Successful Ageing – A Review of Singapore’s Policy Approaches

ETHOS Issue 01, Oct 2006

Given its multifaceted nature, Singapore has tackled the issue of ageing with an inter-agency approach, taking into account public inputs when deliberating policy.

1980s – ANTICIPATING NEEDS

In the 80s, Singapore began to recognise that its population was ageing rapidly. A “Committee on the Problems of the Aged” (1982–1984), chaired by the Minister for Health, was formed to study the implications of an ageing population and recommend solutions to its challenges.

One of its main recommendations was to improve society’s attitudes towards ageing and the aged. The Committee foresaw that the rapidly ageing population would require a national policy aimed at keeping every senior physically and mentally fit to continue to lead a normal, useful and active life.

Addressing the contributions of seniors in the workforce, the Committee called for the customary retirement age to be raised from Addressing the contributions of seniors in the workforce, the Committee called for the customary retirement age to be raised from 55 to 60 (later to 65), and to raise the age for the withdrawal of retirement funds in stages. It also listed alternative employment options such as part-time work, flexi-time and work at home as a means of creating more job opportunities for seniors.¹

Acknowledging that the best guarantee of care for seniors comes from the family, the 1982–1984 committee report also placed special emphasis on the need to foster filial piety among the young.²

1990 TO DATE – A COORDINATED NATIONAL RESPONSE

In the late 90s, an Inter-Ministerial Committee on the Ageing Population (IMC) established a coordinated national response to the challenges of an ageing society. It sought to realise a vision of “Successful Ageing in Singapore”, with a high degree of preparedness for its challenges and opportunities:

We want Singaporeans to age with dignity and to remain involved in society… we must maintain a strong sense of cohesion between the generations. Singapore should be the best home for all ages.³

Building on the 1982–1984 report, the IMC made a total of 78 recommendations in six key areas, viz. Social Integration of the Elderly, Healthcare, Financial Security, Employment and Employability, Housing and Land Use Policies, and Cohesion and Conflict in an Ageing Society.

UNDERLYING PHILOSOPHY: “MANY HELPING HANDS”

Singapore’s policies towards seniors have been guided by a principle of personal responsibility in securing well-being in one’s old age, with the family as the key pillar of support. Indeed, the 1982 Committee considered institutional care as a last resort and most “extreme measure”.

While the emphasis on the family as primary care-giver has continued, the nature and expectations of “filial piety” have evolved in the past 10 years and can be seen in the approach established by the 1999 IMC which involves “Many Helping Hands”. The community, family and seniors must work in partnership to ensure the well-being of the aged:

Every individual has a personal responsibility to plan and prepare for his or her old age. The role of the family and the community is to provide the first and second line of support for those who need care and support; and the role of the State is to set out the policy framework, and provide the infrastructure and resources necessary for the other sectors to play their part.⁴

With the 2004–2006 Committee on Ageing Issues (CAI), a new and urgent emphasis was placed on maintaining a high quality of life for a new cohort of seniors – the baby boomers, who will reach 65 years of age by 2010. This cohort would be healthier due to rapid advances in medical science, and much more educated and economically well off than those of the 1970s and 1980s. The baby boomer generation of seniors will have highly varied needs and aspirations to be catered to, within the window of only a few years.

HOLISTIC AND AFFORDABLE HEALTHCARE AND ELDERCARE

Singapore’s healthcare policy emphasises health promotion and disease prevention, promotes personal responsibility, and encourages seniors to remain healthy and active in the community for as long as possible. The Government has aggressively promoted healthy lifestyles and regular health screenings for early detection of illnesses to lessen the risk of major illnesses. It has also developed a strong network of community-based, step-down care services to support the family in its care-giving role. The implementation of an Eldercare Masterplan⁵ has resulted in more service providers offering a variety of residential, centre-based and home-based care services for seniors.

Healthcare in Singapore is based on access to good, affordable and appropriate healthcare for all Singaporeans, through a combination of market forces and Government intervention and infrastructure. Complementing these measures is the national healthcare financing framework, which is based again on individual responsibility, supported by Government subsidies. The Medisave national medical savings scheme, introduced in April 1984, helps individuals to put aside part of their income in personal accounts to meet future medical needs for themselves or their immediate family. MediShield, introduced in 1990, is a co-paid, low-cost insurance scheme, which helps meet medical expenses from major or prolonged illnesses that Medisave balances would not be sufficient to cover. MediFund⁶ is an endowment fund set up by the Government in April 1993 to help needy Singaporeans who are unable to pay for their medical expenses.

