SINGAPORE (Jan 8): Beatrice Lopez, 85, was among the first batch of medical social workers trained in Singapore. Now retired and having lost most of her eyesight, she still takes pride in maintaining an active lifestyle: she sometimes has friends over and enjoys shopping at Bukit Timah Plaza.
Lopez is one of eight residents at St Bernadette Lifestyle Village, an assisted-living facility (ALF) where seniors enjoy their independence while staff help with chores and monitor their health. The facility is housed in a single-storey bungalow in the upscale Bukit Timah neighbourhood, and boasts a room for each resident and a common living room. Residents pay $3,650 a month.
After living with a domestic worker in a condominium for 12 years, Lopez moved to St Bernadette in March last year. “Anything can happen once you are old; I decided I might as well come into a safe haven. I couldn’t take a chance because I have no family here. So I thought, all my life I’ve looked after others, now let someone look after me,” she says. “Here I can retain more independence. It’s safe and well-managed. So, all that’s left to do is to just live fully day-to-day.”
As Singapore’s population ages, demand for ALFs may rise. As of 2016, there were 69 nursing homes in Singapore. Over half of these are run by public and non-profit organisations. But entrepreneurs and policymakers are introducing alternative models to the nursing home — namely ALFs and elderly-friendly estates. The former are already popular in developed countries such as the US and Australia.
St Bernadette, for one, was started in 2015 by a couple who already runs a nursing home and saw a gap in the marketplace. Family physicians Dr Belinda Wee and Dr Joseph Lee have run the nursing home Good Shepherd Loft since 2010. They noticed that some seniors desired living arrangements that offered more independence. “If we put a senior who is active in a nursing home, the social aspect of their care may be compromised. We talk a lot about the basic needs of seniors, such as eating and taking medication. But then there are executive activities of daily living, such as cooking, shopping and meeting friends. I think this aspect of their care needs to be enhanced in Singapore, and we can do that in an ALF,” says Wee.
The entry of new players is overdue, given the dramatic rise in life expectancy, says Kim Walker, CEO of Silver Group Consultancy, which advises companies on marketing to seniors. “One of the greatest killers of older people in this age of longevity is loneliness. Here is an opportunity where entrepreneurs can provide services to those who are ageing,” he says.
Silver opportunity
This year, Singapore is at a demographic crossroads as the number of those aged above 65 coincides with the number of individuals under 15. UOB economist Francis Tan, who pointed this out in a Dec 6 report, calls the ageing population a “demographic time bomb” that raises significant questions for policymakers. For instance, do we need more nursing homes than childcare centres? He adds: “With the population ageing at such a quick pace, the government will have to increase spending, especially in healthcare and social services.”
Demand for nursing homes is already on the rise. In response to a parliamentary question last year, the Ministry of Health said it had increased the number of nursing home beds from 9,400 in 2011 to 12,800 as at December 2016. A total capacity of 17,000 beds is expected by 2020.
At the same time, a study by the Lien Foundation and NTUC Income in 2016 found that younger Singaporeans were more receptive towards retirement villages than nursing homes. Among respondents aged 30 to 44, 67% would not mind staying in a retirement village, compared with 48% of those aged 60 to 75. In contrast, only 35% of the younger segment would not mind living in a nursing home, compared with 58% of the older segment.
This preference is in line with demographic trends, says associate professor Daniel Goh from the department of sociology at the National University of Singapore (NUS). “The ageing cohorts will be more educated as we head towards 2030. Their children will be more educated and affluent too. They will demand better housing options for their parents, while the ageing parents will be demanding certain retirement lifestyles and can afford them,” he says.
Private nursing home provider ECON Healthcare Group has seen “growing” demand for its nine nursing homes in Singapore, says its executive director Ong Hui Ming. But Ong also notes the increasing interest in retirement villages. ECON developed and manages a high-end retirement village in China’s Suzhou Industrial Park, which was completed in 2013. The 34,000 sq m estate is equipped with an indoor swimming pool, sauna and running track, alongside medical amenities.
“We observe some demand for retirement-living concepts in Singapore with more singles and senior couples not living with their children. These homes can be built with senior-friendly features, club wellness facilities, and supported by a care provider for the healthcare needs. We do not rule out this possibility in Singapore and Malaysia,” Ong adds.
