Thursday, April 9, 2015


by Janice Tai, Straits Times, April 9, 2015

LAST month, The Straits Times reported on the growing number of infirm Singaporeans who have been admitted to nursing homes in Johor Baru.

I was one of the reporters involved. Back home, I had a hypothetical discussion with my grandma on considering that as one of her retirement options.

Across the Causeway, you can get a room in a bungalow for half the price here. The elderly person can tend to the spacious garden outside instead of being cooped up in an eight-bedded ward reeking of stale air, or worse, urine.

Grandma, usually cheerful and mild-mannered, snapped in Hokkien: "I'd rather jump from this building than go there."

Despite her visceral objection, the fact of the matter is that more people in Singapore will soon need to have this discussion on nursing home care for elderly family members.

Sending Grandma to JB is, of course, not the default option.

But the economic case is compelling. Cheaper land, construction and labour costs in Malaysia can halve the cost of nursing home care.

Singapore is also short of nursing home beds, with an average waiting time of several months to be placed in a nursing home. That's because many homes here have been full for years and beds are freed up only when occupants die. All 401 beds at Peacehaven nursing home, for instance, have been occupied for at least the last 10 years.

Aged sick: The new export

THE idea of sending the old and sick to low-cost neighbouring countries may attract unease, as in 2009 when then Health Minister Khaw Boon Wan suffered much flak for suggesting it as an option.

But, in fact, the idea has taken off in other developed countries, where there is a shortage of qualified nurses and facilities amid soaring costs and a rapidly greying population.

But is this arrangement what our elderly folk and their caregivers really want?

My colleague and I spoke to three old people in JB nursing homes who thought they were still in Singapore. Dementia patients make up about half the elderly residents in local nursing homes.

But senior social worker Jasmine Wong at Hua Mei Centre for Successful Ageing says that dementia patients benefit from being in familiar, not strange, surroundings: "Persons with dementia retain old memories while struggling with recent events - so being in a familiar place helps relieve their anxiety and familial visits play an important part in that assurance."

Some research links family involvement and visits to better life satisfaction and early discharge back into the community.

So while nursing homes in JB may make sense as cheaper options, they are at best a niche solution for some. For one thing, their cost is not subsidised. Even a bed in a shared home in JB costs $600 a month - beyond the reach of poorer families.

For the masses in Singapore, there is no running away from the challenge of having affordable, quality nursing homes, especially as the population ages rapidly.

The cost of care

MOST nursing home patients in Singapore pay about $450 to $500 a month for a place, after government subsidies. Nursing home fees in Singapore range from $1,200 to $3,500 a month. This is before government subsidies of between 10 per cent and 75 per cent.

Nursing home operators cite rising labour and land costs as one reason for fee revisions. Econ, for example, raised fees by 10 per cent three years ago. This year, fees went up another 10 per cent, or between $220 and $440 a month. In that same period, wages went up 16 per cent.

What can be done to keep fees low?

SINCE 2012, the Health Ministry (MOH) has operated a new Build-Own-Lease (BOL) model where it builds and owns nursing homes and leases them to operators who have to bid to run them.

This puts downward pressure on fees because affordability is a key evaluation criterion in awarding such leases. Appointed operators are held to their proposed fees for the duration of the bid.

The BOL model also helps to reduce the capital outlay for operators. However, it will apply only to most of the 19 homes coming up over the next five years. There are 66 nursing homes now.

Another way is to incentivise existing operators to keep fees down in exchange for grants. This has worked to slow down fee increases in the childcare sector, where "anchor operators" have to satisfy fee requirements in order to get grants.

New approaches to care

BEYOND cost, there is much that can be done to raise quality. Chief executive of Lien Foundation Lee Poh Wah considers the state of nursing homes here dismal. "I view most of them as cold, clinical factories housing warm bodies which are awakened, cleaned and fed on a regimented schedule. There is an institutionalised absence of life and joy."

Single rooms are the norm rather than the exception in countries such as Australia, Japan and Britain. It is the reverse here, he said, with most people housed in six-bed to eight-bed wards.

To bring back the "home" aspect in the nursing home, the Lien Foundation is setting up a new $15 million building for elderly dementia patients next year.

Besides having single or twin rooms with en-suite toilets, the home will feature a rooftop garden, hair salon and grocery store. Residents can engage in social and recreational activities whenever they wish instead of adhering to fixed schedules.

