Lim Boon Heng
Singapore
“On the first question on foreign domestic worker levy relief for single women who are looking after their aged parents, I think that question should be addressed to the Minister for Manpower and the Ministry of Finance.”
“I shall address the second point first. When it is clearly an item for a Ministry, a Member should address that question to that Ministry because that Ministry is also responsible for that even if it is related to ageing.”
“For those who wonder what the Fourth Age is, it is basically the last couple of years of your life when you are afflicted by, perhaps, chronic illnesses and therefore need to be cared for.”
“The Wellness Programme applies to all estates. In the pilot project, we deliberately chose 12 pilot sites to reflect different mixes. For example, we chose Ulu Pandan, which has a lot of private estates.”
“Maybe MCYS and the PMO could really look into these RC centres to see whether they could incorporate some of the needs of the elderly in these centres as well, like an extra area for karaoke or even mahjong. This area should be quiet and enclosed because the elderly sing loudly as they cannot hear very well.”
“The process has already started. We are already debating this issue in Parliament. The unions have taken up the issue with the management. I know and I am aware of that. So, let the process take its course.”
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“I would say that in addition to building hardware in terms of a barrier-free Singapore to facilitate ageing-in-place, we are working to improve the "software" of options and better support for those who need care. The setting up of the Centre for Enabled Living (CEL) is an important piece in the eldercare landscape. As its name suggests, the care philosophy is to empower seniors and their families, and to enable seniors who need care to be as independent as possible. First, CEL acts as a first-stop centre for seniors who need eldercare and supportive services. It is also a resource centre for information and referrals. Together with the Agency for Integrated Care (AIC), we are working towards an integrated and seamless care delivery and referral pathway. For seniors who are frail and may have multiple needs, CEL will launch its pilot Assessment and Coordination for Enabling service (ACE). It aims to develop such care management expertise over the next two years so that families can be supported in caring for their seniors. Second, CEL helps to empower informal caregivers with practical caregiving skills. CEL is working with key providers, such as NTUC Eldercare and Touch Community Services to provide up to 1,000 training places for informal caregivers, including foreign domestic workers in the coming financial year. Third, CEL is building up VWO capability in providing en suite home- and community-based care and supportive services, working closely with NTUC Eldercare, TOUCH Community Services and St Luke’s. For example, CEL is funding TOUCH to develop and scale up integrated home care covering home help, home therapy and home modification. TOUCH will use Radio Frequency Identification (RFID) technology to enhance efficiency in home service delivery.”
“Currently our services are service-centric. The senior may have meals delivered daily by one service provider, the flat cleaned by another and a befriending visit by yet another. Not only is this approach not cost effective, sometimes there can be adverse outcomes, if services are poorly coordinated. For example, one senior who died alone and was discovered only after neighbours complained of the smell, actually was receiving home delivery meals. Therefore, we need service providers who can provide en suite services, who can work with the local community, and who have systems that can flag significant gaps that may need attention. Services for the elderly are dominated by VWOs, whose focus is on the poor. But it is not only the low-income elderly and the poor who need services. For example, the seniors living alone that I mentioned earlier are not only living in rental flats, but also in 3-room, 4-room, 5-room and even private property. So we need more service providers to cater to the needs of fee-paying clients. I shall also be frank to say that most of our service providers are small, lacking in scale, unable to pay attractive wages, yet incur high costs. Most also provide little training. Mr Baey Yam Keng mentioned capability building in the VWO sector to provide adequate care for our seniors. Yes, there is much to be done regarding productivity in this sector. Much as we want many helping hands, we need to nurture a few large operators with en suite services and critical mass to bring unit costs down and to raise standards, and adopt the active service model. This is the approach we are taking in developing capability for care of the elderly. Ms Ellen Lee asked about caregiver support and home and community care options.”
“For those who need support, to enable them to do as much as possible themselves. The Australians call this the "Active Service Model". Let me illustrate. A senior lady asked for home help services, as she felt she was no longer able to clean her home. When the service officer arrived, she found that the lady had an old heavy vacuum cleaner which this lady now could not pull around. So she proposed replacing it with a new light weight vacuum cleaner. This lady could then continue to clean her home herself, and benefit from the exercise as well. This active service approach is also applied to day care. Instead of prescribing what the seniors do, day care operators give them choices, so that they continue to decide what they want to do. We must not place them in a dependency mode, in an active mode to take charge of their own lives. It is important that we learn to do this. If we take the approach that we will provide care, and we prescribe care, then inevitably the client will expect care, and everything will have to be provided for, or done by someone else. Now one of our Seniors Activity Centres (SAC) reported that the seniors expect everything to be done for them, including carrying goodie bags to their flats. On the other hand, in another Seniors Activity Centre run by TOUCH Community Services, the seniors happily help in organising activities at the centre. TOUCH SAC initiated a "Loving Your Neighbour Programme" in 2009. It aims to mobilise the seniors to show kindness and to keep a look out for one another in their neighbourhood. It is quite clear why the TOUCH SAC can do a lot more than the first SAC I mentioned. I believe the seniors there find life more purposeful. Next, we should take a client-centric approach to delivering services to the elderly.”
“To encourage the elderly to be more active, she often buys tickets for them to participate in community activities for the elderly. Mutual support is possible only when the community recognises the need and each resident is willing to participate. So our grassroots groups, especially the Residents’ Committees, have a key role to facilitate the formation of mutual help groups. That is why the People’s Association is encouraging pot-luck floor parties for people to get to know their neighbours better. That is why the People's Association is encouraging the formation of social interest groups, so that neighbours come together regularly and deepen friendships. This is building social capital, we need to accumulate a lot more social capital that will manifest in neighbours readily helping neighbours. It is a lot of hard work doing floor parties. I have done 100 in the past year in my own constituency, the person who initiated this, Dr Lim Wee Kiak, has already done his first 100th and is embarking on his next 100th. But we have been gratified by the response of the residents. And so I look forward to all our advisors to support our grassroots organisations in this effort of building social capital. Next, developing capability in eldercare. As the number of seniors grows, some will need care. The majority of the old will be cared for by family caregivers at home. In Minnesota, USA, in 2005, 92% of the elderly were cared for in this way. In Europe, the shift is towards home and community care. So, we should keep as many as possible of our seniors at home. Our policies and programmes should be framed around supporting families in the care of the elderly at home. Our approach is to enable people to take care of themselves for as long as possible.”
“Older residents living in a neighbourhood collectively pay annual membership fees that support a small office of two staff or so. This office would coordinate services for the seniors. But more importantly, the seniors will organise themselves, volunteer their talents and skills to one another, and the old-old can leverage on the young-old so that they can age in their own homes. And they call such villages also "Naturally Occurring Retirement Communities". 5.30 pm Typically, we live in high-density HDB flats. Because there are so many people around, we have not realised that we, too, have to organise ourselves for mutual support. As Dr Ong Seh Hong noted, the community must help these lonely seniors. If we depend on SACs and befrienders, then we will need many more staff and volunteers, to know what is happening to our seniors everyday. This is impossible. So, like the old villages in Japan, we too must organise ourselves, so that neighbours look out for neighbours. Incidentally, both stories refer to "villages". And this reminds me of the kampongs of old Singapore. I am glad that some of this kampong spirit lives on today. Tampines Changkat CCC has a Silver Connect Scheme. Ms Tan Lay Hua, a 47-year old home-maker, has taken care of four elderly in her neighbourhood since 2005. The elderly trust her and are very open in sharing their problems with her. They call her whenever they need help. Through her, one of the elderly, who could not afford medical bills, successfully applied for the Neighbourhood Medical Assistance Scheme. Ms Tan even accompanies the elderly for their medical check-ups. She helps them read their bills in English and patiently explains the contents to them.”
