Singapore is facing challenges posed by rising life expectancy and declining fertility rates. These shifts have profound implications for healthcare and government policies.
How can research evidence shape future policies and contribute to the well-being of our seniors? What role do economic and social policies play in preparing us for the impending demographic transition?
The Asia Thinker Series webinar "
Ageing Realities: Shaping Future Policy and Care”, held on 23 March 2023, attempted to probe these questions. Associate Professor in Practice at the Lee Kuan Yew School of Public Policy, Terence Ho, moderated the webinar and facilitated the discussion. The panel featured three speakers: Chief Executive Officer of the Agency for Integrated Care, Mr Tan Kwang Cheak; Senior Research Fellow at the Institute of Policy Studies, Dr Gillian Koh; and Associate Professor at the Lee Kuan Yew School of Public Policy, Dr. Alfred Wu.
The panellists discussed ways of enhancing aged care systems and policies in Singapore, focusing on extending support to seniors and empowering them to shape the life they aspire to lead. This has taken on urgency, considering that by 2030, one in four Singaporeans will be aged 65 and above, classifying Singapore as a super-aged society.
The following are highlights of the panel discussion. The responses have been edited for clarity.
What insights can be drawn from Singapore's holistic approach to ageing, health, and long-term care?
Dr Koh: I'd like to share the findings of a qualitative research
project that we did, which involved speaking to 72 people about ageing, their concerns, and how prepared they are to pay for their needs in the future.
The participants were asked a series of hypothetical questions about their finances, like if they needed an extra S$10,000 to live off, where would that fund come from, and what would they use it for? We noted that health was their top priority, with an estimated S$2,900 of the hypothetical fund spent on health, and caregiving at an additional S$1,700.
In their response, these seniors were very confident about being self-sufficient, saying that S$3,900 of that hypothetical fund would come from their own savings and income.
I condensed seven areas which I anticipate they would need to work on to improve their desired experience of growing old, and they are as follows:
1) The need to conduct more rigorous cost-benefit analyses on senior employment to decide how much to promote it.
2) Job matching seniors to appropriate work and making the process of seeking employment more efficient and intuitive for them.
3) Modifying means-testing to factor in the levels of disability of seniors.
4) Raising and maintaining the quality of professional caregiving in Singapore.
5) Supporting people who prioritise caregiving over their employment, a move which directly affects the security of these caregivers’ retirement plans.
6) Using technology to streamline the seniors’ visits to health and wellness appointments.
7) The provision of a one-stop database for information that relates to ageing, as well as information about programs designed to improve the wellbeing of the seniors.
What is the key aspect in planning for ageing societies, considering resource origins and their reliance on public attitudes toward various programs?
Dr Koh: Singaporeans want more guidance on how much money they should put aside to afford a happy and healthy senior life in Singapore. Campaigns such as Healthier SG were instrumental in closing the gap between life expectancy and healthy life expectancy. By empowering seniors, Singapore can achieve its long-term goals of flourishing in an ageing society.
Are there concerns about the funding, resources, and appropriateness of implementing senior programs that require substantial financial support?
Professor Wu: We have many problems; rising inflation, rising income inequalities; we need to have more money and resources for an ageing society. We need a whole-of-society approach to this. But in the meantime, I think we also need to lead — to devise and implement policies that would help construct an effective and coordinated effort to ageing issues.
How does the Agency for Integrated Care (AIC) contribute to empowering seniors and supporting their caregivers?
Mr Tan: The Agency for Integrated Care (AIC) is an agency operating under Singapore’s Ministry of Health, tasked to coordinate the delivery of aged care services. We are the appointed agency for the administration of national
schemes like the Community Health Assist Scheme (CHAS) and Merdeka Generation (MG) package.
The AIC has over 3,000 volunteers implementing its outreach initiatives, with a heavy focus on empowering Singaporean seniors and their caregivers to be able to live and age well in the community and at home.
With the announcement of Healthier SG by Singapore’s Minister for Health Mr Ong Ye Kung in July 2022, I observed that the role of the AIC has become multi-fold: it supports primary care partners like general practitioners to provide the first line of care, which helps seniors keep healthy as far as possible. But the agency also supports the community partners, like active ageing centres, in delivering to a whole spectrum of needs, ranging from healthy to frail seniors, and even to those at the end-of-life stage.
