What can you do for our Aging Singaporean? Send to JB is OK?

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Principal features of the national policies on ageing

We want Singaporeans to age with dignity and to remain actively involved in society. We want them to be actively engaged in family and community life. And, in line with the Singapore 21 vision, we must maintain a strong sense of cohesion between the generations. Singapore should be the best home for all ages. (Inter-Ministerial Committee on the Ageing Population 1999, p. 13.).

This statement by Mr Goh Chok Tong, the prime minister, illustrates the main philosophy of the government with regard to issues of ageing. Singapore’s government has clearly stated its

stand that the “family is still the best approach — it provides the elderly with the warmth and companionship of family members and a level of emotional support that cannot be found elsewhere” (Minister of Health, Mr Yeo Chow Tong’s keynote address at the Conference on Choices in Financing Health Care and Old Age Security 1997).

The present paradigm of care for the elderly in Singapore is a partnership between the government, the community and the family (Mehta 2000). In tandem with the “Many Helping Hands” policy of the MCDS, the community and the government are expected to lend a hand to ageing families in order to reduce the stress of taking care of older members. This policy emphasizes that the government expects to work hand-in-hand with civic bodies such as voluntary welfare organizations (VWOs), religious institutions, ethnic-based organizations and secular bodies such as clan associations. The support given to these organizations is in the form of funding, land leased at special rates, training of staff and guidance in programme planning. The Elderly Development Division in MCDS plays an active role in this arena.

Financial policies

The essence of the government’s approach is to be compassionate in a way that will not rob the nation of its economic competitiveness. This is exemplified by the current design of financial protection for older Singaporeans — the Central Provident Fund. The CPF, a national social security fund, was established in 1955 as a form of retirement savings plan, which could be partially withdrawn at age 55. Employees under 55 years of age are required to save 20 per cent of their salary in a self-managed asset account, while their employers are also obliged to contribute 16 per cent into the employee’s account. To make it more attractive for employers to employ older workers, the government has set a lower employers’ contribution rate for employees who are 55 years of age and over.

The CPF scheme has gradually evolved into “the world’s most extensive social policy on assets” (Sherraden et al. 1995,

 

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Each working Singaporean has a CPF account, compartmentalized into the ordinary, special and Medisave accounts. Within certain limits, the individual can expend a portion of his or her savings on investments, housing, tertiary education for a child, and even home protection. The last is a “compulsory mortgage-reducing plan (which) protects members and their families from loss of their homes when members die or are permanently disabled” (Sherraden 1997, p. 42). Medisave is a compulsory hospitalization insurance scheme; Medishield is an optional low-cost catastrophic illness insurance; and the Dependents Protection scheme is an optional term-life insurance scheme which covers members for an insured sum until they reach the age of 60. All three schemes cover not only the individual but also his or her family. The CPF scheme has been criticized for its lack of universal coverage and the lack of adequacy of funds for retirement security, especially for the low-income groups (Shantakumar 1999; Asher 1996 and 1998; Lee 1999 and 2001a). The recent National Survey of Senior Citizens 1995 showed that only 33.5 per cent of those above the age of 60 had CPF savings and, of these, 61.6 per cent felt that their CPF savings were inadequate. The main reasons cited for inadequate security were high cost of living, low savings, and high medical costs. Children were the main source of financial support for the majority of the respondents in the survey (Ministry of Health et al., Singapore 1996). In line with its emphasis on family support, an aged

dependent relief is provided under the income tax assessment. A co-residential child/child-in-law is eligible for S$5,000 tax relief annually, while the non-co-residential counterpart is eligible for S$3,500 annually, (US$1 = approximately S$1.80).

Apart from the CPF, there are two other schemes that act as a “safety net” for elderly Singaporeans. The first, a Public/Social Assistance scheme, is disbursed by the MCDS. The eligibility criteria are very stringent, and older persons with living children usually have a very slim chance of obtaining approval. The rates are not commensurate with Singapore’s rising inflation; for example, an adult can obtain a maximum monthly allowance of only S$230 (about US$135). However, a person on Public Assistance is also entitled to free medical services, which is of great help. Secondly, the Medifund scheme is available for poor patients who are unable to pay their hospital bills. However, the onus for applying for this aid is on the patient, and sometimes they are not aware of its existence.

