Social welfare: Pressure on family mounting

Over the past few years, social spending has increased significantly to help the elderly, and lower- and middle-income groups, in the face of rising income inequality and an ageing population.

Examples include the $8 billion Pioneer Generation Package and long-term investments in the pre-school sector. Overall, they make a fairly decent "social safety net" .

But that alone will not be enough, because social welfare is never just about transactions or the size of grants. It is about building resilience and self-reliance among the vulnerable so that they feel confident enough to take charge of their lives.

So while there is no change in the ministerial appointment for social and family development after the general election, its relatively new minister, Mr Tan Chuan-Jin, faces new challenges in supporting the vulnerable, because pressures on the family and individuals are mounting.

Indeed, the mantra of "family as the first line of support" is increasingly being tested.

Two groups, in particular, are feeling the stress: older people who live alone or do not have family members to care for them, and caregivers who are struggling.

The share of one-person households and those headed by a married couple who are childless or not living with their children has gone up from one in five in 2000, to one in four last year. A third of these two household types had at least one member aged 65 and above.

Given that most care for older persons happens in the context of family, this group may receive little care.

Their visits to the doctor may be subsidised or even free, but who will take them there? They may get cans of tuna or Milo given by charities to make a simple lunch, but who will eat with them or talk to them over lunch?

Issues such as social isolation and loneliness are real and here to stay.

The rest of the households may have caregivers, but they are not having an easy time. The pressure on the "sandwiched generation" - people looking after both their children and ageing parents - is great. They have to shoulder both the financial aspect of care, and the physical and psychosocial facets, too.

The latest 2010 National Health Survey that captured caregiver data for the first time showed that about 210,000 people aged 18 to 69 provided regular care to family and friends.

This number is expected to rise.

A study by Duke-NUS Graduate Medical School revealed that nearly half of 1,190 caregivers surveyed have jobs. Yet, they spend 38 hours every week on caregiving, and are more likely to experience higher caregiver stress and depression.

How can the state support them better? Would monetising family caregiving work? Countries such as Finland give a monthly informal care allowance as ageing in the community takes priority.

These are questions that could be addressed.

Besides re-examining care provision within the family as society ages, there is also a need to review the coordination of support services in the community.

On this front, former Minister for Social and Family Development Chan Chun Sing started two significant projects to ensure social services are delivered conveniently and efficiently.

The first was to launch a network of social service offices islandwide so that, together with family service centres, there will be help within 2km of where 95 per cent of needy residents live or work.

The second was to develop a national database of information on aid recipients, or the social service sector's equivalent of the National Electronic Health Records for healthcare institutions, to facilitate multi-agency collaborations and spare clients having to repeat their stories each time they go to a different agency.

Mr Tan will have to see these large-scale projects through.

Beyond that, he will also have to work more closely with the health ministry or form a joint committee to prevent overlapping of services and duplication of manpower when meeting social and medical needs.

In tackling the needs of a greying population, social and health issues are often interwined. That is why countries such as Sweden and Finland have one central ministry, the Ministry of Health and Social Affairs.

Yes, there are a plethora of social and healthcare services already existing in the community, but they are neither integrated nor robust enough to enable ageing in the community. So there is much for Mr Tan to work on.

The balancing act also has to go beyond health and social issues to the economics behind them.

No country has been able to offer free healthcare and social services without raising taxes for middle-income earners.

So the appointment of Deputy Prime Minister Tharman Shanmugaratnam as the Coordinating Minister for Economic and Social Policies is timely, and his clout in this area may heighten expectations on sustainable social development spending.

This article was first published on October 25, 2015.
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