Caring for the Elderly in Singapore: Are We Doing Enough?

by singaporearmchaircritic

After reading last week’s news about an 82-year-old Singaporean man being abandoned by his family in Johor Bahru, I decided to do a bit of research on the state of elderly care in Singapore.

Let’s start by looking at the living arrangements of elderly residents in Singapore, defined as citizens and permanent residents aged 65 and above.

From the chart below, you can see that elderly residents who live with their spouses and/or children constitute around 85% of the total elderly population.

The remaining 15% either live alone, with other elderly persons, or have other living arrangements (such as living in nursing homes etc.).

(source, p.8)

In fact, the percentage of elderly residents who live in old folks’ homes has been consistently low at 2.7% to 3% of the total elderly population from 2001 to 2011 (calculated from Yearbook of Statistics Singapore 2012, tables 3.3 & 22.6).

The bar chart below depicts the distribution of elderly residents in different types of old folks’ homes from 2001 to 2011.

The orange line shows how the elderly population has grown over the same period. It appears that the increase in the number of elderly residents in old folks’ homes is largely in tandem with the growth in elderly population, if slightly lower.

(Yearbook of Statistics Singapore 2012, tables 3.3 & 22.6). Refer to this, pp. 80-81 for the definitions of the various types of elderly care services and institutions.

All seems well if we look at statistics alone: the percentage of elderly residents who live in old folks’ homes in the past decade has been low at below 3% of the total elderly population.

But is this consistently low percentage an indication of a low demand for nursing home places and/or a supply of nursing home places that has kept up with demand over the last 10 years, despite our rapidly aging population?

On the Contrary…

Not so if we go by news reports, which paint a not-so-rosy picture.

From various sources (click on links below), we can gather that in recent years:

1) Families have had a hard time getting a place for their elderly in Singapore nursing homes; the waiting time can be more than 6 months;

2) Singapore nursing homes have raised their fees and more people have defaulted on payment;

3) There have been cases of elderly residents being ill-treated in Singapore nursing homes (here and here);

4) More Singaporeans have turned to nursing homes in Johor Bahru (JB) and demand is growing; unfortunately we do not have figures of the number of elderly Singaporeans in JB nursing homes;

5) The estimated charges at local nursing homes (before subsidy) range from SGD1200 to SGD3500 per month. In JB, the charges are around SGD600 to SGD1000.

6) The cost of putting an elderly in JB nursing homes is considerably lower than that in Singapore. According to Khaw Boon Wan, “The monthly cost of keeping a resident in a private nursing home in Singapore, you can stretch it easily to pay at least 2-1/2 months of nursing home care in Johor Baru.”

7) This is despite a reported increase in government subsidies to the needy to defray nursing home cost. A Ministry of Health spokesperson said, “Along with Medifund and charity assistance, most needy patients and families would either see no change in charges or see a decrease in out-of-pocket payment of up to 35 per cent.”

Restrictive Admission Criteria and Inadequate Supply

The demand for nursing home beds may also be suppressed at artificially low levels because of the highly restrictive admission criteria. This is in line with the government policy of deferring institutional care such that it is a last resort for families (source).

To be admitted into a local nursing home, the elderly must fulfill these criteria (source):

• Have physical or mental disabilities because of medical conditions like stroke, dementia and other chronic illnesses;

• Semi-mobile, wheelchair or bed-bound and need daily nursing care and help in daily living activities such as toileting, walking, etc;
• Tried all possible care arrangements such as hiring a domestic helper, day care, home care, etc;
• Not able to be cared for at home by other family members or community providers;
• Pass the means-test for long-term care subsidies

In other words, my earlier bar chart of the number of residents in old folks’ homes does not indicate demand. Instead, it may well be a more or less accurate reflection of the supply of places in old folks’ homes over the years, in lieu of official figures (except this).

And one big puzzle remains looking at the graph below. While we expect less mobile elderly persons to require round-the-clock care and thus are more likely to be living in institutions such as nursing homes, the graph shows otherwise.

Of the non-ambulant elderly residents, only 9.1% or less may be living under institutional care.

(source, p.9)

Is this seeming paradox a result of the scarcity of nursing home beds or the stringent admission criteria mentioned above? Or is this phenomenon simply due to the valorization of “filial piety” in our society? Has this imposed undue burden and stress upon the family caregiver(s)? Most importantly, has this compromised the quality of care given to the elderly resident?

If you are a social worker or have first-hand experience seeking a nursing home bed for your family member(s), please feel free to share your insights in the comments column below.