“Given the increase in seniors living alone, it would become increasingly difficult to identify and reach out to those who are isolated, by the means we have adopted up to now. Thus, there is an urgency in addressing the issue of social isolation. In the past two years, as Dr Ong Seh Hong has mentioned, there have been several reports in the media of people dying alone, detected only when neighbours complained about the smell. Naturally, we are upset that this should happen. What has gone wrong? Almost all the cases I read about happened in rental flats. There are Seniors Activity Centres serving the rental flats, run by VWOs, with each centre staffed by two or three persons. In addition, the poor who are at risk of social isolation have been placed on a befriending scheme, where the volunteer contacts the senior at least once a week. The befriending scheme is operated by VWOs. The Seniors Activity Centres and the befriending scheme receive funding from the government. Have the VWOs failed in their service? How do other societies take care of their elderly, prevent social isolation, and prevent sad cases of people dying alone? I remember reading a story of how seniors in a small village in Japan put up yellow flags at their doors each day, to let their neighbours or the postman know that they are all right. If there is no flag, it means maybe something is wrong. If the yellow flag is up, the person is all right. In Japan, many of the young people move to big cities for employment, leaving behind the very aged in the villages. In such a situation, the seniors have to organise themselves for mutual help. When old neighbours look out for old neighbours, help will come quickly if something should happen. Another example is "The Village" concept in the USA.”
“We are implementing physical exercise programmes under Seniors for Physical Activities (SPA), which complements the Wellness Programme. Minister of State Heng Chee How, who chairs the SPA committee, will respond to Dr Teo and Mr Ang Mong Seng's queries on the plans to support physical activities for our seniors. I will now speak on two important issues; preventing social isolation and developing our capability to care for frail seniors. Mr Ong Ah Heng, Dr Ong Seh Hong, Ms Ellen Lee and Mr Laurence Wee have noted that social isolation and the plight of our lonely elderly are serious issues that we must pay attention to. Social isolation for seniors is an emerging concern among ageing societies. When seniors are socially isolated, they become disconnected from society. They withdraw into their own world, often literally into their own homes. They are apathetic to all that goes on around them, not caring for others, and not caring for themselves. They lose hope. In 2000, the number of elderly aged 65 above living alone was about 15,000. This increased to 22,000 in 2005. Living alone is the highest risk factor for social isolation. Preliminary results from an MCYS-commissioned study indicate that 26% of seniors who live alone have symptoms of depression compared to only 9% who live with their spouse or family. Further, 16% of seniors with weak social networks outside the household also show such symptoms as compared to only 8% who have strong social networks outside of the household. Based on the survey findings, an estimated 35,000 older people aged 60 and above live alone in 2009. Even if we do not consider the increase in singles and smaller families, this number is expected to rise further, to 61,000 in 2020 and 83,000 in 2030.”
“We have introduced a Wellness Programme, to help people take charge of their own health, and join social interest groups. The pilot project has been successful. The 12 sites reached out to 17,000 seniors aged 50 years and above, of whom 12,000 took part in health screening. Residents who are Wellness Club members have been able to better manage their health. Fifty-eight percent of the 8,857 at risk seniors identified during the Wellness Programme health screenings have seen doctors or nurse educators for medical follow-up. Research has shown that whatever the state of one's health, we can improve our quality of life if we are active physically, mentally and socially. And as Dr Lily Neo requests, when we promote active ageing, we should promote these three points of importance of being active physically, socially and mentally. We have examples from the Wellness Programme. Let me share one. Mr Quah Boon Hwee, a 65-year-old retiree, led a sedentary life before joining the Radin Mas Wellness Programme. He had diabetes and an irregular heart beat. After attending health education workshops through the programme, he realised he had to exercise and watch his diet in order to enjoy good health. Mr Quah's medical condition is now under control. He joined the herb garden interest group and made firm friends with other members. Their group has transformed a small plot of land in the Bukit Merah Community Club into a beautiful herb garden. Dr Lily Neo asked whether we will extend the Wellness Programme to more constituencies. Yes, we will expand the Wellness Programme progressively. The budget is $77 million over the next five years. In fiscal year 2010, 25 new Wellness sites will be launched. The target is to reach out to 50% of seniors over the next five years.”
“The Council for the Third Age (C3A) promotes active ageing through the annual Active Ageing Festivals, and works with partners to promote lifelong learning, enhancing seniors' ability to contribute to society. And this is not just one event in a year but there are five other events organised by our CDCs, and funded by C3A. As the $20 million GO Fund is for the fiscal year 2006 to 2010, there is no need as yet for an endowment fund. C3A will continue to use the GO Fund to fund lifelong learning opportunities for seniors. Importantly, as employability depends on the attitude of employers and older workers, C3A will also encourage a mindset shift of both seniors and employers. C3A is one of AARP's international partners for the International Innovative Employer Award, which recognises employers that have implemented age-friendly practices in their organisations. Five Singapore companies have won the award in the last two years. So I think as we do more of this, as we showcase what some of the progressive companies do, I hope that others will also follow. With respect to employment, there is a tripartite group that is working on this. But reports throughout the world show that there will be a skills shortage that is been faced in the US and Europe, because the baby boomer generation is retiring. The employers are beginning to realise the assets that they have. They are now keen to employ such older workers. We should learn from this. C3A will be organising the International Consortium for Intergenerational Programmes Conference in late April 2010, focusing on intergenerational relations at the family, workplace and the community. We also have to learn how to manage a more diverse group of employees, with age ranging from 20-plus to maybe even 70s.”
“We have one of the fastest ageing population in the world. Today, there are about 300,000 people aged 65 years and above. In 20 years' time, we will see a three-fold increase to about 900,000 people. That is why we are preparing for an ageing society and that is why it is important and urgent to do so. We have taken steps to enhance the financial adequacy of our seniors: better returns on CPF savings, CPF LIFE for a stream of income until they pass on, enabling people to work longer and to monetise their homes. And we are working on financing of long-term care. We have promoted active ageing, so that seniors lead a full and meaningful life. Dr Teo Ho Pin and Mr Ong Ah Heng have asked what the Government is doing to promote healthy lifestyles and enhance the quality of life of our elderly as part of our long-term strategy to deal with an ageing population. We are encouraging them to take charge of their ageing and be in control of their health and well-being. To enable seniors to move easily out of their homes to places they wish to go to, we have been creating a barrier-free environment: lift upgrading for lifts to stop at every floor, barrier-free walkways, retrofitting buses to take wheelchairs, and ramps and lifts at MRT stations. We require new developments to be designed to the Code on Barrier-Free Accessibility in Buildings. There is also the Universal Design Guide, which recommends to the industry how to design to meet the needs for all people, including the elderly. We will assess the effectiveness of these measures. Dr Lily Neo discussed active ageing, particularly lifelong learning and the employability of our seniors, while Dr Teo suggested the setting up of an Active Ageing Endowment Fund.”
“Sir, I agree that we should recognise these community support groups. In fact, we do, but not in the monetary sense. There is a Good Neighbours' Award scheme which is jointly offered by People's Association and HDB. Most are aware that in different constituencies, the grassroots organisations also give their own Good Neighbour Awards and these are usually presented at the National Day dinners. So I think we should do more of this. LIFTING OF BAN ON SALE OF CHEWING GUM 5. Ms Denise Phua Lay Peng asked the Minister for National Development when is the appropriate time for lifting of the ban on the sale of chewing gum in Singapore.”
