collected is often not put to use, says Dr Tsao. "We follow through and help connect the dots."

The aim is not merely to provide a "care service", but build an entire system of care.

A spokesman for the Ministry of Health, which oversees ageing issues, says another noteworthy aspect of the Whampoa project is that it brings together various groups working in the area to "act in concert to meet the diverse needs".

Around once a month, representatives of partner organisations - including the local grassroots, social service and health agencies, and community eldercare groups - meet to discuss challenges that seniors face and devise solutions.

Tan Tock Seng Hospital, which is close to Whampoa, is another key partner. Last year, it started a programme to pay closer attention to patients warded three or more times over the preceding year.

Dr Tan Kok Leong, deputy head of the hospital's continuing and community care department, says that once they are discharged, the patients are put under the charge of the ComSA team, which comprises doctors, nurses and social workers.

"The ComSA team provides multidisciplinary community care, looking after a patient's medical, functional and psycho-social needs," says Dr Tan.

"This helps to reduce the likelihood of re-admission."

Spotting seniors who need help

Their efforts are paying off, especially when it comes to helping frail and poor old folk with limited family support, such as cancer survivors Tan Siew Luan, 75, and her husband, retired labourer Lim Guan Thye, 82.

Madam Tan, a mother of five, had uncontrolled diabetes and often missed her daily insulin injections as she depended on her caregiver son, who was often not around.

After the Tsao Foundation medical team intervened, she has learnt to take the pills and her son has been giving her regular insulin injections. Her diabetes is now under control.

Instead of taking a 30-minute bus ride to the Toa Payoh Polyclinic, her husband, who has dementia, now goes to the aged-care mobile clinic at his doorstep, which is open twice a week.

The couple first came to the notice of ComSA care staff in 2013, when they attended a block party.

"While talking to them, we realised that the couple were missing appointments, not taking medicines and could not convince their children to accompany them for these appointments," says Ms Fiona Hon, a nurse-care manager from the Tsao Foundation who monitors the couple's health and well-being with teammate Chua Hui Keng.

There was a time when Madam Tan did not leave the flat for more than a year because she was too weak. Apart from ill health, the couple also had money woes.

Their eldest son gave them $100 a month. Other children chipped in with smaller amounts when they could.

The couple got by on free food and meal vouchers distributed by grassroots and welfare groups.

They say their children are poor and would "scold" them if they asked for money.

Mr Lim says he once tried approaching the local community development council for aid, but gave up when he was told to provide the payslips of all five children.

"There are children who often brush off their parents' requests for money or care," says ComSA care manager Ms Chua. "But they may listen to a third party."

She helped to rope in Jalan Besar's Social Service Office (SSO), under the Ministry of Social and Family Development, which gives financial aid.

The SSO chipped in with $400 in financial assistance a month and persuaded four of their children, who work in low-income jobs, to contribute $50 each.

Meanwhile, the Awwa Family Service Centre, another ComSA partner, is pitching in with counselling and job support for one of their sons, an odd-job worker who lives with them.

The medical director of Tsao Foundation's Hua Mei Centre for Successful Ageing, Dr Ng Wai Chong, points out that "psycho-social factors" such as the love and support of children have a huge impact on the physical health of older folk.

"If a person has money woes or feels neglected or depressed, medical intervention alone may not improve his health," says Dr Ng, who is one of the doctors at the aged-care clinic.

Trying to reach seniors outside the current care system is another key aim of ComSA, adds Dr Ng.

"We knock on doors to assess risks and find families that need help but never really asked for it," he says.

Last year, the team stumbled upon an elderly couple in a rental flat looking after six young grandchildren as the parents were in jail.

"They were old and frail but incredibly had never touched the healthcare system," says Dr Ng.

Like the Lims, they are now being helped by several agencies.

The foundation is also working with the Saw Swee Hock School of Public Health at the National University of Singapore to test a risk-assessment tool, a software formula which helps to identify older folk who are at risk of medical or cognitive decline, disability or loneliness, based on questions put to them.

Among those deemed at risk is Madam R. Letchmi, 83, though community support has enabled her to continue living at home rather than in an institution.

Her right leg has been amputated and her husband, her sole caregiver, died in 2011.

She does not see her older son very often; her younger son died of a sudden heart attack more than 30 years ago.

These days, she often feels breathless. Her joints ache. Her memory is fading.

She used to miss her doctors' appointments when the volunteers who accompanied her for visits were unavailable.

The Tsao case-management team has since arranged for free taxi rides from ComfortDelGro.

She does not mention it, but it is loneliness that seems to affect Madam Letchmi most keenly.

Sitting on the floor of her two-room rental flat, she shows The Sunday Times old photographs, faded and torn payslips and old medical records of her husband, younger brother and son, some dating back 40 years ago.

"So many memories I have here," the articulate former canteen helper whispers, in tears as she gently caresses the old cloth bag in which she keeps these priceless possessions from her past.