Allium Healthcare Holdings, a wholly-owned subsidiary of G K Goh Holdings, is developing a 129-bed nursing home on Venus Drive, comprising just single and double en suite rooms. Designed like an upscale private residence, the home will also be equipped with hydrotherapy and spa pools. Last August, Allium CEO Bernie Poh told EdgeProp that the facility is targeted at the “underserved” middle- and upper-income groups.
Meanwhile, Wee and Lee of St Bernadette are setting up another facility on Adam Road with room for eight. The market for ALFs, Wee says, is still in its infancy. “It’s like being a start-up, like Grab or Airbnb,” she says.
Ageing at home
The government, too, is experimenting with the idea of “ageing in place”, or enabling seniors to remain in their own residences but having improved access to healthcare and other amenities. It recently unveiled a public housing development named Kampung Admiralty — an 11-storey complex comprising two blocks of studio apartments and two-room flexi-flats, as well as a medical centre, eldercare and childcare centres, retail outlets and a community park. The development was launched in a build-to-order (BTO) exercise in 2014, with priority given to seniors with married children living nearby, or those living nearby who wished to downsize their flat. More than 40% of units were booked under the Housing Development Board’s (HDB) Studio Apartment Priority Scheme and Senior Priority Scheme.
Accounts executive Christina Foo, 55, is among the first batch of residents at Kampung Admiralty. She and her husband, a driver, previously lived in a four-room flat, but decided to move closer to their son. They earn a combined income of about $5,000 and are preparing for retirement in the next decade. Most of the units were sold on 30-year leases, which makes them more affordable. Foo says she paid about $95,000 for her apartment. “It’s very convenient here, with the food outlets and medical facilities nearby. My house is near the park and it’s quite nice,” she says.
Retired hospital attendant Dorasamy Kuppamah, 72, similarly moved to be nearer to her daughter. She shifted to her apartment last November, from a three-room flat in Pandan Gardens. While she lives on her own, Kuppamah says the neighbourhood makes her feel less isolated. “I have good neighbours here; when I don’t open my door for some time, they knock to make sure I’m okay,” she says.
Kuppamah’s one grievance is that the nearby playground attracts noisy teenagers from the neighbourhood. But consultant Walker says encounters with young people are precisely why ageing at home is a better option than moving to a nursing home. “Ageing in place is an effort to keep people housed in familiar surroundings as long as you possibly can. In HDB estates, the elderly living there can go downstairs and interact with the market sellers. They have to be surrounded by young people, whether children or annoying teenagers. When you take people out of that and put them in an artificial environment, you are depriving them of a normal existence,” he says.
NUS’s Goh also believes Kampung Admiralty provides a good housing model. “The concept is to co-locate senior housing with young families, eldercare facilities with childcare facilities, with shared community spaces and parks that are both elderly-friendly and children-friendly... It is a good model because current social scientific studies support such arrangements as beneficial for the well-being of the elderly as well as encouraging young families to have a healthy respect for the elderly,” he says.
The challenge is in scalability and cost. The government plans to build nine other BTO developments that co-locate childcare and senior centres. This is part of a $3 billion national plan for ageing announced in 2015. “We had 440,000 seniors [above 65] in Singapore in 2015. This will increase to 760,000 in 2025 and double to 900,000 in 2030,” Goh says. He questions if the 10 projects will be able to house a significant proportion of seniors.
Fung John Chye, director at the NUS Centre for Ageing Research in the Environment and associate professor at NUS’s department of architecture, adds: “From an economic standpoint, it is not easy to sustain such a model, which is highly dependent on its prime location next to a mass transport node, town or neighbourhood centre. The small number of seniors living in the apartment units of Kampung Admiralty alone cannot support the amenities, which have to rely on high foot traffic from the [mass rapid transit] to be commercially viable. If Kampung Admiralty were replicated elsewhere under a different site condition and the amenities remained concentrated in a single development, it would mean some parts of the neighbourhood would be underserved.”