“We will continue to grow a range of eldercare options and to support seniors and their caregivers in making informed choices that meet their requirements. (1) From citizens aged 40 and above. NOISE LEVELS AT CASTLE GREEN CONDOMINIUM 37. Er Lee Bee Wah asked the Minister for Transport in view of the noise levels from MRT trains experienced by residents of Castle Green Condominium (a) whether this is due to an increase in the frequency of train runs or the lack of maintenance of the tracks; (b) what can be done to ensure that noise levels will not deteriorate further, with higher demand for train services; and (c) what further measures can be taken to insulate the noise, apart from the current standard checks implemented by the train operators.”
“Many started out serving the vulnerable and lower-income seniors out of compassion and goodwill. We are building on this foundation and working with key players in the sector to enhance their capability and capacity. We want to scale up existing services. We want more integrated service delivery as frail seniors will require multiple services. And we want sustainable funding models as far as possible. As the ageing population grows, we have to ensure that care services are available, affordable and delivered efficiently to all seniors and caregivers. Finally, CEL is developing more caregiver support and training programmes. By attending a short training course, family caregivers can learn, for example, how to better support seniors in activities of daily living. More importantly, caregivers can also learn to manage one’s own wellbeing. The Caregiver Training Grant from MCYS is available to caregivers. Many families also tap on foreign domestic workers to care for older persons. It will be beneficial if we train these workers to be more proficient in basic eldercare. In this regard, CEL is working with the Workforce Development Agency, Tsao Foundation, NTUC Eldercare and other training bodies to develop more structured training courses for both informal and formal caregivers. The courses for formal caregivers would be accredited under WDA’s Workforce Skills Qualifications framework. Caregiving for the elderly is ultimately a decision for the senior and the family caregivers to make. There are different considerations in every circumstance – level of care required, affordability, emotional and social support from family and neighbours or the senior’s own preference to age-in-place.”
“However, they were not sufficiently trained to provide care at home, including basic skills such as transferring the elderly father from bed to wheelchair. The family became anxious that their quality of care was not good enough. They were worn out. Their father’s situation was not improving. In the end, they asked for their father to be placed in a nursing home. This is an outcome that could have been avoided. Mr Laurence Wee asked how we are enhancing caregiver support and reducing caregiver stress. How could we avoid the scenario I have just described? This is where the Centre for Enabled Living (CEL) comes in. First, CEL acts as a convenient first-stop referral agency, which helps seniors and caregivers access social care support services and schemes. Anyone with care needs or caregiving needs can approach CEL for information, referrals and other assistance. CEL would assess their needs and refer to suitable service providers. CEL works closely with the Agency for Integrated Care (AIC) to help families navigate the continuum of medical-social services more efficiently. CEL is also working with partner VWOs to develop a case management framework for more complex cases. Some seniors might require care and supportive services from a few providers. CEL will help to better support these seniors and caregivers within the home and the community, and to prevent premature institutionalisation. Second, we are building the capacity and capability of the eldercare providers and developing more care options in the sector, including respite care. Many eldercare service providers today, for example, home help services and day care centres, are non-profit organisations and voluntary welfare organisations.”
“Mr Laurence Wee has made a very important point. The family must remain the first line of support for the elderly, particularly those who are frail. While the Government and the community should continue to help to support family caregivers, this must not take away the primary responsibility of the family. Take Japan, for instance, where caregiving for the elderly has been traditionally viewed to be the family’s responsibility. With the introduction of the national long-term care insurance in 2000, there has been a shift in such a view. This is because the scheme is funded through general taxation and compulsory insurance premiums(1). There is little co-payment from the care recipient or the family when care services are required. Caring for the elderly is now seen more as the state’s responsibility! In developing our long-term care financing, we should take care to avoid this pitfall. However, while the Government will not take over the role of the family, we will ensure that caregivers are given the support they need to carry out their responsibilities. We are aware of some of the challenges today faced by seniors and their caregivers. First, many people do not know what care options are available and which options best suit their needs. Most would not actively look out for such information until the need suddenly arises. Second, seniors generally require a holistic suite of care services. More can be done to ensure a more efficient delivery of family- and senior-centric care. Third, many caregivers require caregiver training, support and respite care options. There was a case where a family brought home their elderly father who had suffered a stroke. Being filial and caring, they acquired the necessary equipment and applied for a foreign domestic worker.”
“The Ministerial Committee on Ageing will continue to pursue a whole-of-Government response to ageing issues, along the four strategic thrusts: firstly, enhance employability and financial security; secondly, enable ageing-in-place; thirdly, provide holistic and affordable healthcare and eldercare; and fourthly, promote active ageing. Madam, I support the motion. 5.11 pm”
“Complementing the Wellness Programme, the People's Association (PA) is working with the CDCs and Health Promotion Board to launch a national briskwalking programme later this year. Briskwalking is an easy-to-do exercise with proven health benefits in a social setting. We hope that this initiative will encourage three-quarter of Singaporeans who are not exercising regularly to do so. PA is also promoting qigong and taichi. Three-quarters of Singaporeans are not exercising regularly. Recently, we had a fitness test conducted for the committee members of the Wellness Programme in the pilot sites. About 120 persons participated. These are community leaders who are by nature active. Half of them were not fit. I understand that a similar exercise was conducted for people who have been engaged in briskwalking. Seventy-five percent are not fit. So it shows that there is a lot more for us to do. You cannot just simply only encourage exercise and briskwalking, qigong and taichi, but we must also enable them to measure what they have achieved so that they will have targets to improve upon. As mentioned by the Minister for Health, we will do more to promote healthy lifestyles and reduce chronic diseases among seniors. The Integrated Screening Programme and the Chronic Disease Management Programme are preventive programmes brought into the community through family physicians and nurse educators. We will also promote health in the schools, workplaces and the community. It will take time and persistence to change our national health and wellness culture. But it is critical if we are to ensure that the current and future generations of seniors are healthy and independent for as long as possible and, therefore, being able to live where they are and age-in-place.”
“Family caregivers need more support to understand and manage dementia, and other mental illnesses affecting the elderly. The final aspect relates to whether our community is one which encourages seniors to be active and watches out for them. As a society, we should work towards an inclusive and age-friendly community, where our seniors are not excluded from community life. Dr Lim Wee Kiak asked for concessions. The same calls had been made during the Committee of Supply debate this year and last year. I had said that concessions made sense, if they make business sense. So we should encourage companies to be creative so that whatever concessions we give to seniors make business sense for them. I have no doubt that some companies are looking at this and that before too long, there will be companies announcing such concessions for seniors. Whether that includes the kind for public transport, that is a different matter. Tapping on community infrastructure, we have been piloting the Wellness Programme in 12 constituencies for more than a year. In each site, 1,000 residents aged 50 and above will undergo health screening, taught how to manage their conditions and be physically active and more socially engaged. We have seen encouraging results since the pilot was started over a year ago and have learnt useful lessons. We plan to roll out the programme to other constituencies after the pilot. A key objective of the Wellness Programme is to place seniors in interest groups, where they can establish friendships and support each other in leading healthy lives. A recent OECD paper observed that group settings work better in sustaining behavioural change. One of the main tasks of the full-time Wellness coordinator is to facilitate and develop such interest groups.”
