Mr Chua Chin Kiat,
Chairman of Centre for Enabled Living (CEL)
Mr Henry Quake,
Chief Executive of CEL
Ladies and Gentlemen
Thank you for organising this conference, which is the third in the series. Such conferences are always important occasions for all of us to come together to share, to learn, and to promote understanding in the important work that many of you do.
What is the big issue facing Singapore? Mr Chua Chin Kiat has touched on this earlier. I will also share with you some of the stories that I have come across over the last few months as I go around visiting my residents in Buona Vista and Commonwealth. Some of the residents have stayed in their current flats for over 40 years. Many of them have stayed there since it was built. They were the second batch of Housing and Development Board (HDB) flats that was built. Many of the elderly are in their 70s or 80s.
In the past, the young will take care of the old. Generally, we would think of the 30-year olds taking care of the 60s. However, people are living longer now. You meet many people who are in their 80s, and their children are perhaps in the late-50s or 60s. We see more old taking care of the very old. In these circumstances, you have the 60s having to take care of their parents, in their 80s and sometimes in their 90s. This challenge is very different from having a 30-year old taking care of a 60-year old. This is one type of story you will typically find.
A second archetype of elderly folks is those who are quite successful in their lives, and brought up children who are also successful. However, their children may not necessarily live with them. Some could be working overseas. The elderly are staying alone.
The third type of people that I meet in my constituency is those who are not old, usually in their 40s. Many of them are females and are single. They are happy with their lifestyle now. The only issue and what worries me is that in 20 or 30 years’ time, what will happen to them? If you look at it today, perhaps up to 30% of the cohort will not get married in their lifetime. This will be the future group of the elderly single.
These are the real archetypes of what is happening in Singapore. Because of that, we have to review the way we provide care for the elderly and those who need help. We always maintain that the family is the first line of support. We still want the family to be the first line of support. However, if you examine the three archetypes, the first archetype demonstrates that even though the family may be around, the family is quite different as the person providing the support is an elderly themselves. For the second archetype, the family is still the main support, but the family has either become smaller, or in the globalised economy, not staying with them anymore. They provide emotional support via the webcam, internet, or sometimes they may not be there physically. They may be able to afford some care helper, but they might not be there emotionally. For the third archetype, the family for the single is an extended family not in the usual nuclear family of the husband, wife and children. We have to evolve our thinking on the way to adapt our model of service delivery in such a context. People live longer, people have smaller families, and some people may not have children at all. These are our challenges.
In our mental model of care, we usually talk about three types of care. There is home-based care, community care and institutional care. For all three types of care, we will have to evolve.
Let’s start with home care. Home care is resource intensive – you need a one-to-one ratio. The first challenge requires us to tackle our manpower constraints. Even if we employ foreign caregivers, there will be social and cultural issues to overcome.
We have started caregiver training since June 2009. We are happy to know that about 6,400 informal caregivers have undergone training. This is a very small number. Even if we have 100,000 caregivers today, this is not sufficient. We need to do much more. Once a caregiver is into the job of providing care, it is fairly difficult or almost impossible for the caregiver to attend training. What can we do more and do better? There are a couple of ideas we can explore.
First, prevention is better than cure. We should not just reach out to those who are already in need. It is important and incumbent on all of us, that even before our parents get very old and immobile, to at least understand some basic forms of caregiving. It could be the tangible things that you do, such as lifting a person without hurting our backs, or providing the emotional support required. I encourage everybody that before we come to the situation where we need to provide intensive care to someone, it is good for us to start finding out the training available, and to undertake some of these training because one day, we will need it. It could be for ourselves, our families, maybe our friends and their families. The network must be there.
The second thing we can do better for home care is looking into the short attention span of the youngsters today. The question is how to package bite-sized information to reach out to more people. It would be useful if we have nice little YouTube videos lasting not more than a minute to show some basic techniques of how to care and support. People can click on their iPhone or iPad as they travel. 6,400 informal caregivers being trained up to the black belt level is a good start, but it is not enough. We also need many green and yellow belts. We need bite-sized modular training packages to allow people to take it in small chunks, preferably even before they need the help in their family. We hope to encourage more to come forward for training and explore ways to use the media and internet so that we can reach out to more people. By the time we get into the caregiving situation, it is too late to look at those videos and understand those issues. We want to encourage more people who are not in the situation, to come forth, learn something and pick up an important skill. One day, it will come in useful.
The second topic is community care. Based on the archetypes which I have shared, we need to evolve our model of community care. We have a positive example in our pilots – the Seniors Service Centre situated at the Golden Jasmine Studio Apartments in Bishan. It is run by ECON Health and Wellness Centre. This is a very good example as it shows the upstream integration we have done to prevent the downstream issues. This is where we work with the Ministry of National Development (MND) and HDB to build flats in the precinct, whereby all the elderly needs can be catered for. It could be the design of the flats, to the types of social services that are available at the void deck. This is a self-contained community, for elderly to provide emotional support to one another. At the same time, you have a community with access to the services they may need.
We are very happy that the model has worked and I am pleased to announce that we will roll out three more of such projects very soon at the following places; at Kang Ching Road, Strathmore Avenue and Ang Mo Kio Avenue 1. Even with these new centres, it will only be 1 + 3. In time to come, the government will take the lead to work with the service providers, HDB and Urban Redevelopment Authority (URA) to plan for all these precincts so that our elderly can age-in-place and with dignity. We would also like to encourage service providers to come forth. Elderly industry is the sunrise industry, with tremendous opportunities. Many of them are increasingly educated and they have the means to afford the service that they will require at their old age.