A native Tamil speaker, she picked up Hokkien and Malay when she was growing up in a kampung. She later learnt English by paying a small sum to one of her son's teachers.

"They are gone now," she says, pointing to the flower-bedecked photos of her husband and younger son.

The pain of losing loved ones still lingers. But she has new friends now.

Smiling through her tears, she turns and gives Ms Hon a big hug.

"And this is my best friend," she says.

The dancing doctor and his motley crew of proud pioneers
By Radha Basu, The Sunday Times, 5 Apr 2015

Every Sunday morning, the Curtin University campus in Jalan Rajah plays host to a very special teacher. Cardiologist Tan Yong Seng's classes combine music and medicine, two of his biggest passions. He gives health talks, followed by exercise and song-and-dance sessions.

His 40 or so "students" are special too. Most are proud members of the pioneer generation and call themselves the Whampoa iSing group.

Known affectionately as the "dancing doctor", Dr Tan, 55, has been a grassroots leader for a decade and chairs the Whampoa Active Ageing Committee.

His classes began in 2008 at the Whampoa Community Club. He is using a Curtin classroom while the CC is being renovated.

One recent Sunday, the sessions began on an inspiring note - on how living to 100 can be a blessing, if we remain mentally connected and physically fit. "This South African lady celebrated her 100th birthday by jumping out of a plane with an instructor," says Dr Tan, flashing a picture on his Powerpoint slide.

"How many 10 years do we want to live?" he asks.

"Ten!" some voices shout back in unison. Many here want to celebrate their 100th birthdays.

Then the classroom fills with music, song and dance. The motley crew sing in English, Mandarin, Cantonese, Hokkien, Malay and Tamil, following lyrics flashed on a giant screen.

Later it's time to show off cha-cha-cha and rock 'n' roll moves.

Retired teacher Woo Oi Leng, 68, is a regular at the sessions which can stretch to four hours.

"I come here for the fellowship, for the company of other seniors," says the widowed mother of three who lives nearby. She went on vacation recently and missed two classes. Friends asked where she was. "They care for me, they miss me when I am not around. It makes me happy."

Like her, most of the others live nearby. But some, like retiree Aw Chong Kway, make a longer trek.

"The sessions make me laugh, they train my mind and they help strengthen my muscles," says Mr Aw, 79, who drives down every Sunday from Yio Chu Kang. "I could not find anything similar near where I live."

Dr Tan, who has a grown-up daughter, believes one can welcome old age rather than be fearful of it.

"I use this platform to teach, to learn to share. As we grow older, our bodies naturally become stiffer. So we dance, we do simple exercises. We want seniors to be healthy and active throughout their lives," says Dr Tan, who runs his own clinic at Gleneagles Medical Centre.

One day a couple of years ago, one of the regular attendees brought along her recently widowed octogenarian mother, who was lonely and depressed.

To her great surprise, the older woman met one of her childhood friends at the session. "They were meeting after decades and shared so many memories together," says Dr Tan.

The incident gave him the idea to use the community's annual year-end carnival as a platform for residents to share their favourite Whampoa memories.

"It's a great hit with seniors. It makes them feel connected and happy. I, too, learn a lot from them."

Many voices, one goal
By Radha Basu, The Sunday Times, 5 Apr 2015

The Tsao Foundation has brought together about 20 organisations to help build Whampoa's Community for Successful Ageing (ComSA).

"Older folk have diverse needs. It's impossible for any one agency to meet all of them," says Ms Peh Kim Choo, director of Tsao's Hua Mei Centre for Successful Ageing, who is leading the project.

The Whampoa grassroots groups and the Ageing Planning Office under the Ministry of Health are key partners. Others involved in the project include:
- Healthcare: Tan Tock Seng Hospital (TTSH), Institute of Mental Health, Ren Ci Hospital, Toa Payoh Polyclinic and the National Healthcare Group.
- Eldercare and social support agencies: Whampoa Community Club, Social Service Offices@Toa Payoh and Jalan Besar, the Awwa Family Service Centre, NTUC Eldercare, Touch Home Care, St Luke's Eldercare, Beyond Social Services, Brahm Centre and the Handicaps Welfare Association.
There are plans to rope in more partners, including local businesses, merchant associations and the police.

Here is what some key players have to say about the project.

Pioneering effort

"ComSA is a first in Singapore where a sustainable and comprehensive care network is being co-created by the grassroots and community partners, promoting both health and well-being."

- Whampoa MP Heng Chee How

Community care

"As part of a partnership begun late last year, the ComSA team provides community care to TTSH patients who have been admitted to hospital three or more times in a year. We hope this will reduce the likelihood of re-admissions."

- Dr Tan Kok Leong, deputy head of continuing and community care at Tan Tock Seng Hospital

Coordinated service

"The ComSA team has helped us coordinate services for the elderly in Whampoa. The monthly meetings - which bring grassroots, VWOs (voluntary welfare organisations) and health agencies on a common platform to discuss needs, challenges and solutions - are indeed useful."