“It is designed to be integrated with the local community. We will need to study if such models can be adapted to the Singapore context. In the meanwhile, HDB's studio apartments are very popular and I think maybe that is the direction we should go and expand beyond the studio apartments. I am sure that, over the next couple of years, some practical projects would surface. Next, I turn to supporting family caregivers. Families in Singapore and elsewhere remain the first line of support and care for the elderly. But as our families decline in size and more women join the workforce, it is important that we provide enough support to these caregivers, a point mentioned by Dr Lam Pin Min. Caregiver training is an under-recognised but important service. Those who have undergone such training are usually better able to cope with their care responsibilities or seek the appropriate help. Grants of $200 per year are available for a family member to obtain training. And I expect, again, over next year or so that we will see more of these initiatives being implemented. We should train our foreign domestic helpers to care for seniors and better support the family. Some can even learn basic nursing skills, such as the dressing of wounds. It is estimated that foreign domestic helpers account for 30% of the care to the elderly at home. We should provide more tailored and structured courses for them. We also need to help our caregivers cope with seniors with dementia. In the West, dementia has been described as an epidemic. It is a leading cause of burden of disease and affects not just the quality of life of the senior, but also that of the caregiver. Within a decade, 45,000 seniors in Singapore are projected to have dementia, double the number today.”
“The Agency of Integrated Care under the Ministry of Health is also coordinating services for adult and elderly patients from the hospitals across various care settings. Thirdly, services should be home- and community-based as far as possible, although institutions like nursing homes have their place for those who need more care. Our high population density and urban setting work in our favour. It is easier to deliver services cost-effectively. More day care centres will be set up over the next five years. Again, Dr Lim Wee Kiak wants them to be set up earlier. But it is a question of demand, whether people want the services and are prepared to pay for these services. So we cannot simply just expand the number of such centres because they are not cheap to operate and we cannot certainly set them up well ahead of the demand. Governments, especially in Europe, are moving away from institutions to care at home. It is what the seniors prefer. It is also more cost effective. They have also tried to integrate housing and services so that seniors who do not require nursing homes can live in serviced housing together with other seniors. Some examples are in the UK, the Abbeyfield Society, a non-profit organisation, has set up "group homes" that provides care with housing. Residents live as independently as possible, often with about eight to 10 persons in a house, overseen by a house-keeper or manager. Only a few of the residents in Abbeyfield Society homes ultimately need to move on to a nursing home. In the Netherlands, there are "Apartments for Life" which tailor services to the needs and decisions of the elderly. These apartments are co-located with nursing home units, and amenities such as the clinic, grocery store, activity rooms, restaurant and café.”
“An “Elderfund", in the form of Medifund Silver, is currently also in place for more targeted assistance of needy elderly and we will grow it when the budget position allows. From the supply side, services must be cost-effective, appropriate and scalable. To do so, it requires us to look at who are the providers, how they are funded, whether they have a supply of qualified workers. Today, home-based services – meals, housekeeping, nursing, medical – are delivered by fairly small VWOs focused more on the low-income. We may need larger players for economies of scope and scale. Singaporeans must be willing and able to afford such services – it is not always the case today, making it difficult for providers to operate profitably. It is encouraging that there are private sector players who are nonetheless, despite the constraints, already present in a nascent market. Secondly, services should be packaged around the needs of the person and the family. Overseas experience suggests that a more integrated delivery of services to the person can result in better patient satisfaction, less caregiver stress and cost savings. In the US, care coordinators are engaged by insurance companies to assess and advise on the most appropriate care arrangements for the senior and his family. Very often, the family is able to take care of the seniors at home if suitable support from professional services is organised to help them. In Singapore, we need to move from a service-centric to a person-centric delivery of care. Some providers are doing this. Touch Home Care provides a suite of services for their clients, ranging from home medical, home nursing, home help services, rehabilitation, caregiver training and even home modification.”
“Can it be done earlier, as Dr Lim Wee Kiak asked? I think we should encourage the public transport companies to do so. We have not yet achieved a barrier-free environment, but we are making good progress. Old private commercial buildings are encouraged to retrofit, but it may not be cost-effective for some of them to do so. A few months go, visiting experts from the US told me that we should take advantage of our increasingly senior-friendly public housing to develop services that help seniors age in place. These services are available, but we must develop them as our population ages. People prefer to continue living where they have been. Assoc. Prof. Kalyani asks about our plans to enable ageing-in-place. Apart from the physical infrastructure, we also need to develop the software. Developing our long-term care system will need to consider the following issues: firstly, we need to ensure that the system is financially sustainable. From the demand side, Singaporeans must save enough or purchase enough insurance to finance their care needs. In the US, it is estimated that 70% of people turning 65 will require some form of long-term care in their remaining lifetime. The exact figure will differ for Singapore, but we need to set aside enough funds for our care needs. Dr Lam Pin Min is right that rising health care cost is a major concern. We are studying how to develop a long-term care financing system that will parallel the "3Ms" framework for medical care, with the "3Es": we are considering a savings component either under Medisave or "Eldersave". The existing “Eldershield” will also be improved over time.”
“With respect to the question of age limit, for example, of taxi drivers, which is of 73 years old, well, I think we will progress. Dr Lim probably knows that three years ago, we raised the retirement age of taxi drivers from 70 to 73. So, this was three years ago. I suppose the cry for further extension of permission for taxi drivers to work beyond 73 would one day result in success. My intention this afternoon is to talk about ageing-in-place. Our priority is to help Singaporeans age in place. It means helping them to live in the homes they have grown old in. To do so, three aspects are important. First, our physical environment, in and outside the home, must be safe and accessible even for those who have some mobility issues. Second, services and amenities must be available to cater to the range of needs of the elderly. I refer in particular to long-term care services. Thirdly, the community should include and support the elderly so that they remain active physically and socially. There is more to do in all these aspects, although we have made very good progress in the last few years. Let me give a few examples on the physical environment. All new HDB projects initiated from 2006 will incorporate universal design features and elder-friendly fittings. By 2011, all HDB precincts will be barrier-free, and about 40% of the precincts are already barrier-free. By 2014, lifts of all eligible HDB blocks will be upgraded to stop at every floor. We are also developing a green environment that encourages people to be physically active. By 2010, all pedestrian walkways, access to MRT stations, taxi and bus shelters, and public roads will be barrier-free. Buses are progressively fitted to take those who are wheelchair-bound, a programme to be completed by 2020.”
“Mdm Deputy Speaker, thank you for allowing me to speak on the Motion of Thanks to the President. I am regularly asked by people I meet what we are doing on ageing issues. In end-March, MCYS released a report summarising the work done to prepare our population for ageing. Titled "Adding Life to Years", the report also contains practical information and personal stories for the public. Assoc. Prof. Kalyani Mehta asked about our public education efforts. We have published this report, and it is available on MCYS’ website. It has also been circulated to Members. In June, the Chinese, Malay and Tamil versions of the report will be released and distributed. With this report, MCYS will work with the Council for Third Age to consult community leaders and the public on ageing issues over the next two months. Mdm Deputy Speaker, I have not intended to touch on work-related issues or employment of the elderly. But listening to Dr Lim Wee Kiak, I thought I should just briefly mention that discrimination is a perception. If we cut the CPF contributions or wages of those who are older, it is not necessarily discrimination. To have a good understanding of why we do it, I would encourage Dr Lim Wee Kiak to engage the tripartite partners – the NTUC, the employers, and Ministry of Manpower – on the rationale for this. And there are very good reasons for it, arising from the seniority-based wage system. We do not want the seniority-based wage system to discriminate against senior workers in Singapore, to their detriment. That is the reason why we have this. So, let us not look at the present provisions of wage cuts and CPF cuts for seniors as discriminating against seniors, which is in favour of seniors.”
