Speech by Dr Amy Khor, Senior Minister of State for Health, in response to motions on Ageing with Purpose and Support for Caregivers

Empowering our Seniors for Healthy Longevity

1.        Mr Speaker, the Ministry of Health (MOH) supports both motions. Healthy longevity presents opportunities for us to transform ageing into a positive force. We are second in the world for healthy life expectancy at birth, after Japan and ahead of South Korea ^[1] Japan has already started challenging the notion of what “old” means.

2.        The Japan Gerontological Society shared a report in 2017 which recognised how their current seniors are much fitter than past generations, and suggested redefining “old” as those “over 75”.^[2] We can redefine ageing and turn it into a positive force, if we embrace longevity and its opportunities.

3.        In 2015, we set out to do this with the Action Plan for Successful Ageing, a $3 billion plan with more than 70 initiatives across 12 areas to make Singapore a Nation for All Ages. We have made good progress on these initiatives, including on senior-friendly designs, as raised by Ms Tin Pei Ling.

4.        As we continue to make progress on these initiatives, we need to plan ahead for successive generations of seniors, who have different needs and aspirations. The Merdeka Generation seniors, for example, are living longer and healthier, and are more educated, skilled and IT savvy, compared to our Pioneers.

5.        MOH is strengthening efforts in three areas to enable Singaporeans to look forward to their senior years with confidence and grace. We call it the “3 E’s” framework – One, Empowering good health and active ageing. Two, Enabling communities of care, and three, Evolving new models of ageing in place.

Empowering good health and active ageing

6.        First, we want to empower seniors to stay healthy and active, and provide opportunities for personal development and community participation, so they can continue to find purpose and meaning in their senior years.

7.        Good health is a life asset that we must continue to invest in. We have expanded the reach of preventive health services to seniors in the community in recent years. Last year, we rolled out Project Silver Screen, in partnership with Temasek Foundation Cares, to check seniors’ vision, hearing and oral health, at low or no cost, and follow-up on abnormal results if needed. About 45,000 seniors have benefitted from this nationwide functional screening programme since January 2018.

8.        We are also leveraging our network of about 3,000 Silver Generation (SG) Ambassadors to proactively assess seniors’ health statuses when they visit them at home, and encourage them to participate in the preventive health and active ageing programmes in their neighbourhoods. Beginning with the Pioneers in 2014, our SG Ambassadors have made more than one million home visits and engaged about 450,000 seniors aged 65 years and above.

9.        As noted by Dr Lily Neo, we are also extending active ageing programmes to more communities. By 2020, two in three Residents’ Committees nationwide will host active ageing programmes. We agree with Mr Daryl David that efforts to inculcate healthy living habits among seniors should start early.

10.       One of the ways we do this is by targeting mature workers aged 40 and above through Health Promotion Board’s workplace health programmes. Over 60,000 mature workers in seven sectors including transport and security have participated in such programmes which have been customised to each sector’s workplace environment. In line with his suggestion for a multi-agency approach, we formed the HealthySG Taskforce in November last year, to coordinate an integrated approach across public agencies to encourage Singaporeans to adopt a healthy lifestyle. The taskforce, chaired by SPS Amrin Amin, is in the process of gathering feedback and ideas and we look forward to the public’s contributions.

11.       Ms Joan Pereira and Dr Lily Neo suggested building more Senior Activity Centres to promote wellness activities close to where seniors live. Besides Senior Activity Centres, we have been siting such programmes in eldercare facilities to provide a continuum of active ageing and care services to seniors in the community.

12.       One example, as shared by Ms Joan Pereira, is the “Wellness Kampung” initiative in Yishun. Piloted in 2016 as a partnership between Yishun Health, St Luke’s ElderCare and the Nee Soon grassroots organisations, the network of three wellness and care centres provide wellness activities such as healthy cooking demonstrations and recreational activities, as well as day care and rehabilitation services for frail seniors.

13.       MOH is also building larger day care centres called “Active Ageing Hubs” which offer a range of active ageing and care services, similar to the “Wellness Kampung”. We have opened five of such hubs to date and expect another five by 2020.

14.       Going forward, we will work closely with community partners to provide a good range of customised active ageing programmes to suit different profiles of seniors in their neighbourhoods. While the gender diversity debate in the corporate world has been cast as a shortage of women directors in listed and non-listed companies, it is interesting that the problem is reversed for our seniors in these programmes – men are scarce in this space!

15.       Anecdotally, our community partners share the same observation as Mr Ang Wei Neng that only about one in five or 20% of their participants are men.^[3] Even for senior learning courses, only about 30% of the participants are men. So where have all the men gone? We agree with Mr Ang that there is scope to increase male participation in our active ageing programmes and are determined to do so.

