Integrating care for seniors a priority

SINGAPORE - The fact that Singapore has one of the world's fastest ageing populations is no big secret. By 2030, elderly people in the country are expected to number 870,000.

If the total fertility rate remains low, Singaporeans aged 65 and older could constitute one in every three citizens and permanent residents by 2050. Over this period, the median age of its resident population will also have gone up from 39 years old in 2012 to 55 years old in 2050.

Seven working adults in Singapore supported one retiree over the age of 65 in 2011. By 2030, this ratio is expected to drop to just 2.3 working adults to a retiree.

This imbalance suggests that the costs of long-term care in Singapore will be increasingly funded by an ever smaller working proportion of the population.

An ageing population will inevitably need greater investment in eldercare. Yet, the capacity of Singapore society and families to provide or pay for formal care is also threatened by changing demographics.

A worrying trend of falling birth rates, rising divorce rates and more children choosing to live farther from their parents are compounding the situation. This breakdown of traditional family structures is pointing the way to a future where elderly people are becoming far less likely to receive care from their families.

Integration of care lacking

In preparing a recently launched KPMG eldercare report commissioned by the Lien Foundation, we had the opportunity to interview more than 45 eldercare practitioners from all over the world.

A recurrent theme from these discussions is that many leading eldercare practitioners believe that current long-term eldercare practices are focused on the wrong areas. Despite the best of intentions, long-term care today is often based on a health-care provider's systems and procedures.

Long-term care should be focused instead on delivering a patient-centred outcome. Along with promoting positive outcomes from medical treatment, care should be centred on addressing a patient's needs and preserving his or her dignity.

We often see a lack of coordination between medical and social care for the elderly sick. Doctors are trained to cure illnesses and heal injuries. Symptom relief is a secondary priority. Many doctors therefore end up failing to address the emotional, spiritual and psychological sufferings which accompany many treatments.

In contrast, social care professionals are often only concerned with comfort, pain relief and the ability of the patient to live with dignity.

These two components need to be better coordinated. Otherwise, the elderly patient becomes a victim.

In some cases, the patient may end up enduring aggressive, demoralising and expensive medical procedures, when he or she would have been better off convalescing at home, or in a nursing facility.

Nowhere is this more important than in end-of-life care, where a person could suffer unnecessarily and incur great expenses without advance care planning or an Advance Medical Directive.

Holistic approach needed

So far, long-term care has attracted relatively little attention and investment from governments. Yet there is an urgent need for action.

The aged care specialists interviewed for the Lien-KPMG report pointed to the need for governments to go beyond building more and bigger senior care facilities to tackle the ageing crisis.

A holistic approach towards eldercare is needed. This involves developing policies that integrate, rather than differentiate between housing, urban planning, transport, health, social care and other areas.

Australia and Japan are possible role models for a comprehensive eldercare system.

In April last year, the Australian government announced an aged care reform package with the objective of building a fairer and more sustainable aged care system.

This package provided A$3.7 billion (S$4.6 billion) over five years to encourage health-care providers to create a seamless system that would allow elderly Australians more options and easier access to a full range of services.

Greater priority will also be given to providing better access to residential care, and more assistance for those with dementia.

In Japan, the government has established a regional care system for senior citizens who need long-term care and want to remain in their homes.

As a first step towards this goal, the Japanese government created home help services and housing with care services. The importance of preventing health conditions and improving wellness is also being promoted, with the aim of controlling health-care costs.

Conversation on eldercare

In this year's Budget, the Ministry of Health (MOH) committed itself to enhancing the quality of aged care.

New measures include developing more options for home and community-based care, and providing Medisave top-ups for the elderly.

The MOH is also setting up a Geriatric Education and Research Institute modelled on similar institutions in the United States. This new institute aims to increase the proficiency of health-care workers. It also hopes to educate health-care professionals about the special needs and clinical management of elderly patients.

Hopefully, all doctors and caregivers will gain the right skills to ensure that a patient's social, emotional and psychological elements are also taken into consideration.

In the long run, I believe that care facilities will expand and overcome their current fragmented state by merging into more efficient networks.

Health-care providers will also improve how they deliver services and ensure that these are effectively supported. Matters such as end-of-life care, providing conditions for a "good death" acknowledging the wishes of a patient will become increasingly significant issues.

At the same time, policies will need to be developed to encourage quality long-term care programmes which challenge existing perceptions of old age.

Platforms such as the ongoing series of Our Singapore Conversations represent ideal opportunities for citizens to come together and engage in deeper conversations around issues such as what constitutes "good ageing", who should pay for long-term care and which new eldercare models should be supported.

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