“At the end of the day, however, each individual is responsible for preparing and living out one's golden years, with the family playing an important supporting role. Within the next two months, MCYS will be releasing a public report to update on what the Government has done to prepare for an ageing population. It will contain useful information and practical advice on how Singaporeans can prepare well, and how we can work, live and play in our later years. As we add years to our life, we should also add life to our years. I hope that the report, titled "Adding Life to Years" would inspire all Singaporeans to be happy, healthy and active today and in the future. [Mr Deputy Speaker (Mr Matthias Yao Chih) in the Chair] 4.34 pm Developing Singapore as a Pre-eminent Financial Centre”
“I think Mr Baey's point is that we should also encourage family packages so that the seniors can enjoy certain activities together with their grandchildren. Today, if you go to a cinema there are concessions on weekdays, Mondays to Fridays, before 5 pm but for seniors. So his point is that we should encourage the cinema operators to give concessions so that they can go together with their grandchildren. We should certainly encourage them to do so. Ageing is a sunrise industry not just in Singapore, but all around the world. Our Asian hinterland dominates population ageing; the number of people aged 60 and above will quadruple to 1.2 billion by 2050. For this reason, we want to develop Singapore as a knowledge and business hub for ageing. Let me give you some examples: EDB is leading efforts to develop the health and wellness industry in an ageing population. In January, two conferences, "Reinventing Retirement Asia, and Asia Forum on Ageing", were held in Singapore, involving many international experts and partners. The Silver Community Test-Bed Programme under MCYS is into its second call for proposals to test-bed age-friendly products in HDB homes. Last year, Singapore Management University, with the support of the MAS, has set up a Centre for Silver Security to conduct research on retirement security in ageing populations. As we can see, Singapore is becoming a vibrant place for research and business on ageing. Let me conclude by saying that the work of the Ministerial Committee on Ageing builds on previous efforts to prepare our population for ageing since the 1980s. There are still some major items on the agenda, such as long-term care financing and developing more care and community services for an ageing population.”
“In 2007, the Council for Third Age (C3A) was set up by MCYS to champion active ageing. Last year, the CDCs partnered with the Council to hold active ageing carnivals all over Singapore, greatly enhancing outreach efforts. As more seniors become active agers, we will certainly see them come out to contribute their time and expertise, at work and in the community. Mr Baey Yam Keng asked if the Government should do more to encourage concessions and discounts for seniors. Certainly I encourage commercial companies to do so. But I think ultimately this must still be based on commercial considerations. Otherwise, the costs of concessions would fall back on the rest of society, and everybody else has to pay more. What we can do, however, is to encourage companies to see that being pro-seniors is also pro-business. 4.30 pm Let me offer an example. It is well-known that NTUC Fairprice offers senior citizens a 2% discount on Tuesdays. It does this not just because of Corporate Social Responsibility, but also to attract customers, since Tuesdays tend to be the slowest day of the week. Tuesdays are now one of the busiest days, alleviating the heavy weekend traffic at the supermarkets, and raising the yield per square metre of floor space used. Part of the mission of the Council for Third Age is also to build a vibrant market for seniors in Singapore. Last month, it organised a 50 Plus Singapore Expo, which received an enthusiastic response from about 70,000 seniors. Special deals for seniors were on offer from the 150 participating companies, ranging from health screening to customised travel packages and I believe concessions or special offers were provided to these seniors. Over time, I am confident that more companies will want to reach out to our increasingly affluent seniors.”
“Eldershield provides a good basis from which to refine our long-term care financing mechanisms. Eldershield was reformed in 2007 to provide higher payouts of $400 per month for up to 6 years. Supplements are also available to provide higher payouts or longer periods of payout, or both. In the same way as how our 3Ms, "Medisave, Medishield and Medifund", cover medical care, we will need to look at whether to set up a parallel of having 3Es to cover long-term care expenses. The 3Es being Eldersave, Eldershield and Elderfund or maybe it is possible to enhance the 3Ms. Together with means-tested Government subsidies, which are available for most care services today, we want care in old age to be affordable for all Singaporeans. The Government will study how such a financing framework can be more holistic and robust. While we set about to deal with the challenges arising from an ageing population, we must not forget that the extra years we have is also a blessing. How can we help seniors add life to years? We want to enable older Singaporeans to lead happy, healthy and active lives. Our efforts on employment, financial security, ageing-in-place, health and long-term care will go a long way to achieve this vision. Changing our attitudes about ageing is also important. An international survey conducted by AXA tells us that retirees in Singapore tend to think 70 is old. On the other hand, retirees in the US associate being old with the age of 78. The irony is that the US life expectancy is lower than Singapore's! The boxer Muhammad Ali probably exemplifies this optimistic American spirit. He once said, "Age is whatever you think it is. You are as old as you think you are". Efforts to promote positive mindsets about ageing have intensified over the last two years.”
“I have said that we should not inadvertently monetise family care and responsibility. Nonetheless, we will take a look at this issue in the context of financing long-term care. All around the world, countries are grappling with how to finance long-term care. One issue is to manage the rising demand for long-term care services. Another is that long-term care services tend to be more fragmented than medical care, and therefore not as cost effective or as "person-centric". Long-term care is also expensive, requiring us to examine who pays for the care. There is growing consensus that national policies should not prescribe the form of care, but should allow personal choice. Last month, there were visitors from overseas who shared their experiences and said the greatest mistake that the United States made was to build so many nursing homes that became the automatic option of choice, which is very costly and something which they now find difficult to unwind. They suggested to us that we have the opportunity to keep people at home because of the nature of our housing and we have the Public Housing Programme that no other country has, which provide us with the elements to build support services for the elderly around that framework and we will study accordingly. In most OECD countries, total long-term care expenditure average 1%, but can be as high as 3% of GDP. Welfare states, in particular, find that they have to ration services to contain public expenditure. The UK is now considering a mandatory private insurance scheme for long-term care, a radical departure from its state-funded health service. We have to understand these models better as the devil is in the details. We are not starting from scratch.”
“Some of these courses can be accredited to the Workforce Skills Qualifications framework, so that these caregivers can also find employment in the eldercare sector, something that Ms Ellen Lee hopes to see. More services will also be introduced to provide more options for caregivers. I am pleased to announce that MCYS will fund the building of six new day care centres for seniors over the next five years. Day care centres provide care and keep frail seniors socially engaged. They also provide respite for family caregivers. We are improving maintenance exercise programmes at these centres, so as to keep our seniors physically and mentally active. Going forward, the Ministry of Health will enhance the provision of services in the Intermediate and Long-Term Care sector, which it will elaborate on later. Even for those without family caregivers, seniors should be supported to live as long as possible in their own homes. Among the more vulnerable seniors are those living in HDB rental flats. Today, there are 19 Seniors Activity Centres serving seniors in one-room rental flats. Operated mainly by Voluntary Welfare Organisations, they provide basic information and referral, organise social activities and engage homebound seniors. Over the next five years, MCYS will also fund the set up of about 22 Seniors Activity Centres (SACs) and expand some of the existing SACs. Working hand in hand with the local grassroots, the SACs are part of the social safety net for vulnerable seniors. Overall, MCYS will spend an additional $18 million on these day care and Seniors Activity Centres. Mr Chiam and Ms Ellen Lee also mentioned financial assistance for caregivers. I am mindful that other members of this House have previously called for an allowance for family caregivers.”