- Ms Sharon Chua, general manager of Social Service Office@Jalan Besar

Working together

"Working with Tsao and other community partners in Whampoa helps us understand each family's unique needs and work jointly to support them."

- Ms See Toh Huixia, assistant director of the Awwa Family Service Centre

Medical help for seniors comes to their doorstep
By Miranda Yeo, The Straits Times, 9 Apr 2015

A FALL four years ago left retired cleaner Lim Ah Ngiew with a debilitating spinal condition that forced him to use a wheelchair.

The 69-year-old, who also has chronic conditions like high blood pressure and glaucoma, let his health decline instead of going for scheduled physiotherapy sessions and medical checks.

"It was inconvenient to travel and I didn't want to trouble my son to take time off from work just to take me for a check-up," he said in Mandarin.

Things turned around in 2012 after he joined a pilot project in Whampoa that helps seniors receive medical help and other services in their own neighbourhood. Now, a trained volunteer wheels Mr Lim to twice-weekly check-ups at a nearby mobile clinic, and medical staff monitor his condition, as well as provide transport to take him to hospital check-ups.

Mr Lim is among hundreds of residents who will benefit from the Community for Successful Ageing scheme, which will be officially launched on Saturday (11 Apr).

Spearheaded by the non-profit Tsao Foundation, it links up residents with a communitywide system of health and social support services.

The Tote Board has pumped $4 million into the project, with Tsao Foundation giving another $1 million.

The project will identify high-risk elderly residents in the community who need medical care but have financial constraints or lack family support.

Those with more severe conditions or mobility issues can visit a mobile clinic in Whampoa. The clinic's family physicians are trained in geriatrics and will contact the patients' hospital specialists when needed.

Trained volunteers and medical professionals will monitor more severe cases through house visits and phone calls. In less severe cases, patients are referred to polyclinics or enrolled in peer-support programmes so they can care for themselves and socialise.

The programme has helped 120 elderly residents receive primary care in their community since 2012. The number of seniors receiving medical aid is projected to rise to 688 by 2017. Another 600 residents with less severe health conditions will be enrolled in the peer-support programme by 2017.

Ageing in place: Bringing home ideas from abroad
By Radha Basu, The Sunday Times, 5 Apr 2015

In early February 2012, The Straits Times ran a two-page feature I wrote on "naturally occurring retirement communities" (NORCs) in New York as part of a larger special report on retirement living options overseas which could be emulated in fast-ageing Singapore.

I had spent two weeks visiting 13 communities in the United States and Europe that offered older folk varied choices on how they want to live.

NORCs are high-rise housing blocks or clusters of landed homes not specifically designed for older folk, but which evolve organically as their residents age.

They typically have "supportive services" to enable older people to age in the same communities they have called home for decades. These programmes - ranging from art and exercise classes to home nursing - are usually run by charities. Services of social workers and home-help aides are also available.

Some of the largest NORCs in North America are located in urban high-rise housing complexes, not unlike Singapore's Housing Board estates.

The Straits Times report on NORCs struck a special chord with readers and many wrote in wishing that such services would become available here. Weeks earlier, the Government had announced that three estates - Whampoa, Bedok and Taman Jurong - would join Marine Parade in getting age-friendly features and facilities.

That same year, 2012, the Health Ministry, which oversees ageing issues here, invited the Tsao Foundation to start working in Whampoa. The area already had many robust and popular active ageing programmes - such as weekly exercise sessions - championed by the grassroots groups.

"We were impressed with the numerous initiatives that Tsao had pioneered in the area of aged care," a ministry spokesman said.

"By bringing active ageing and aged-care programmes together, we hope to develop Whampoa into a Norc, where initiatives are planned and implemented based on a thorough survey of residents' needs."

The ministry also hopes to develop more NORCs in places like Bedok and Marine Parade, which are already home to a large number of older folk.

Efforts are also being made in areas such as Kreta Ayer, Ang Mo Kio, Choa Chu Kang and the West Coast to provide more services that can help seniors to "age in place".

As of last June, there were more than 430,000 people in Singapore aged 65 and above, up by nearly 100,000 from just four years earlier. The numbers are likely to rise to nearly one million by 2030.

While roaming the senior-friendly corridors and compounds of two of New York's largest NORCs and sharing in the laughter and bonhomie among octogenarians in gardening, exercise and even drama classes, I could not help but wish for the same in Singapore.

I had been writing about older folk here for the greater part of a decade by then, but most of my stories - about the impending "silver tsunami" - seemed so gloomy in comparison.

Today, things are changing for sure. There are still many seniors who face health, money, emotional and caregiving concerns.

But wandering through Whampoa, watching older folk giggle and gossip through exercise, makan and music sessions, I could not help but bask in that same joy of living I experienced on crisp, cold Manhattan mornings just three short years ago.

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