To ensure all elderly have their housing needs met, Goh says, policymakers could consider both public and private sector solutions. “The government could facilitate a large private sector for senior housing options to allow for the diversity to emerge, and for it to be competitive enough to keep prices down for middle-income Singaporeans. Public sector senior housing will be an equally important arm to keep the private sector competitive as well as making senior housing options affordable to lower and middle-income Singaporeans.”
Avoiding “geriatric enclaves” will be another priority, says Eugene Tan, a former nominated Member of Parliament and associate professor of law at the Singapore Management University (SMU). “While there are pockets of the elderly that were isolated from society in HDB rental housing and older HDB estates, there has also been effort to rejuvenate older estates through the Selective En bloc Redevelopment Scheme and building new apartment blocks to bring [in] younger residents... There is the imperative to plan in advance, develop the infrastructure, ensure adequate financing and secure society’s buy-in for the eldercare policy,” he says.
Across the causeway
Some Singaporeans are turning to cheaper facilities in neighbouring Malaysia. In the sleepy suburban neighbourhood of Taman Johor in Johor Bahru, a row of bungalows houses about 190 residents — with 20 Singaporeans among them. While they look like residential properties, the houses belong to City Heart Care Licensed Nursing Home. The enclave is targeted at aged residents from Malaysia and Singapore, with the Woodlands Checkpoint just a 30-minute drive away.
In one of the double-storey bungalows, a 74-year-old Singaporean resident, who only wants to be known as Wong, browses an old photo album with his wife and grandchildren. The former taxi driver reminisces about his motorbike road trips to the northern Thai province of Chiang Mai, and even all the way up to the Golden Triangle — the region bordering Thailand, Myanmar and Laos. “I was so active then, I loved to travel. I miss it a lot,” he says.
A stroke in 2010 left him unexpectedly wheelchair-bound and in need of constant medical care. Wong and his 73-year-old wife were then living in a two-room HDB flat. They did not qualify for subsidies to admit Wong to a nursing home in Singapore, owing to the “middle-income” status of their three children.
“The nursing homes in Singapore would have cost us at least $3,000 a month. We decided it would be more affordable to find a place for my husband in Malaysia,” says his wife, who lives in Singapore with one of her children. Wong’s room in City Heart Care, which he shares with two other residents, costs about $900 a month.
Like Wong, many aged Singaporeans who make the move to Johor Bahru are attracted by the lower cost, says Jeremy Yeo, the Malaysian owner of City Heart Care. ECON is also seeing more demand from Singaporeans for its two nursing homes in Malaysia, says Ong. Its Johor Bahru facility, ECON Medicare Centre and Nursing Home, Taman Perling, currently houses about 20 Singaporeans. She cites the high standard of care and lower costs as the main factors.
Associate professor Tan Ern Ser, from NUS’s department of sociology, says the affordability and proximity make Johor Bahru a “viable and attractive” option for some. “The bottom line is whether seniors are able to enjoy a decent quality of life, possessing good financial, emotional, physical and social health,” he says.
Dubbed “grandma export”, this trend of seniors moving to cheaper accommodation in less-developed countries has gained popularity in Germany, where the aged move to neighbouring Poland and Slovakia. SMU’s Eugene believes the relocation of aged Singaporeans may grow in popularity, but is unlikely to become a trend. “If it becomes a norm or a growing number of retirees choose to relocate out of Singapore for their retirement, then the central notion of Singapore as home for all becomes severely undermined,” he says.
Indeed, at Spring Valley Homecare, another nursing home in Johor Bahru, the number of Singaporean residents has declined over the past year. Director Frankie Ker attributes this to more of them qualifying for nursing home and other medical subsidies in Singapore. “Once they get subsidies in Singapore, they go back. It’s more convenient for them to live in Singapore,” he says. Fees for open wards at Spring Valley cost about $600 a month.
Nevertheless, NUS’s Goh says it is important for senior housing development to keep pace with the growth of the ageing population. “We don’t really have the luxury of time as the numbers will double in a decade. The elderly are repositories of wisdom and experience, and they will carry these along with them across the border if they do retire in Johor Bahru.”
This story appears on Issue 812 of The Edge Singapore (week of Jan 8) which is on sale now.