From the outset, the state opted for a non-welfare state approach and is reluctant to make cash payments directly to needy persons. This Singapore-style welfare strategy has been called “supply-side socialism” (Straits Times, 18 September 1994), in which any form of financial assistance is usually provided at source — for example, to the Housing Development Board for people in rent arrears, or to a nursing home to subsidize frail aged people. The rationale for this approach is to reduce the temptation of abuse by the recipient or his/her family members.

Health policies

In the arena of health care, Singapore has designed a system of subsidy for hospital beds under which Class C patients receive an 80 per cent subsidy, Class B2 patients receive a 65 per cent subsidy, and Class B1 patients receive a 20 per cent subsidy. The subsidy for nursing home beds has been revised following the recommendations of the report of the Inter-Ministerial Committee on Health Care for the Elderly in 1999. The philosophy adopted by the state is that each individual is responsible for maintaining

his or her health and well-being, and should save for a rainy day. If this fails, the family should help out; the government will only come in as a last resort. A great deal of money is therefore being spent by the government on life-long public health education, as was seen in the recent announcement of the establishment of a statutory board, the Health Promotion Board (Straits Times 23 February 2001). This is a logical follow-up of the recommendation of the IMC on Health Care for the Elderly on the establishment of a national disability prevention programme.

Another dimension of primary health care, on which the government is focusing, is subsidized health screening for senior citizens. For a nominal fee of S$5, a person aged over 60 can access a basic health-screening test. This service has been promoted by the Ministry of Health using neighbourhood organizations, such as community centres/clubs as venues. The IMC Report on Ageing Population has also highlighted the importance of a comprehensive system of “step-down care” after a patient is discharged from hospital.

 

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While some of these services are presently available, inadequacy, unequal geographical distribution and affordability remain major issues. Linked to this topic is the need for more supportive programmes at the neighbourhood level to assist families in caring for their elderly members. Such programmes could include meal delivery, help-line telephone services, equipment loans, “elder minding” and even neighbourhood respite care. It is hoped that a viable network of such integrated services can prevent premature institutionalization. A continuum of care for sick older persons, from acute to community-based to home care, is the aim of the Singapore Government’s policy for the older Singaporean, although this has yet to be achieved.

Housing policies
Through the Housing and Development Board (HDB), which is a statutory board, the Singaporean state has socially engineered children either to live together or to live within a short distance of their elderly parents and/or parents-in-law. “In 2000, about nine in 10 elderly persons above sixty five years and over lived with their spouse or children” (Government of Singapore 2000, p. 5). In their four-nation comparison of living arrangements of elderly persons aged 60 and over, Knodel and Debavalya (1997) found that the percentage of elderly people living with their children was highest in Singapore compared with the Philippines, Thailand and Vietnam. Elsewhere in the region, for example in Korea (Choi and Suh 1995) and Japan (Yamasaki 1999), the decline of co-residential living arrangements among older persons is an established trend.

The high rate of co-residence of older Singaporeans is probably explained by various housing schemes to encourage extended family living; the high cost of housing, given the scarcity of land area; and the cultural inclination towards filial care. It is not possible to describe all the housing schemes in this chapter, so selected examples will be cited. Among these, the Multi-Tier Housing Scheme gives priority allocation to extended-family applicants, and the Joint Selection Scheme is

designed to allow families to select flats on priority so that married children and parents can stay in separate HDB flats but in close proximity. The CPF Housing Grant Scheme allows a married first-time applicant who buys a resale flat from the open market in order to stay near his or her parents or vice versa, to apply for a housing grant ranging between S$30,000–S$40,000, depending on the geographical proximity between the two generations. Apart from these examples, there are other housing schemes, such as the Joint MCDS-HDB Project, which is equipped with elderly-friendly facilities. This is targeted at low-income elderly people in rented one-room flats in which modifications such as non-slip tiles, lift landings on every floor and an alarm system have been installed at no cost to the resident. A Studio Apartment Scheme is aimed at elderly HDB flat-owners aged 50 and above who wish to downsize from larger to smaller elderly-friendly flats after retirement. In addition, the government provides funding to selected voluntary organizations to run activities for older persons within the ground floors of these selected blocks.