As part of this national framework, healthcare affordability for seniors is ensured through significant government subsidies in “Class B2” and “Class C” restructured hospital wards. ElderShield was introduced in 2002; it is an insurance scheme established to cover severe disabilities, especially at old age.

Healthcare and Eldercare policies also address the basic needs of the less privileged. In 2001, an Eldercare Fund was established to subsidise step-down healthcare services to the needy. Less well-off Singaporeans have their Medisave accounts topped up when the national budget permits. Through a public assistance scheme, destitute persons also receive a monthly allowance and free medical services during occasions of illness.

FINANCIAL SECURITY: LIFELONG FINANCIAL PLANNING

Under Singapore’s Central Provident Fund (CPF) system, individuals are responsible for planning and saving for their financial security in old age. Surveys have shown that many Singaporeans rely mainly on family support and were not prepared adequately for their financial needs in old age.

In recognition that family support may not be sustainable given the trend of smaller families and longer life expectancy, a “basic needs CPF model” was adopted after 1999 to cater to basic living expenses, medical and housing needs in old age. Individuals would have to make independent provisions for their desired retirement lifestyles beyond this basic level.

In recent years, the Government has taken steps to refocus the CPF system on its primary objectives of providing for retirement, housing and medical needs. Policy recommendations have been made to ensure more funds for retirement (e.g. increasing Special Account contribution rates when the CPF contribution rate was restored to 40%) and to enhance returns on CPF balances. A comprehensive public education programme on planning for financial security was also initiated. As a result, public awareness on the importance of preparing for retirement early has increased in the past five years.

Nevertheless, the financial security of seniors in the near future remains a challenge. One concern is that a significant number of seniors are “asset-rich, cash-poor”. Under consideration are initiatives that would allow seniors to monetise their assets, such as reverse mortgage schemes, or helping seniors to downgrade to smaller flats or sublet their flats.

EMPLOYMENT AND EMPLOYABILITY

Having older persons employed for as long as possible keeps them healthier mentally and physically. It also integrates them more effectively in society, and enhances their financial security. Singapore will also need to tap on older workers to meet manpower needs as the workforce ages. To this end, the Tripartite Committee on Employability of Older Workers (2005) has recommended a four-pronged approach: expand employment opportunities for older workers, enhance the cost competitiveness of older workers, raise their skills and value, and shape positive perceptions towards older workers.

Mindsets are already changing. A recent study commissioned by the Hong Kong Shanghai Banking Corporation (HSBC) found that Singaporeans, unlike their counterparts in other countries, wish to continue working for as long as possible to remain financially independent. Employers in Singapore, more than anywhere in the world, actively encourage their older employees to continue working; very few companies here encourage full early retirement. More than half of Singaporean companies surveyed agreed that retirement of older workers means the loss of valuable skills and knowledge.⁷ This is highly encouraging for the future.

ELDER-FRIENDLY HOUSING,TRANSPORT AND LAND USE

An elder-friendly built environment is a key determinant of the extent to which seniors have access to service and are integrated into the community. For instance, accessible infrastructure helps seniors maintain social networks and participate in social and economic activities. The key principle adopted in housing and land use policies for seniors is “ageing-in-place” – allowing seniors to grow old in the home, community and environment that they are familiar with, with minimal change or disruption to their lives and activities. Land use policies aim to provide a comprehensive range of housing options, complemented with good support care services, and a more elder-friendly public transport system over the long term, to cater to the diverse needs and higher expectations of a growing senior cohort.

In 1990, a “Code on Barrier-Free Accessibility in Buildings” was enacted to ensure that new buildings conform to a set of standards on barrier-free provisions. Housing Development Board (HDB) studio apartments equipped with elder-friendly fittings and features were also introduced in 1998 as a customised housing option for the elderly. In 2001, the Lift Upgrading Programme was introduced to allow lifts to be provided at every level of high-rise HDB blocks where feasible.