More operators could develop care models that create homely environments where residents can choose their own schedules, not adhere strictly to regimented ones.

The time is right for a revolution in nursing home care.

One area crying out for a change is facilities for dementia patients. One in 10 of the older adults already has the brain disorder. But many nursing homes here are not purpose-built for them and they can often be seen wandering aimlessly along the corridors.

With a spike in the number of nursing homes, there should also be a way to assess the quality of homes, and publish these ratings, as the United States does.

Already, Singapore is one of the fastest-ageing countries in the world. As of last June, there were more than 430,000 people in Singapore aged 65 and above. That is a whopping 100,000 more elderly folk than just four years earlier.

The numbers are likely to rise to nearly one million by 2030.

It is clearly not feasible to think about exporting Singapore's elderly en masse to low-cost neighbouring towns.

In the end, sending Grandma to JB is not the best solution to the issue of providing aged care.

(The full article is available only to subscribers of Straits Times. Get a copy today or subscribe.)

Wednesday, April 1, 2015


For Malaysians living in Malaysia, the Goods and Services Tax (GST) comes into effect today - 1 April 2015. This is not an April Fool joke. It's for real. Nothing can be harsher than the reality of struggling with limited financial resources to maintain the same lifestyle. It does not help that we also have a weak ringgit. A double whammy indeed for everyone, especially for retirees and pensioners. They will have to tighten their belts a notch or two.

The time is certainly right for the introduction of a senior privilege card. Senior citizens in countries like Australia and the USA have been using such cards for years. About time seniors in Malaysia had one too, and SeniorsAloud will continue to push for it.

The opportunity finally came in Oct 2014 when SeniorsAloud received an invitation to participate in the Social Impact Innovation Challenge, organized by Agensi Inovasi Malaysia (AIM), in the Prime Minister's Department.

Our team members Kamil and Lily attended a one-day workshop as part of the challenge. We were taught how to pitch ideas. We brainstormed a few potential ones and finally decided on a senior discount or privilege card as our entry in the Elderly Care category. We were told that the 12 finalists would receive RM50,000 plus RM25,000 seed money to kick-start their projects.

We worked hard and came up with a slide presentation which we had to submit to AIM through their crowd-sourcing platform Ureka. Before the deadline came up, we were informed that there was no need to submit the slides. A brief write-up about the project would suffice. To cut the story short, our entry was approved. But we never got the chance to move on to the next round where we could pitch our senior privilege card to the selection panel.

Anyway, rather than see our efforts go to waste, we are happy to share the slides here. We welcome feedback, if any.

Setting the context - why the need for a senior privilege card

We figured we would target the middle class as it was affected the most by the rising cost of living. The lower income groups were eligible for welfare packages and subsidies, but the middle class fell outside the ambit of government aid. 

Presenting our objectives. Noble indeed, but perhaps too ambitious?
Identifying the groups that would benefit from a senior discount card. We imagined the long queues waiting to apply for our card, much like lining up to get the Rabbit card for seniors to travel on public transport at 50% off the regular fare.
Some of the many benefits cardholders would enjoy.

As an added bonus for cardholders, we would include free transportation to hospitals by volunteer drivers who would regard this as contributing to the community. Seniors helping seniors.

Phase One: How it works. Such services are already in operation overseas.

Two models to choose from should the project receive the green light. You will be surprised to know how difficult it is for an elderly person to visit the hospital on her own for a check-up or for treatment.

Ok, a little self-promotion here is necessary if you want to sell an idea or business proposition. Our Unique Selling Points.

A vision chart of all the big companies that would want to be listed on our privilege card. We can dream big, can't we?
Wouldn't you want to own one, and not leave home without it?

To be sure, we already have tons of discount cards, privilege cards and membership cards. But one specially for seniors? Some companies have been issuing such cards to seniors as part of their customer service. But how useful are the cards?

I have a privilege card from a pharmacy that is valid till 2017. I hardly ever use it. Why?
  • There are simply too many terms and conditions governing the use of the card.
  • The discount is small - usually 10%. 
  • The discount is applicable for a very limited range of items. 
  • It is valid only at outlets operated by the issuing company.

In other words, there is no ONE card that offers seniors a decent discount across a broad range of goods and services.

Isn't it time we had ONE?