Likely future developments
The blueprint for future development of ageing policies in Singapore has been laid out in the two IMC Reports on Health Care for the Elderly (February 1999) and the Ageing Population (November 1999) which spans the recommendations of six work groups: Social Integration, Health Care, Financial Security, Employment and Employability, Housing and Land Use, and Cohesion and Conflict.

It is worth noting that a three-pronged approach was adopted towards achieving social integration: developing the “heartware” (positive attitudes and values towards older people), “software” (policies, programmes and services) and “hardware” (the built environment, including transport). On 12 January 2001, the minister for community development and sports outlined publicly for the first time the main features of the Five-Year Master Plan of Elder Care Services (Straits Times, 13 January 2001). Many of the points are logical concrete plans stemming from the

recommendations of the two IMC reports. The three key strategies outlined in the master plan are:

The setting up of an appropriate infrastructure and a new service delivery system
The revamping of funding policy for voluntary elder care services
The provision of a continuum of programmes targeted at healthy older persons, frail elderly people and their caregivers.
Under the first strategy, multi-service centres, to meet the needs of different generations and managed by community development councils, would serve as one-stop centres. Multi-service centres would be complemented by Neighbourhood Link Centres, which would function as information dissemination and referral services while at the same time tapping the resources of healthy older persons and other age groups to engage in volunteer activities. Under the second strategy, from 1 April 2001, the funding for voluntary organizations was to involve subsidizing elderly-related services on a per capita basis rather than on a programme basis, wherever possible. A differential subsidy scale was to be introduced so that lower-income users would receive a higher subsidy. A competitive system of bidding for funds to operate a service was also expected to be launched.

Out of a total of S$93 million allocated towards the master plan, more than S$30 million was to be used for programmes for fit elderly people. A case management service was to be launched for frail elderly persons to facilitate accessibility to multiple services. Last, a formal commitment was made by the government to establish carer centres, in acknowledgement of the physical and emotional stress of caring for elder relatives and to provide family caregivers with information, training and recognition.

Apart from the outline developed by the minister, it is anticipated that Golden Manpower Centres, which offer training and employment opportunities for older Singaporeans, will be expanded. The relatively low labour force participation (LFP) rate of Singaporeans aged 55–60 years old is of concern to the government. The reasons lie in part in the low educational levels and lack of skills of older workers, as well as a lack of employment

opportunities. The Golden Manpower Centres can help to mitigate the full impact of an ageing workforce on the economy. However, it is paradoxical that, while the retirement age has been gradually increased from 60 to 62 as of January 1999, the labour force participation rate of older workers has not increased much. In 1997, the LFP rate for the age group 55–64 was 43 per cent, markedly low as compared to their counterparts in Japan (67 per cent), Korea (64 per cent) and Hong Kong (52 per cent) (Inter-Ministerial Committee on Ageing Population, 1999).

To succeed, the government will have to work on the mindsets of both older workers and employers, in addition to providing incentives to employees to remain in the labour force. It is hoped that future cohorts of older persons, who are expected to be better educated than those of today, may be more inclined to continue working beyond 55 years of age. However, as seniority wages may work against their continued employment, a flexible, performance-based rather than seniority-based remuneration system is needed to deal with this challenge.

Last, Eldershield, an insurance scheme related to disability in old age, was introduced on 30 September 2002. The premiums are deducted from the Medisave portion of a CPF policy holder’s account and, in the event of at least one ADL disability, he/she is eligible to apply for a subsidy of S$300 per month for a maximum period of 5 years. The premiums are higher for women than men as a result of their longer life expectancy. The coverage is for life and premiums have to be paid between the ages of 45 to 65, unless a Singaporean voluntarily opts out

 

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Long-term care (LTC)
It may be pondered whether there will really be a pressing need for long-term care facilities, given that a relatively high number of elderly people in Singapore live with their family members. Indeed, according to the National Survey of Senior Citizens 1995, 86.2 per cent lived with their children, an increase of about 5 per cent from 1983. The survey also reported that 3.1 per cent of senior citizens lived alone, while another 5.2 per cent lived with

their spouse only (Ministry of Health et al., Singapore 1996). The survey was national, covering a sample of 4,750 older persons and achieving a 50 per cent response rate. Subsequently, the Singapore Census of Population 2000 recorded an increase in “elderly only” households from 1.8 per cent in 1990 to 2.8 per cent in 1999. Parallel to this trend, there was also a decrease of extended or multi-generational households from 6.7 per cent to 5.6 per cent. The census also documented an increase in one-person households from 5.2 per cent in 1990 to 8.2 per cent in 1999