We are also happy that there are three Day Care Centres that have partnered the Institute of Mental Health and Changi General Hospital to pilot dementia-friendly measures. They have been such a success, and we are happy to announce that henceforth, all the MCYS-funded Day Care Centres will be dementia-friendly. To date, we have about 20,000 elderly suffering from dementia. In time to come, the numbers will continue to grow, as people are livinglonger, and the chances of having dementia will increase. This is why we want to make sure all our Day Care Centres are dementia-ready. All the features and good lessons we have learnt in the three centres will be rolled out progressively to all the centres.
Next, we need to look at new models of institutional care. We have seen many interesting examples from other countries where either the community evolve organically for elderly to age-in-place, or have purpose-built institutions to take care of the elderly. Some of our mindset will need to change. Some of the younger, more educated, more affluent people, and some of them might be single, may already be looking forward to such services. In time to come, some of them may want to move into a community where they can provide mutual support. We know that in the Asian context and culturally, we frown upon moving into institutional care. We think that it is against our values of filial piety to put your parents in the institutional home. However, in time to come, there might be a group of people without the necessary family support and their extended family will have to be redefined not by their children, but by their friends and the new networks they build up. They can enjoy their later years with dignity and pride when they learn to take care of themselves, and help one another in the community.
Indeed, old people can give help as well. One of the most successful projects that I have seen is the Lions Befrienders. In the past, the mental model for a befriender is for the young to help the old. After a while they say, why can’t the old people help old people and old people befriend old people? If we can do that, you give the elderly a sense of purpose and mission which improve their well-being over and beyond what we can do for them. Old people are very energetic and very passionate. They can start interest groups on their own and I have seen this at the Bukit Merah Community Club and the Wellness Programme. They are people with experience, people with passion and people who want to do many things for themselves. That is the real meaning of enabled living. Not for people to help them, but for them to take care of some of the things which they can do.
Now I will move on to the disability community. I am happy and glad that Chin Kiat has been heading the Public-Private-People group in drawing up the new Enabling Masterplan.
The disabled is always and will always be part of our society. When we say that we want to take care of the weakest and most vulnerable groups in society, they form part of this group. It is important for us to reach out to do what we can for them – not just to help them but also to enable them to help themselves, which is more powerful.
Subtitling for the Hearing Impaired Community
The hearing impaired community has been asking us to provide some subtitling or captioning for key national programmes of significance on our national television. On this note, I am happy to announce that MCYS, the Ministry of Information, Communications and the Arts (MICA) and the Media Development Authority (MDA) have agreed that we would work towards this. In time to come, we will see key national programmes, whether it is National Day Rally or critical security announcements, having subtitles on national television so that the hearing impaired can also participate in the programmes and get the information they need.
We will be announcing more of these details in time to come but rest assured that MCYS, MICA and MDA will do what we can to work with partners to find the resources to reach out to this group of people. Although they can access the Internet, we want them to be part of the wider society when it comes to critical announcements. Many people talk about having an inclusive society. We want to work towards being an inclusive society.
Another issue that is close to heart recently is that of the London Cabs. The first thing I will say is “Don’t worry, we will find a solution.” The issue is how best to provide transport for the people who need it and, at the same time, to give them a sense of independence.
If it is a pure economics argument, we would not have spent all the money to retro-fit our MRT stations and buy a fleet of buses that can enable wheelchair-bound people to use it. If you look at it from an economics standpoint only, the cheapest solution will be to have a dedicated fleet of vans and taxis to shuttle them around. I was told 50% of our buses are now able to take in wheelchairs.
But we have gone beyond economics. We want to see them to be part of the larger community, to participate in life together with the rest of the community. We are committed to do what we can within the bounds of what we can afford to integrate them into our society.
MCYS has spoken to the Ministry of Transport (MOT), Land Transport Authority (LTA) and various other agencies. We will be working towards a one year extension for London Cabs. In the meantime, Chin Kiat has to work very hard as part of the Enabling Masterplan to develop a holistic solution for the longer term. We know the constraints of the private operators. We also know the needs of the wheelchair-bound community, and more of them will increasingly require customised wheelchairs (e.g. high-back and powered wheelchairs) which will take up more space and require more effort to be transported around. But I think as a society, between the government, the private sector and kind-hearted individuals, we will find a solution. We will get there and resolve this issue together.
When we resolve this issue, it will be a testimony to the power of the Public-Private-People partnership. It is not just the solutions that we are interested in. It is also the process at which we arrive at these solutions. We want input from all the stakeholders. We want to develop a suite of solutions that can meet different needs. That is what we have committed to do.
There will be a chance for everybody to play a part. For Voluntary Welfare Organisations (VWOs) that are interested to work on this issue, it is a sunrise industry. You may want to give us your ideas on how to provide an affordable fleet for this group of fellow Singaporeans. For the public transport corporations, this is also a chance to exercise some corporate social responsibility. The government will work with all to provide a solution.
Today, I have touched on a few issues on caring for seniors and our disabled fellow Singaporeans. I would like to conclude by saying this - the government is always committed to caring for all Singaporeans from all walks of life. It is our duty. We come forward, whether it is parliamentarians, ministers, civil servants, to serve the country and Singaporeans. We will do our utmost to make sure we develop solutions for Singaporeans. We will do what we can to make sure that we retain the fundamentals of planning forward – looking long term, maintaining financial discipline and yet, at the same time, touching the lives of all those who need us.
Our job is not to design a system whereby we pick out a few champions to showcase the sector. There will always be people who have the extraordinary willpower to succeed. My job is to make sure that we design assistance where the Average Joe can succeed. The average families who may not have as strong a willpower as those on the higher end, they too will get a chance to succeed.
I hope that you will come and join us in this journey together, where the public, private and people sectors will come together. Thank you very much.