16.       The example he brought up of the Men’s Shed movement in Australia is interesting, as it recognises that men find it easier to make friends through work-based activities such as carpentry. We may not have backyards or sheds like in Australia, but we have our void decks and common spaces, where we can see our men at work! For example, in Kampung Senang, male senior volunteers under the “Silver Mobility Aiders” programme help to maintain and service wheelchairs for their fellow seniors. In Yishun, the “Repair Kakis”, a group made up of about 15 men who used to be technicians, electricians and engineers, get together weekly to help repair, assemble and fix various electrical appliances brought in by their fellow residents.

17.       I am encouraged to hear that Mr Henry Kwek is planning to bring in more communal sports for the senior men in Kebun Baru. Indeed, we need a concerted effort to find meaningful activities and innovative ways to bring the male seniors together, and create local versions of these men’s sheds! For a start, MOH welcomes suggestions from all the men in this House, on new active ageing approaches to get men not just to talk, but also to learn and play “shoulder to shoulder”!

18.       We also want to support our seniors’ aspirations to continue learning. Today, the National Silver Academy (NSA) offers over 1,000 courses for seniors to pursue their interests in a wide range of areas such as art, wellness and life skills. These courses have attracted some 26,000 participants thus far. We will continue to grow the senior learning opportunities under the NSA, including in areas such as IT and digital literacy, as suggested by Ms Joan Pereira and Ms Tin Pei Ling, and make them even more accessible by bringing more of these courses into the community. Seniors can also utilise their SkillsFuture Credits for many of the NSA courses to learn new skills that can help them find freelance work opportunities, as suggested by Mr Henry Kwek.

19.       We recognise that seniors are invaluable assets to the community, and we want to empower them to contribute their knowledge and wisdom by volunteering. One example is 68-year-old Mr Chia Shih Thow who started volunteering with Montfort Care 10 years ago after he attended their “YAH!” (“Young At Heart”) programme. Mr Chia was inspired to hear of other senior volunteers through the programme and signed up as a Health Ambassador first, before taking on other roles such as medical escort, befriender and games facilitator. He is now back at where he first discovered his passion for volunteering, inspiring others as a group facilitator in the “YAH!” programme.

20.       To help others like Mr Chia give back to the community, we have set up the Silver Volunteer Fund to provide funding to community-based organisations that create volunteering opportunities for seniors. We have other sources of funding to support good ground-up initiatives, such as the Tote Board Community Healthcare Fund and the Community Silver Trust dollar-for-dollar matching grant which was extended to active ageing programmes in 2017. We will continue to review the funding for such programmes, including the suggestion by Dr Teo Ho Pin to set up a Healthy Living Endowment fund.

Enabling communities of care

21.       Second, we want to enable strong and cohesive networks of care that support all seniors, especially vulnerable seniors, to age-in-place with dignity. SMS Tong has talked about how we can strengthen support for family caregivers. The community plays a key role in supplementing and complementing the care and support provided by families to build a robust community care ecosystem for our seniors.

22.       We envision such an ecosystem to be underpinned by four key layers of support. First, through the “preventive health home visits” which I talked about earlier. Second, by providing a systematic and comprehensive range of preventive health and active ageing programmes, such as chronic disease screening and nutrition classes in the community. Third, building up a network of befrienders in the community, and fourth, linking them up with the necessary care and support services.

23.       Mr Henry Kwek talked about the importance of local coordination. Our Community Networks for Seniors initiative, which I am pleased to report, has been expanded nationwide now to 89 neighbourhoods and areas, brings together stakeholders on the ground, including government agencies, care providers and community organisations, to close the last mile delivery of active ageing programmes and care services, and provide timely and coordinated care for our seniors when needed.

24.       We agree with Ms Cheng Li Hui that more support should be extended to vulnerable seniors who are at high risk of social isolation and loneliness. Mr Faishal Manap also raised the issue of elderly suicide. To clarify, while the number of elderly suicides has increased in recent years along with our ageing population, the suicide death rates among our elderly have in fact declined over the past decade. The suicide rate among Singapore residents, aged 60 years and above, fell from 22.4 per 100,000 residents in 2007 to 16.4 in 2017.

25.       Nonetheless, each suicide is one too many. Hence, we will further strengthen our efforts to prevent suicides by proactively reaching out to pre-empt social isolation and provide support for those at-risk. For example, our SG Ambassadors today are trained to identify seniors at risk of social isolation when they make their home visits, and proactively link them up to community befrienders in their neighbourhood who can check in on them regularly.

26.       Care Line, a 24-hour senior helpline which will be expanded nationwide, also calls seniors regularly to check whether they are well and provides urgent assistance if seniors call in, distressed. Our community outreach teams also reach out to seniors with or at-risk of dementia and depression.