The increase of 3 per cent in one-person households is a matter of concern due to the potential of social isolation, vulnerability to depression and suicide, as well as the lower possibility of immediate treatment at times of crisis. While a healthy older person may not have much difficulty in managing to live independently, frail or handicapped older persons are far more likely to need formal and informal assistance.

Other demographics affecting the need for long-term care are:

The ageing of the aged population. In Singapore, this follows the trend in many other countries (Kinsella 2000) in which the rate of increase of the “oldest-old” population (people aged over 75) is greater than that of the “young-old” population (60–65 year olds). A consequence of this demographic transformation appears to be a substantial increase in the utilization of health care services. In 1995, for example, people aged 65 and over accounted for only

7 per cent of the population but totalled 17 per cent of all hospital admissions and 19 per cent of out-patient polyclinic visits (Phua and Yap 1998). These statistics have alerted health care policy-makers in planning for future demands.

Older women. The feminization of ageing is a common feature that reflects the gender bias in the numbers of older women surviving as compared to older men in very old populations, given women’s advantage in terms of life expectancy. Although this can be seen as a neutral demographic feature, health statistics show that women tend to suffer more from chronic illnesses while men tend to be inflicted by acute or fatal illnesses such as cardio-vascular disease (Muller 1992). The net result is that in many countries women often require physical assistance due to illnesses such as arthritis, rheumatism and asthma. Longer life expectancy, chronic illness, and quite often inadequate financial resources accentuate the needs of older women for LTC (Lee 2001a). In Singapore, women outnumber men in nursing homes. The lack of research data on ageing women per se is a gap that needs to be addressed in Singapore, as in many other developed countries.

In Singapore, Shantakumar’s monograph 1994 based on 1990 census data highlighted that “frail widowed elderly women would be significant among the future aged, with attendant problems of financial security, medical and health supports” (p. 50). Parallel to this it should also be remembered that a considerable proportion of middle-aged and elderly women provide care to older relatives, such as spouses, parents and parents-in-law. Indeed, it has been suggested that women can expect to spend as much time caring for an ageing parent as raising children (Clair et al 2000), so the lifetime cumulative negative costs of this in terms of finance, physical and mental health, and lost opportunities are experienced by most women at old age. Women almost everywhere comprise the majority of informal family caregivers to older persons, including in Singapore (Mehta 2000). Recent research in the Singapore context has documented the stress faced by female spouses in the caregiving role (Mehta and Joshi 2000). However, more optimistically, the likelihood of better

education and longer careers may benefit future cohorts of women in developing countries when they reach old age.

Lonely older persons. Lonely people, be they male or female, often require social networks to maintain their integration with the rest of the society. Indeed, the well-being of older people is closely linked with the availability of social support, a key point that has been emphasized by many social researchers (Antonucci 1990; Argyle 1992). A clear trend surfacing in the demographic statistics of Singapore is the increase in single males and females. For the age group 40–44, the number of single male Singaporeans increased by about 5 per cent between 1990 and 2000 (from 10.4 to 15.5 per cent) while the commensurate increase for females was 3 per cent (from 11.4 to 14.1 per cent) (Department of Statistics, Singapore 2001). Although the possibility of marriage after the age of 45 cannot be excluded, the chances are usually slimmer. At the risk of sounding pessimistic, it is highly possible that loneliness could be a common experience of single men and women in old age, unless they prepare for this by servicing friendships and maintaining ties with siblings, cousins and other relatives

 

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Financing of long-term care
The financing of LTC is a complex area because it is interwoven with the total health care delivery system. Unarguably, Singapore has made considerable progress in the provision of health care and, in comparison to many other developing countries, it has a comprehensive health care system accessible to all Singaporeans (Smith 1994). In the early 1990s, a review of health care policies identified the need for cost containment of health care expenditure and the government’s role in provision of secondary and tertiary care. One of the key recommendations in the main report of the review was:

The (Singapore) Government should take the lead to implement a comprehensive programme for the care of the elderly sick. This includes the provision of more hospital beds for geriatric care, nursing homes, day care

and respite facilities, and home support services. The private sector, voluntary organizations and general practitioners should be encouraged to participate in this programme. (Ministry of Health, Singapore 1992, p. ix).