“Can we do the same at our grassroots, among neighbours? We are now working out how brisk walking and taichi, already popular activities in the community, can be better promoted. I know that Dr Teo Ho Pin will like more money to be provided for brisk walking but I put it to him that it is an activity which should come from the ground and we should not need to spend so much money to motivate people to do this activity. Even with all our efforts to promote healthy lives, some of us will fall sick, become frail and require care. We project that the number of seniors needing help with activities of daily living will double to 65,000 over the next decade. For these seniors, most of them will look to the family. Mr Chiam See Tong and Ms Ellen Lee both spoke on the need to provide greater support for caregivers. Caregiving is an important and, at times, stressful task. As family size becomes smaller, the burden on caregivers will also rise. The Government will look to ensure that caregivers are given the support they need to carry out their responsibilities. Caregivers should be given better information and guidance on care options. For seniors discharged from hospitals, the Agency for Integrated Care helps families to coordinate the appropriate services required to support the senior within the home and the community. We have to be more senior-centric and provide services across the medical and social care continuum in an integrated fashion. We will also look at expanding caregiver training and support programmes. Today, families can tap on subsidies under the Caregiver Training Grant to attend caregiver training courses. We will raise awareness and availability of these courses.”
“Through the pilot phase, we will develop a model which we hope to introduce to other constituencies next year. So while the focus is on the seniors themselves, we are also hoping that this programme will promote inter-generational bonding. In the pilot programme, there are examples of younger people from the schools working with seniors. So, therefore, the respect that we want the younger generation to have of seniors can be transmitted through such joint activities. Sixty-year-old Mr Ho Toon Fang has benefited from joining "Wellness@Punggol South" last year. Mr Ho used to stay at home and barely exercised. Today, he is a regular user of the gymnasium at the Wellness centre, and has found friends with common interests. Last December, he was part of a group that called themselves "OCBC - Old Can Be Contributing". This group of seniors collected newspapers together with students to raise money for needy residents. I hope that more such stories of healthier and active seniors will arise through the "Wellness Programme" and as this example shows, young students are involved and so those values which the older generation holds on to will be transmitted through these activities. Neighbourliness is also key to healthy lifestyles. Last year, I announced that Mr Heng Chee How will study ways to promote physical activity among older Singaporeans. It is well known that regular physical activity is essential to our health and well-being. It even reduces the risk of mental illnesses and some types of cancer. The problem is that not enough people do it. One lesson that Mr Heng and his team have learnt is that physical activity is best promoted and sustained through social groups. Finland has only five million people. But it has 9,000 sports clubs, run mostly by volunteers!”
“15 pm Resources have been allocated to improve public education, prevention, detection and early treatment of mental illnesses. Late last year, the Community Psycho-Geriatric Programme commenced training of grassroots volunteers in early detection and follow-up of suspected cases. More than 400 grassroots leaders and frontline staff from CPF Board and Town Councils will be trained this year. We should not just rely on grassroots leaders and community touch points. At the end of the day, families, friends and neighbours are best placed to care and support our seniors. In line with this, the People's Association has made "neighbourliness" a central theme in its workplan. It has launched a "Neighbours Connect" programme to build social networks within each RC. We target for at least 200 RCs to implement the programme over the next five years. Small acts of kindness go a long way. About two years ago, one of my former colleagues, Ms Debbie Ng, was discharged from hospital after a knee operation. As her daughter had to work in the day, Debbie had considered admitting herself to a community hospital for rehabilitation. But when a neighbour heard of her situation, she immediately offered to help Debbie in the day by cooking some simple meals. There is nothing better than being able to recuperate in the comfort of your own home. And there are no hospital bills to pay! Neighbourliness is another reason why we are piloting the Wellness Programme in 12 constituencies. The programme helps residents aged above 50 to better manage their health and to be engaged with others through social interest groups. Residents, assessed through health screenings to be at-risk, will be referred for follow-ups.”
“It keeps them active and self-reliant. I have often been cheered by the impeccable service provided by older staff at fast food counters. Let me turn next to the community. Hardware-wise, we have made good progress in building an age-friendly community. We are on track for all HDB precincts to be barrier-free by 2011, and for lifts to be at every floor by 2014. Within five years, community clubs and RC centres will have basic barrier-free features. To expand the range of housing options for seniors, HDB is building more studio apartments, two-room and three-room flats. Seniors wanting to encash their housing assets have more options. For seniors living in smaller flats, we are implementing the lease buyback scheme this year. Hardware must be backed up by software, so that our community is not just a pretty, but empty shell. Far too often, we read about seniors and their families struggling to cope with mental illnesses. Last month, Mdm Voon, who has mild dementia and depression, went missing in Genting. We are happy for the family that she was found in Singapore a week later. But there have been other cases where seniors with mental illnesses die alone and unnoticed, abandoned by their families and shunned by their neighbours. As a society, we need to be more aware of mental illnesses among the elderly. At times, the stigma and misperceptions are worse than the illness itself. We must address this early, if we are to manage them well in an ageing population. The incidence of dementia, one form of mental illness, is expected to rise sharply. Within a decade, 45,000 seniors are projected to have dementia, double the number today. They will make up 8% of the elderly population. 4.”
“According to a global survey by insurer, Aviva, six in 10 Singaporeans would like to work beyond the retirement age. This is the second highest rate in the world after Hong Kong. We must, however, accept that working longer does not equate to working in the same job, in the same organisation, at the same pay. The seniority-based wage system, which has been with us for decades, is a barrier against continued employment. Under this system, it might cost employers less to recruit and train a fresh employee, than to retain an older worker. Ultimately, pay has to be based on the value of the work produced. Thus, the terms of re-employment have to be negotiated and unions and employers are doing so. And WIS, as I said, favours senior workers and should be taken into account. I agree with Mr Sin that we should help the elderly find jobs that are less physically demanding and more meaningful. But there are practicalities and, sometimes, it is unfortunate that the only type of work that an elderly person can do is the type that he described. Nevertheless, we should try to find meaningful work for seniors. In the US, the concept of an "encore career" has been embraced by baby boomers there. These new careers in the second half of life are usually in the social arena, and provide meaning, self-fulfillment and also income. This is an area where Ms Ellen Lee has been speaking up for, on behalf of seniors, and, I think, an area where our seniors can be gainfully engaged. Today's economic environment also allows for experimentation with flexible work arrangements that meet the aspirations of our seniors. However, we should not deny seniors of work which may be more physically demanding. If seniors want to and are able to work in these jobs, we should encourage them to.”
“Mr Chairman, Sir, I thank the Members for their strong support of the elderly. And the voices that have been put forward, on behalf of the seniors, are commendable and I hope that the whole generation of younger Singaporeans will listen to them. We know we are all growing old and Singapore is ageing fast. Although, during this time, there is a tendency to put this aside because of other pressing issues, I think we should still take the opportunity to prepare ourselves for the much larger number of seniors that we are going to have. Mr Sin Boon Ann requested for an update on the efforts that we have to prepare for ageing. I will first cover financial security. In recent years, the Government has focused on helping Singaporeans to work longer and save more. This is necessary because we are living longer. CPF LIFE will be implemented from 2013. The Workfare Income Supplement (WIS) scheme has also been refined to better support older lower-income workers, and for WIS, seniors get more. Retraining and upskilling opportunities have been expanded. Our tripartite partners have also been actively promoting re-employment, before it is legislated in 2012. As Ms Cham said yesterday, 706 unionised companies have committed to re-employment, with about 5,400 workers above 62 years old already being re-employed in October 2008. Some have not had their contracts renewed, so the number fell to 4,650 in December. But, our employment rate for workers aged 55-64 years is 57% today, and we will still work towards the target of 65% by 2012. Ultimately, we should build a culture where seniors are engaged in purposeful and fulfilling work, for as long as they are able. More Singaporeans are sharing this view.”