27.       Ms Lee Bee Wah shared examples of how the senior residents in her constituency help other seniors. Indeed, seniors find it easier to relate to and befriend other seniors, for example, by being able to communicate in their native dialect and mother tongue. They are a valuable volunteer resource pool to tap on, as highlighted by Ms Joan Pereira. In fact, four in five community befrienders and one in four SG Ambassadors are senior volunteers.

28.       Building communities of care involves our younger generation as well, and I am heartened to hear of the intergenerational initiatives shared by Mr Mohamed Irshad. The Council for Third Age organises intergenerational learning programmes which provide opportunities for seniors and students to interact and learn from each other.

29.       More than 20,000 students have participated in such programmes to date. Under the Action Plan for Successful Ageing, we are also co-locating childcare and eldercare facilities, such as those in Mr Christopher de Souza’s ward, to facilitate intergenerational programming.

Evolving new models of ageing in place

30.       Third, we want to continue to evolve our typologies of ageing in place to meet the needs and aspirations of future generations of seniors. In recent years, the Government has announced efforts to ensure that our current and upcoming cohorts of seniors, such as the Merdeka Generation, have greater assurance for issues of concern to them, such as coping with healthcare expenses. More details on the Merdeka Generation Package will be shared at Budget. I will also share more about how we will reach out to the Merdeka Generation seniors at the Committee of Supply this year.

31.       We need to anticipate what future generations of seniors might deem important to age-in-place gracefully and confidently, and be prepared to evolve our models of care, or experiment with new ones.

32.       Mr Melvin Yong has suggested a review of the current Build-Own-Lease (BOL) funding model for nursing homes. We do regularly review our nursing home development models. Our BOL framework introduced in 2012 has allowed us to ramp up our nursing home capacity to meet the needs of our frail seniors.

33.       Under this framework, the Government pays for the capital costs of development, and tenders out the operating rights to both private and voluntary welfare organisation operators so these operators do not have to bear the upfront capital costs. This model also allowed us to encourage quality care as providers are evaluated on the quality of their proposals, which includes aspects like model of care and community integration plans. Our tenders allow providers to propose how much they intend to charge patients based on what is sustainable to them, and the price competition helps keep nursing home fees affordable for elderly residents. We also regularly review our funding for nursing homes, separately from the providers’ fee bids, to ensure providers are adequately funded for the services provided to subsidised residents. In fact, we recently reviewed and increased funding for nursing homes in 2018. We will continue to review our BOL framework to ensure that nursing home residents can access good and appropriate care at affordable fees.

34.       We continue to find innovative ways to mobilise community resources to better support our seniors, such as in the area of transport raised by Ms Cheryl Chan. The Agency for Integrated Care had worked with private-hire companies such as Grab to train their drivers to help seniors, who have limited mobility or are in wheelchairs, get into or out of the car safely to bring them for their medical appointments or to senior centres. The GrabAssist service is also available for those who wish to book a ride from the over 1,000 drivers that have been trained to date.

35.       Another area we are looking to evolve new typologies of ageing in place is in the staging of assisted living services within housing estates. In 2014, we piloted “in situ” care precincts by staging care services and assisted living support out of Senior Activity Centres within rental precincts through our Care Close to Home (C2H) programme. C2H is currently offered at 15 sites across Singapore, including in Dr Lily Neo’s ward, serving more than 3,500 clients.

36.       We are reviewing how we can develop new options of assisted living for seniors to facilitate ageing in place, as suggested also by Mr Henry Kwek, Ms Joan Pereira and Ms Rahayu Mahzam.

37.       As announced at the Committee of Supply last year, MOH is working closely with Ministry of National Development to develop new assisted living options that include care services. More details will be shared at the Committee of Supply this year.

We can shape a nation of successful agers

38.       Longevity is not a curse but a blessing and offers us possibilities to live more meaningful and productive lives. As future cohorts of seniors are more educated and skilled, there is no better time to take advantage of our longer life years than now.

39.       Mr Speaker, I am a proud member of the Merdeka Generation, and wish to end my speech by encouraging my fellow Merdeka Generation seniors to embrace our longer life years, be positive and proactive, so that we can age successfully.

40.       I personally believe that there is no better investment to make than that in good health. As the Chinese saying goes, “Health is Wealth” (健康是财富). Just as the Pioneer and Merdeka generations have each played key roles in shaping Singapore’s early years, we all have a responsibility today to shape our communities to build successful generations of successful agers.

41.       On this note, Mr Speaker, I support both motions.

[1] Source: World Health Statistics 2018 report, World Health Organization.

[2] Source: The Straits Times article on “How old is old? 75, say Japan’s medical experts” dated 21 February 2017.

[3] Source: Based on a quick survey of Senior Activity Centre providers i.e. Montfort Care, Ang Mo Kio Family Service Centre, NTUC Health, TOUCH and Thye Hua Kwan.