Although the health care system targets all Singaporeans regardless of age, this report emphasized the needs of elderly people.

Continuing care is seen as addressing issues from a global perspective relating to all aspects of health and social service systems continuing care is not, therefore a type of service as such, but a system of service delivery. (Hennessy 1996, p. 4).

The term “continuing care” is increasingly popular in some countries, indicating the appreciation that physical health and social health are intricately connected — which is especially true with regard to services for older persons. Indeed, Evashwick (1996) stresses that a continuum of care should be client-oriented and emphasize “wellness” rather than illness. An effective comprehensive array of elderly care services in any country would have to acknowledge the blending of heath and social services and, in Singapore as in many other countries, as noted in Chapter 1, the term “seamless” in health care delivery systems is gaining popularity with policy-makers and service providers. As a complement to acute care, the concept of step-down-care has been developed.

With the entry of the baby boomers’ cohort, the shape of the population pyramid is slowly changing into a pillar, and policy-makers have recognized the pressing need for an integrated system of long-term care. The major question is, as ever, who will pay for these services? In Singapore, government policy has been that the financial responsibility for older people lies with the individual, the family, the community and, lastly, the state (Phillips and Bartlett 1995; Smith 1994; Teo 1994). The state has also set up Medifund, a fund which provides financial assistance to patients who cannot afford their hospitalization bills, and an Elder Care Fund to finance

the operations of nursing homes run by voluntary welfare organizations (Straits Times, 24 August 2000). It can be seen, therefore, that the funding of health and social care services to date has been via a combination of sources: individuals (and indirectly, employers), the family, voluntary welfare institutions and the state. A safety net exists for those who do not have any family, in the form of Public Assistance from the government, the Medifund scheme and various charitable organizations.

 

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CONSTITUTION OF RED STAR COMMUNITY SERVICE

NAME
1.1 This Society shall be known as the “Red Star Community Service”, hereinafter referred to as the “Society”.

PLACE OF BUSINESS
2.1 Its place of business shall be at “111 North Bridge Road # 27-01, Peninsula Plaza, Singapore (179098)” or such other address as may subsequently be decided upon by the Committee and approved by the Registrar of Societies. The Society shall carry out its activities only in places and premises which have the prior written approval from the relevant authorities, where necessary.

OBJECTS

3.1 Its objects are:

a) Initiate, assist and organise activities for jobless and poor resident, elderly, ex-convict and ex-convict family.

b) Provide food and drink service for jobless and poor resident, elderly, ex-convict and ex-convict family.

c) Provide Home and Care Service for jobless and poor resident, elderly, ex-convict and ex-convict family.

d) Provide Counselling service for jobless and poor resident, elderly, ex-convict and ex-convict family.

e) Provide Legal Aids service for jobless and poor resident, elderly, ex-convict and ex-convict family.

3.2 In furtherance of the above objects, the Society may improve the poor, jobless, elderly and ex-convict mobility so that they able to return to their family and community.

 

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St Luke’s Hospital is a community hospital that provides professional healthcare services to the needy elderly regardless of race and religion. It was named after the patron saint of the medical profession, St Luke. St Luke’s Hospital for the Elderly Sick was registered as a voluntary welfare organization in the Registry of Societies in October 1991.[1] It was renamed as St Luke’s hospital in September 2004 to signify the hospital’s role as a community hospital while retaining its focus on its core expertise- geriatric care. The idea of setting up community hospital was first mooted by a group of Christian doctors and nurses after a report from the Advisory Council on the Aged in 1988 raised important issues concerning the lack of adequate elderly care facilities in Singapore. A projection of the number of facilities and resources needed to provide adequate healthcare services to Singapore’s aging population in 2030 revealed serious shortfalls.[2] In response to the problem of inadequate healthcare facilities for the elderly, a group of 8 churches and Christian organizations including the Graduate Christian Fellowship and the Singapore Nurses’ Christian Fellowship came together to set up St Luke’s Hospital for the Elderly Sick. St Luke’s Hospital is headed by a board of directors and various committees that oversee the daily operations of the hospital.

this hospital doesn't proivide FREE geriatric care. another thing, not many know about ST LUKE HOSPITAL and the kind of services it provides.

same to those organisations u mentioned, not many are even awared of their existence or how to sought help from them.

how many know there is an ORANGE GROVE VALLEY? it has a branch in JB at less than half the price it charges here.