“We should look at it over a longer period of time.”
“In the US, the age is 77 or 10 years later. If we remain healthy, there is no reason why we cannot be active until 80. We are old when we think we are old. Having a reason to wake up every morning or leading a meaningful life contributes as much, if not more than a healthy lifestyle. Each of us has to find our reason for waking up – be it work, family or friends. We set up the Council for Third Age (C3A) to change public perceptions. I think the work is important and therefore the C3A should focus on this task in the next few years. We are working on a pilot wellness programme. It is aimed at keeping our seniors socially and physically active. It encourages seniors to take charge of their own health and join social interest groups. Such groups can be funded on sports, hobbies or even study. The wellness programme will connect seniors to other seniors and help them lead active and healthy lives. We plan to roll it out to all constituencies after the pilot programme. With respect to Prof. Kalyani's point about a register for elders living alone, we can do this through the wellness programme and working together with the CDCs. In fact, this is what some of the pilot sites are now doing. I need also to say that if we have seniors engaged with their neighbours, then the incidence of loneliness and therefore suicides will be less, and the incidence of people dying alone will be less. But I need to correct Prof. Kalyani who said that the rate of elderly suicides in Singapore has risen. In fact, I mentioned to the press after the Straits Times' report that if we looked at the rate over the past few years, we actually see a gradual decline. So, I think, we should not compare one year versus the next and say that there is an increase.”
“We should keep these ratios, and enable the GPs to handle the health problems of the elderly well, so that they do not have to queue up at the polyclinics. For long-term care, we have ElderShield. ElderShield was enhanced last year to provide better payouts in the event of severe disabilities – $400 per month for six years. ElderShield is a sound scheme which allows for risk pooling. It allows the elderly and the family to decide how best care is provided. I know that some Members have in this House asked for a caregiver's allowance. This deserves careful study. In an ageing population, many of us will be caregivers. Who should provide such an allowance? We have to be careful about putting a price tag to what is traditionally a family duty. It may lead to unintended consequences. The way forward may be to build on ElderShield. We will study this; in fact, we are studying this. With respect to caregiver leave, it is not a simple matter. It has to be arrived at with consensus of the employers because quite apart from childcare, eldercare can actually be a more costly item if we provide eldercare leave. So, it is something I would not rule out but we should not rush into. We are reviewing the provision of rehabilitative services and social daycare, nursing home and caregiver training, taking into account rising demand, and including dementia which is rising in demand as well. I need to mention that home-help services are expensive. There are several service providers, but none have sufficient critical mass to be efficient and that is why the cost is so high. So, I think the way forward is consolidation. There is a need to change our perception of ageing. According to an international survey, people in Singapore sees 67 as the age when someone becomes old.”
“The lift upgrading programme is well underway, and so is the programme to enable buses to take the wheelchair-bound. New HDB apartments adopt universal design. Private developers are required to follow the new design code. Beyond the physical infrastructure, we are setting in place support systems to enable the elderly to stay with their families in their homes. This includes daycare services, home-help services and caregiver training and respite care. We will be guided by the principles that services should be people-centred, something that may be missing in the Many Helping Hands approach, as mentioned by Prof. Kalyani. For example, a centre for information and referral is being actively studied. And we should encourage various organisations that are providing services to the elderly not to be too narrowly focused. It takes transport and manpower to deliver a meal. It takes transport and manpower to do home-cleaning services. If they can be combined, I think at least we save on transport. So, I think there is a scope of things that we have to look at when we talk about the people-centred approach to servicing the elderly. On holistic and affordable healthcare and eldercare – will the elderly be able to pay for medical bills? The 3M framework for healthcare is in place, comprising Medisave, MediShield and Medifund. It is sustainable. Improvements have been made to the system in the past few years and further improvements can be expected. Patients can tap on Medisave to pay for treatment of chronic diseases. The poor are supported not just by polyclinics but also by GPs under the primary care partnership scheme. Currently, polyclinics handle 20% of primary care cases, and GPs handle 80%.”
“Mr Deputy Speaker, I thank Prof. Kalyani for her suggestions, which are meant to be taken as inputs for policy formulation. I am sure that our agencies will study them as they review their policies and services. Let me first briefly explain our philosophy towards policy formulation and what we do for the people. We want all citizens to be well prepared for old age. As they age, they should continue to lead active, secure and meaningful lives. Government policies will enable them to do so. But the individual must take personal responsibility on how he lives his life. When he needs care, the family should provide the first line of support. Then comes the community and the State. The role of the State is to support the individual and the family. With this philosophy, we have four strategic thrusts and they are: first, enhance employability and financial security; second, enable ageing in place; third, provide holistic and affordable healthcare and eldercare; and fourth, promote active ageing. We have paid a lot of attention to ensure that people have enough money for old age. The CPF is the bedrock of our system. We save for our old age. Recently, we have made improvements to the CPF with the introduction of CPF LIFE. Most CPF account holders will get a stream of income for life. The low income are helped to accumulate CPF savings through the Workfare Income Supplement. Work provides both income and active engagement for seniors. We encourage re-employment. Legislation will be in place by 2012. We are also enabling Singaporeans to unlock the value of their homes if they need more funds in their old age through lease buy-back or change to smaller homes. A few years ago, we started to modify our environment and public transport so that they are barrier-free.”
“To reduce social isolation is indeed the top priority. So for the various ageing issues that we are dealing with – financial security, healthcare funding and the social engagement of seniors – and if we are successful in making life more pleasant for seniors and getting most of them, if not, all of them, to be active, then I think the incidence of suicide will certainly fall. SINGAPORE SPORTS COUNCIL STADIUMS (Opening hours) 14. Mr Baey Yam Keng asked the Minister for Community Development, Youth and Sports why Singapore Sports Council stadiums are open for public use only till 8.30 pm, and whether the opening hours can be extended so that more members of the public can benefit from the facilities.”
“As far as resources are concerned, I have already mentioned some of them. MCYS and NCSS have provided support for various voluntary welfare organisations to look after, particularly, the poor aged. The Health Promotion Board is also providing funds for public education. With respect to a target, I think it is very difficult for us to set a target about how low the suicide rate you can set. But what I think we should do, which comes to her third point, is that we should address the issue of loneliness among the elderly and since we are going to have more elderly amongst us in the years ahead, then we need to do as much as possible, work on the ground to get our seniors to come out of their homes, and not to stay at home and therefore be isolated, leading to depression. It is a massive effort. We are doing this through the Wellness Programme, and there are encouraging results. But after a period of two years, we will be able then to say what works and what does not, and therefore roll it out across the country.”
“Family, friends and neighbours also need to help support the elderly, and encourage them to seek professional help if they are depressed. Suicide prevention cuts across the work of various Government agencies and many voluntary welfare organisations. With a comprehensive approach to mental wellness, we hope that the number of suicide cases, especially among the elderly, will come down. Ms Eunice Elizabeth Olsen: Thank you, Minister. I have three supplementary questions. Firstly, what are the current resources available to address this issue and, moving forward, does the Minister see this as a priority in the whole gamut of ageing issues? Secondly, is there any target to bring down the suicide rates? And, thirdly, what the Minister thinks is the best way to address this issue?”
