Lessons Learnt for Ageing in Singapore Thelma Kay

Lessons Learnt for Ageing in Singapore Thelma Kay ACHA , Kuching , October 2017

Demography/Ageing Landscape of Singapore • • Total Population : 5. 78 million Total fertility rate: 1. 2 Life expectancy: Males 80. 6 Females 85. 1 Smaller household size Increasing number of older old – frail, vulnerable Feminization of ageing >90% in high-rise housing, 82% in public housing • <0. 3% of 65+ in institutional care

Singapore’s Ageing Landscape Old Age Support Ratio* Elderly Population 65+ 1, 000 900, 000 800, 000 Elderly Persons : Persons of Working Age 2010 700, 000 600, 000 500, 000 2020 400, 000 300, 000 200, 000 100, 000 2030 0 2010 2020 2030 One in five residents will be over 65 in 2030 *Definition of old age support ratio should be re-examined

Principles and policies • Whole of government approach (multisectoral, multiagency) • Older persons as resource/asset not burden/problem • Culture and tradition – filial, social piety (Pioneer Generation Package) • Building blocks at different levels (many helping hands)self, family, community, government • Inclusive society – greater collective responsibility and social solidarity, co-create society

Institutional Framework • Ministerial Committee on Ageing (multisectoral) • Age Planning Office - under Ministry of Health • Agency of Integrated Care (AIC) – coordinates and integrates long-term care , under Ministry of Health • Action Plan for Successful Ageing (2016) • Healthcare 2020 Masterplan • Smart Nation ( digitally enabled population) • Laws: Maintenance of Parents Act Mental Capacity Act • Elder/family friendly provisions in other laws eg. income tax

Economic policies • Social security policies: - Central Provident Fund : Mandatory comprehensive savings schemes used essentially for retirement, healthcare , housing • Employment and labour market policies: - Extend retirement age ( Reemployment Act 2012) • Tax policies • Immigration policies esp. foreign domestic workers, care staff

Infrastructure polices (housing) • Universal design for all government housing • Falls prevention programme (screening, workshops) • Home modification - Enhancements for Active Seniors (EASE), now nationwide -Subsidized elder-friendly home modifications to improve home safety e. g. anti-slip floor treatment, grab bars for falls prevention.

Health and care policies Promoting a healthy body and mind - Health screening with follow-up ü ü ü Health counselling Community nurses Link to neighbourhood doctors - Mental First Aid Kit – to reduce risk of mental illness - Involving young generation ü School health promotion programme ü Health promoting schools (youth ambassadors) - Healthier food options in food outlets (Healthier Hawker Centre initiative) - Health Promotion (exercise stations, walking trails, interest groups ) - National Seniors’ Health Programme - Workplace health programme

Social Policies • Community based support – Community facilities ( community club, senior centres, etc) – Activities (e. g. sports - active. SG , courses - course Xpress etc – Neighbour help neighbour, befriending and monitoring network. • Family friendly policies – – Tax relief for parental support, more for living together Priority given to multigenerational housing Family life education Maintenance of Parent Act • Social assistance programmes − Comcare schemes (benefits and transfers) etc…

Coordination and cooperation • Coordinated at high level - Ministerial Committee on Ageing • Holistic, multisectoral and integrated - economic, health, housing/infrastructure, and social services Plan, process, implement Design actual and specific services Establish quantitative outcome indicators Assign interministerial responsibilities Ø Ø • “Many helping hands” - web of support from family, community, VWOs, private and public sector • Learning from other countries e. g. intergenerational contact zones (playgrounds, childcare/eldercare centres, Project Spring-Winter)

Implementation and monitoring • Ministries and agencies in their respective sectors • NGOs as service providers • Community-based delivery by location/shared affiliation (e. g. faith-based) • Task forces to supplement or course-correct eg. task force on transport • Monitoring in accordance with KPI • Periodic review by Ministerial Committee on Ageing • Reporting to parliament ( especially Committee on Supplies), ASEAN , United Nations and other bodies

Issues for further action • Co-ordination between Health and Social Ministry (even intraministry) • Insufficient involvement of Finance Ministry and Social security office • Over-reliance on NGOs for delivery of services • Life course approach not reflected in ageing plan (education, savings, health) • New old , better educated, still healthy – higher expectations but more ready for self-care, ageing in place, technology, new economy • Avoidance of hard truths – need for nursing homes, inadequate retirement income, future of work, LTC, dementia