Give eldercare the same urgency as childcare

SINGAPORE - Madam Zauyah Omar, 57, was forced to quit her job at a chicken slaughterhouse to look after her husband Mohamed Hussin Ahmad, who has terminal lung cancer.

Initially, she tried going to work by locking him in alone at home. But he fell from his bed and fractured his hip. Unable to walk, he now needs constant care.

She then tried looking for a day-care centre for him, but was told that the one near her one-room flat in Marsiling closed before she finished work.

It would also not accept him because he could not walk, she said.

"So I have no choice but to quit my job," she added.

The couple, who are childless, are surviving on state aid.

Madam Zauyah clearly needs an eldercare support service, but was unable to access it. Her loss of livelihood will impact her financial future.

Singapore's first in-depth study on caregiving commissioned by the Ministry of Social and Family Development shows that fewer than 5per cent of caregivers made use of home and community-based eldercare services. Only 1.9per cent used adult day-care centres, another 3per cent used day rehabilitation centres, while another 4.5per cent used home nursing services.

According to the study, the majority of respondents said they did not use the services because they had no need for them. This explanation may not reflect the full picture.

While researching an in-depth special report on the plight of Singapore's 210,000 caregivers looking after the sick, disabled, or frail old folk at home, many interviewees told me that low overall capacity, costs and a mismatch between what is on offer and what people want could also explain why so few people are using eldercare services.

Let's talk about capacity first. There are about 3,000 places available at about 60 eldercare centres islandwide. This seems frightfully low, given that Singapore is among the fastest ageing societies in the world. There are already close to 250,000 people here aged 70 and above, up 55 per cent from a decade ago.

By comparison, there are about 280,000 children aged seven and below, a number which has stayed stable over the past decade, given that Singaporeans are having fewer babies.

Yet, there are 104,300 childcare and infant-care places available in more than 1,070 centres in Singapore currently, up 60 per cent from 65,500 just five years ago.

New centres and funds are being announced regularly. The latest, a $40 million infusion of state funds, was made public just last week. The number of childcare places and enrolment - not just islandwide but even in individual housing estates - is being closely tracked online.

Given Singapore's rapidly greying population, there is an urgent need to set up more eldercare services and to publicly track demand and supply.

The Health Ministry could not release enrolment numbers, waiting times and vacancies for home care and nursing home services. Day-care centres, it said, are running at 84 per cent capacity islandwide, though in some locations, the wait for a place can stretch to 50 days. Another 240 day-care places will be made available over the next six months. By 2020, there will be 5,500 more.

Unlike most centres now, these "integrated" centres will provide rehabilitation, socialisation, nursing and dementia care services under one roof.

But 2020 seems very far away. Indeed, caregivers interviewed claim that the wait for some services - such as those for dementia care - can stretch to nine months or more. In the absence of adequate support services, they are finding different ways to cope.

Some caregivers I met look after loved ones during the day and work at night. Others have quit their jobs. One has hired a moonlighting maid - which is illegal. Stress levels are high.

But merely ramping up capacity will not do. Demand must match supply - and centre timings at odds with caregivers' work schedules is not the only problem.

Caregivers say that eligibility criteria are too rigid and that most centres are unable to deal with older folk with multiple illnesses.

Ms M.G. Ang, 40, for instance, wrote in to say that a dementia centre turned away her 79-year-old father because he suffered not just from dementia but also from cancer. Ms Kathy Loh, 50, was told that she could send her mother to a day-care centre only if she was accompanied by a maid.

Costs, too, are a key issue. While subsidies have increased and income ceilings have been relaxed, with the full fees of some services stretching to $76 a day, some families may still find it tough to cough up co-payment amounts.

From past interviews, I sense that there seems to be the thinking that Singapore does not need to invest heavily in community or home-based eldercare infrastructure because of the easy availability of maids.

But we need a Plan B. While about half of families taking care of elderly or disabled folk at home are currently making use of maids, the arrangement may not be suitable for all. Attrition rates of maids are high. Three caregivers I spoke to claimed that their helper had abused their loved ones in their absence. In a fourth case, a maid complained to the police after a mentally ill person she was caring for tried to kiss her.

Finally, in ramping up eldercare services, the Government cannot go it alone. Community involvement is also needed. During a trip to study eldercare options in the United States, I was struck by the number of citizen-led and funded initiatives that were thriving there.

In one project, in Princeton, younger volunteers spent time visiting frail old folk being cared for at home. During emergencies, older folk call these teams of volunteer carers, who are happy to help, as they know that once they grow old, they can benefit from the service themselves.

"In this town, we like to solve our problems ourselves," the project's founder told me. He believed, he said, in the Power of One - that individuals too can pitch in to solve national challenges.

As Singapore braces itself for the silver surge, that's a message we should all heed for sure.

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