 

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this hospital doesn't proivide FREE geriatric care. another thing, not many know about ST LUKE HOSPITAL and the kind of services it provides.

same to those organisations u mentioned, not many are even awared of their existence or how to sought help from them.

how many know there is an ORANGE GROVE VALLEY? it has a branch in JB at less than half the price it charges here.

Very sad ruling party talk big never work hard. Singaporean less interested to question the ruling party. The ruling party take thing for granted. Those who unable to pay or unable to get help end up jump and die to end their life. Very sad. Social worker also resigned. Very sad.

 

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i see another deviated minded sdppies with much hatred prejudices.:oIo:

LTS' old man is a real cheongster who pays pilgrimage to hatyai every month. his situation is a very different story that the aged play the bad guy role instead.

can u tolerate your own father who goes messing around outside? after using all the allowances given to him for "cheonging", he returns home and demand for more money? mind you, the money is to remit his "lovers". if u can tolerate that. do teach us how to achieve it.

the general discussion here is whether is it right for our gov to use money and shun the responsibility of our aged to JB or other places which are cheaper? do u think that's fair after toiling your whole life and some would have to be "exiled" and maybe died in another country other then singapore which is all along his home?

if u cannot contribute intelligent opinions, i suggest brat like u just keep quiet and listen. you could be our future robot without a heartware.

I agree with you that the lack of general wellfare, at least to a reasonable degree in the face of rising inflation is going to be something we should all look at, reflect and then do something about it! For me, i see migration as the only way out. I am halfway through it now, i am helping my parents apply too.

By the way, LTS you could be nicer to your dad, i know of someone whose dad chained him to a sink from young, broke his son's arm and denied him of education for no other reason than because he thinks his son birth date clashes with him and brought him bad luck. He beats his son till he fainted many times and one time nearly had to be brought to hospital.

This young man had to work full time in his teens from 14 to support his family as his dad gambles rather than drives his taxi. He was always looked down upon since young because of his dad. When he was 19, he got slapped by his dad and threatened by his mum for having to do NS. His dad's constant gambling, borrowing while letting his taxi idle caused his son to have to pay his debts until the age of 30 and he even went into debts just to pay off his bills.

This same son worked 2 jobs and finally succeded a little in life. He just brought his entire family to US for holiday and bought stuff for his parents including a 2nd hand BMW for his dad while he himself just drives a cheap Korean car. He also pays for all the car bills and he doesn't even get to ride in the car as the dad mainly drives the relatives and friends around.

This guy also pays his dads home, utilities and phone bills even when he himself does not has enough. He gave up his religion for the family and delayed having children for many years because of his dad's debts.
He is willing to go to hell for his family.

I am not asking you to be like this guy, your dad no matter his faults, gave birth to you. Its not easy being ones dad, people do make mistakes. Be gentle with yourself, be gentler with others.

He may just want to relax now that you are grown and he wants to enjoy himself. Be it cigarettes, petrol whatever, your dad brought you up. Even if he didn't, you are born because of your parents. That is a debt we can never hope to repay in this life.

Now that your dad is in his twilight years, he should be able to enjoy himself. Without your dad and mum, there will not be you, we as children cannot chose our parents but we can chose how we lead our lives and treat them.

Not every Singaporean is as shallow or as selfish as you may think.

The example i have given aside, being good to our parents does not involve giving a lot of money or expensive stuff, its the heart. Even when the son had no money, he gave almost all he had for food for the week to his mum, the mum cried when his suspicious dad secretly opened his wallet and found only a 2 dollar note inside.

Believe what you believe, there are children out there who still love their parents. I believe it is good to be kind to animals but be kinder and more gentle to ones parents. They will not be with us forever.