“This is why it is important for seniors to age actively, be socially engaged and join in community and interest groups. There also needs to be increased public awareness of mental health issues of the elderly, including depression. We should reduce the stigma. Family, friends and neighbours who suspect the elderly may be depressed, should encourage them to seek help early or call for help on their behalf. The Health Promotion Board (HPB) will continue to raise awareness of mental health issues among the elderly. They will also work with Voluntary Welfare Organisations, such as the Singapore Association for Mental Health (SAMH) and the Samaritans of Singapore (SOS) to organise regular outreach programmes that include talks, discussion forums and workshops, to raise public awareness on mental health and suicide. MCYS and NCSS work closely with various community organisations to help vulnerable elderly cope with crises or stressful periods of their lives. Some of the services available include: (i) Counselling services provided by the Family Service Centres, the SAGE Counselling Centre, the Samaritans of Singapore and a hospice helpline and hospitals; (ii) Support network programmes by Seniors Activity Centres for those living in rental flats and befriending services to lonely elderly. I think this is the particular focus of Ms Olsen's question. (iii) Lastly, financial assistance is available for elderly persons without family who face financial difficulties through the ComCare Fund. Here, I would like to inform the House that, to date, we do not know of any Public Assistance recipient committing suicide. Sir, elder suicide prevention is complex. It requires the elderly to lead an active life and stay socially engaged.”
“Suicide rates in Singapore have declined significantly over the years. However, suicide rates among the elderly are still comparatively higher than the younger age groups. In fact, the suicide rate for those aged 75 years and above is almost two times that of those aged between 40 and 54 years old. And this is worrying. Suicide is due to the interaction of a number of factors. There is no one root cause. It follows then that intervention efforts need to be multi-pronged, and involve different players including the family, the community and the state. Depression in the elderly can lead to suicides. Loneliness and social isolation, sickness and ill-health, the loss of a beloved spouse – all these can trigger depression and a sense of hopelessness or lack of meaning in life among the elderly. Family has a very crucial role to play. Family support can help to strengthen the emotional and mental well-being of an elderly person. There is no substitute for family in giving the elderly or, in fact, every one of us, a sense of purpose, meaning and joy in life. Beyond the family, the community also has a role to play. This is why we launched the Wellness Programme in November last year and started the Council for Third Age (or C3A) to promote active ageing. Through the Wellness Programme and C3A, we hope that seniors will form social interest groups, stay physically active to delay the onset of illness, and keep mentally alert as they pursue hobbies and interesting activities. When the elderly come and do things together regularly, the bonds among them strengthen and deepen. And if some of these interest groups and activities help to make friends out of neighbours, they not only reduce loneliness amongst the elderly, they also lead to mutual help and support.”
“2 billion people will be above 60 years old, four times the number today. This is as large as China's population today! This year, the EDB has made health and wellness a key growth theme. It intends to work with partners, such as healthcare providers, to create development platforms, such as "Hospital of the Future" and Home and Community Care. These platforms allow companies to develop products and services for an ageing population. Last year, I shared that the Ministerial Committee on Ageing would pursue four strategic thrusts: Financial Security, Healthcare, Ageing-in-Place and Active Ageing. We are making progress in all these areas. These thrusts all lead to one vision of successful ageing - happy, healthy and active seniors. The Government cannot do this alone. The family and community provide the social bonds and care that make life worth living. The individual must be committed to a long and happy life. At 110 years old, Sister Teresa Hsu is probably the oldest active "Ager" in Singapore. She has been serving the community most of her life. I would like to share a quote on her philosophy of life: "I prefer to laugh than to weep. Those people who cry to me, I always tell them it is better to laugh than to use tissue paper. Laughing is free but tissue paper still costs five cents." Teresa Hsu is committed to a long and happy life, and may all Singaporeans emulate her. Youth Development and Values”
“The objectives of the Wellness Programme are very much in line with the fundamental objectives of grassroots organisations – bonding the community. So this Wellness Programme is not something we do separately; it is something we will have to do together with the grassroots organisations within the constituency. For now, the Wellness Programme is a pilot. Each site is given the leeway to experiment with what works best for their community. As mentioned, outcome indicators will be monitored to closely track for effectiveness. After two years, the Government will evaluate how the Wellness Programme can be rolled out nationwide. Whilst a number of Members are very anxious that they have a similar programme within their own constituency, I think it is best for us to see what the pilot comes up with, what works and what we can do to bring the best practices together to make it a successful programme. So far, I have shared what the Government, in partnership with the people sector, is doing to help seniors achieve a happy, healthy and active life. But there is no reason why the private sector cannot be involved. The private sector can service the needs of our ageing population, while being profitable at the same time. The Health Ministry's pilot scheme to open up subsidised nursing home beds to the private sector is an interesting experiment. Two months ago, the Silver Industry Committee, under Mr Philip Yeo, successfully organised a silver industry conference and exhibition. The public response has been very encouraging. I understand that exhibitors are keen to participate next year. Scaling up for the silver business is increasingly possible. It is not just Singapore which is rapidly ageing, but also the rest of Asia. By 2050, 1.”
“So we have to change the conventional image of the elderly. Mr Baey Yam Keng asked what we are doing to promote an active lifestyle for seniors. Last May, the Council for Third Age was established to champion active ageing. MCYS currently funds the Council. On the Ministry's behalf, the Council also administers public education and the Golden Opportunities! (GO!) Fund. One of the first things the Council did was to re-brand Senior Citizens' Week to the Active Ageing Festival, which was held last November. The Festival had a good start. This year, the Council intends to promote active ageing more extensively. It will work with the CDCs to bring this message to the community. Over the next two years, a Wellness Programme will be piloted in six sites all over the island. Two have been launched at Jurong Central and Punggol South. The key objective of the Wellness Programme is to support seniors in the community by identifying and meeting their needs, through information and referral, service coordination and development, as well as outreach efforts to promote active ageing and wellness. Each site is expected to reach out to at least 1,000 seniors. MCYS is allocating $4 million to this pilot. One element of this is to help the seniors improve the quality of their life. Health screening is one part of the programme, but to get them, from the results, to a healthier lifestyle is the difficult part. KPIs will be established to see whether this Wellness Programme really makes a difference. Although each Wellness Programme will have at least two full-time staff, the support of the Advisor, grassroots leaders, Government agencies and the community-at-large is crucial to ensure it meets these objectives.”
“Real protection comes from preventing these cases from taking place, and if they do happen, to resolve them through mediation and counselling. Applying the law should be the last resort. It makes reconciliation almost impossible. Social workers find that many family disputes can be resolved. Frequently, the issues revolve around ignorance about care giving and relationship issues, financial hardships, and even neglect or unbecoming behaviour by the parents. There is only a small minority of 'unfilial children', which should be swiftly dealt with by the law. We will continue to make efforts to raise public awareness of elder abuse and maintenance of parents. But as importantly, we must strengthen the help offered to the elderly, to reconcile with their family, where possible. Very often, the one complained about is also the one providing the financial support. So we have to be very careful to treat this sensitively and delicately so as not to break that relationship forever. But neighbours can play a part too, to help watch out for elderly neighbours and support those with care giving responsibilities, and this is why strong social bonds in the community are important. Whilst the community can facilitate and support, the individual must also do their part to be active. Our seniors lead very sedentary lives. Hitherto, society's image of the elderly is that of frail men and women using walking aids or wheelchairs. Typically, whenever we want a picture to depict the old, that is what comes up. This is not true of our seniors above 75 – eight out of 10 of them do not need walking aids to get around. The emerging generation of seniors – post-war baby boomers – are even better educated, healthier and probably wealthier.”