Since 2000, the Land Transport Authority (LTA) has been retrofitting existing Mass Rapid Transit (MRT) subway stations to ensure elder accessibility. In addition, low-floor, step-free and wheelchair-accessible buses have been introduced. These features will eventually be available on all public buses.

ACTIVE AGEING AND SOCIAL INTEGRATION

Public education efforts have attempted to reshape values, attitudes and perceptions towards ageing and seniors. The intent is to foster a society where older persons are valued as contributing members and remain actively engaged in their families, communities and society.

In 1999, the Ministry of Community, Youth and Sports (MCYS) introduced year-round public education programmes on active ageing, highlighting the need to plan early for old age and maintain an active, engaged senior lifestyle. These messages are complemented by other programmes from various agencies and voluntary organisations.

The importance of seniors maintaining active lifestyles continues to be emphasised, with efforts to encourage healthy living, active lifestyles, social networks, lifelong learning and strong family ties. In 2005, the Government committed $20 million to the Golden Opportunities! (GO!) Fund, which provides seed funding for programmes and activities promoting different aspects of active ageing.

One key thrust of Singapore’s ageing policies has been the social integration of seniors and inter-generational cohesion. Strong families continue to be seen as the first line of support for seniors. While children have the responsibility to take care of their elderly parents, seniors can also contribute, for example as active grandparents.

Recognising the need for work-life balance in support of stronger family ties, the Government has introduced pro-family practices in the workplace.⁸ Some policies also actively encourage inter-generational bonding within families. These include the CPF Family Housing Grant, priority for parents and married children buying new HDB flats to live with or near each other, tax incentives for children looking after aged parents and CPF top-ups among family members.

COHESION AND CONFLICT IN AN AGEING SOCIETY: THE IMPORTANCE OF INTER-GENERATIONAL BONDING

In an ageing society, conflict could arise between the young and the old. With the increasing number of nuclear families, grandparents have fewer opportunities to interact with their married children and grandchildren. Communication between the two generations can be impeded by language barriers, since many elderly speak only dialects while the young are more comfortable speaking English. People will have to turn increasingly to friends and community in their older years.

Inter-generational cohesion is therefore important in ensuring that both the young and old do not see each other as competitors for limited resources. The IMC had proposed a review of policies that cater to two-generation families and to extend them to three-generation families. Since 1999, more emphasis has been placed on inter-generational bonding, for example, by encouraging seniors to take on a more active role in the family as grandparents and caregivers. In July 2002, the Family Matters!Singapore Taskforce on Grandparenting and Inter-generational Bonding was set up to promote activities or events that foster interaction and bonding between people of different generations, providing opportunities for older and younger generations to interact and engage in meaningful exchanges and learn from each other.⁹

CONCLUSION

Singapore has had a head start in meeting the challenges of an ageing population. While much has been achieved over the last five years since the publication of the 1999 IMC report, more remains to be done before the baby boom generation reaches 65. To be effective, the Government must take an integrated approach and encourage greater co-ordination and collaboration between agencies. Equally important is the need for the community to respond with the same level of commitment and to take ownership of the issue of ageing. A positive and mature attitude towards seniors and ageing, at all levels of society, will be necessary for ageing policies to be truly successful.

NOTES

1. Report on the Committee on the Problems of the Aged, (Ministry of Health, February 1984),
   pp24-26.
2. ibid, p41.
3. Prime Minister Goh Chok Tong in a letter to Minister Mah Bow Tan, Chairman of the 1999 IMC (9 November 1999).
4. Taken from the IMC report (1999).
5. The Eldercare Masterplan (2001-2005), spearheaded by the Ministry for Community, Youth and Sports, was a result of a broad-based review of elder care programmes and services conducted between June 1999 and July 2000.
6. Future of Retirement: Insights for Singapore (London, UK: HSBC, 2006). The report was authored by the Oxford Institute of Ageing under the directorship of Dr Sarah Harper.
7. In the workplace, pro-family practices such as flexi-work arrangements, extended maternity leave and childcare leave have been introduced. The civil service is now on a five-day work week.
8. Since July 2002, the Family Matters! Singapore Taskforce on Grandparenting and Inter-generational Bonding has received more than 100 project applications from 65 organisations and disbursed more than $500,000 in funding.