In February 2023, we launched the “Refreshed Action Plan for Successful Aging”, which is premised on how seniors wish to lead their lives, rather than focusing on their basic needs. The three pillars in this plan are: Care, Contribution, and Connectedness, all of which emphasise giving seniors the chance to improve their quality of life by pursuing the lifestyle they want.
The onus is on us, as agencies within the public sector, to ensure that the public money invested in key programs that go out to seniors are well used and achieve the outcomes they sought to achieve. We keep within this agenda by being clear about the objectives of each programme, evaluating the execution of said programmes, and focusing on long-term outcomes instead of solely thinking about short-term output.
I found Dr Koh and Professor Wu's studies not only insightful but also remarkably consistent with our Silver generation outreach to seniors. The sentiments toward ageing and the aspects they consider vital for quality of life align closely. In terms of a hypothetical S$10,000 investment, the priorities that emerged through the study resonate with our understanding, especially concerning healthcare peace of mind and the significance of caregiving. Seniors emphasise the critical role of social-emotional support in achieving a high quality of life.
To address these concerns, the key is to mobilise our entire community, echoing Professor Wu’s emphasis on shared responsibility. As he highlighted, the perception of seniors, both by themselves and those around them, is a crucial aspect that requires a shift in mindset.
Can you provide more details on the caregiving gaps you mentioned? Additionally, what recommendations do you propose to address and support caregiving in Singapore?
Dr Koh: I am referring to the quality of caregiving. For instance, many families have foreign domestic helpers — it seems very critical to many households. But the observation is that they can benefit from the provision of support in terms of training, so that they are more effective in physical care and also to some extent in basic medical care. And can they have better remuneration and training to make the profession more attractive to Singaporeans as well.
Furthermore, institutions and elder care centres with continuous professional caregiver support, alongside the establishment of additional drop-in centres — announced by the government, will be extremely helpful.
What is the general sentiment among the public regarding funding initiatives for an ageing society?
Professor Wu: We often express the need to care for the sick and elderly. However, an analysis of this on the policy level reveals a nuanced public stance on supporting these demographic changes. In Asian societies, two key factors, namely, pervasive inequality and varying evaluations of how to aid senior citizens, contribute to this complexity.
The widening income inequality is present in many Asian societies, which has created a massive need for welfare programs, and therefore, public spending, programmes supporting seniors, would be very costly and therefore, place more burden on the government’s budget as well.
The public opinions would invariably evolve with changing situations, and there is not a fiscally sustainable one-size-fits-all solution that could address ageing societies.
Dr Koh: The unrest surrounding the pension reforms in France serves as a prime example. In the French system, I observed that sustaining seniors would require additional taxes, and the generation of more funds hinges on an increased workforce.
How can we build better and more coherent planning for longevity and an ageing population that balances various aspects of healthcare, community, and social needs and complexities?
Mr Tan: Firstly, we need to understand the needs and aspirations of the seniors, not just in the now, but in the future, in terms of quality of life.
Secondly, we really need to move upstream. Don't wait until the candidates come, don't wait until they grow frail when they need a residential care facility, hence the whole move towards healthy SG. We need to move upstream, look at those who are well, and help to keep them well as long as possible.
Dr Koh: The government has refreshed its Action Plan for Successful Ageing, which reinforces the need for a whole-of-society and whole-of-government approach to managing the more advanced issues that our seniors will face.
As we study that, we can see the part that we can play in that picture is through the emphasis on volunteering in caregiving, which we provide, but also in facilitating difficult conversations with the seniors in our families about end-of-life care. This is so that our seniors feel they have a plan and can have a sense of agency about how they wish to age and how they want to leave.
Professor Wu: My main message is for us to have more debates in our society. We live in a very polarised world; we disagree with each other on almost everything. But today, I feel very comfortable because many of us are talking about how we need to have a mindset that is geared to being more inclusive towards our seniors at home, at work, and in the community.