Next healthcare reform involves helping elderly grow old in community, not assuming all will get frail: Ong Ye Kung

SINGAPORE — The next major area of reform for the healthcare system is ensuring that the elderly can keep living full lives in the community while guarding against the assumption that they will always become sick and frail, Health Minister Ong Ye Kung said on Wednesday (Oct 5).

Rounding up a two-day debate on a White Paper on the Healthier SG initiative, Mr Ong said that Singapore needs to squarely tackle the challenge of an ageing society, which has far reaching consequences in other various aspects of our lives such as in education, manpower and infrastructure.

He noted that by 2030, about one in four Singaporeans will be aged over 65, up from one in six today.

In addressing this challenge, however, Mr Ong cautioned against falling back on specialised care such as in nursing homes as a default, and warned about how loneliness can be detrimental to the health of seniors.

SUFFERING IN OLD AGE 'NEED NOT BE A GIVEN'

Mr Ong said that among those who grow old, the “rapid escalation of disease burden and suffering (that comes with age) need not be a given”.

Society can delay health concerns such as the onset of chronic illnesses and frailty to a much later age, if active steps are taken to stay healthy, he said.

“The Government can make policy changes and reform our systems to help individuals achieve that,” he added.

Mr Ong also said that the society must be wary of the assumption that seniors will “always become sick and frail, and unable to take care of themselves”, as it would exacerbate the challenges of an ageing population. 

Such a mindset may move people to take steps out of concern for the elderly — like telling them not to cook if perhaps they left the stove on and discouraging them from stepping out of the house if they'd had a fall.

But such actions would end up depriving seniors of physical activity, a sense of agency, and dignity, Mr Ong added.

“We want to protect them, but we unintentionally expose them to an even greater risk of isolation and loneliness. That is when the spirit wears out, and the body gives way,” said Mr Ong.

If such a mindset becomes entrenched, over time seniors will become a “problem to be contained and put aside” such as in nursing homes, he said.

For an ageing society like Singapore, Mr Ong said that the aged care system is “equally critical” to two other components of the overall healthcare system, namely the public health system — which Healthier SG aims to enhance — and the acute health system.

The minister acknowledged that nursing homes serve an important purpose in the aged care system, and Singapore is ramping up the bed capacity to 31,000 beds by 2030 from 16,200 now.

However, he stressed that nursing homes “cannot be the mainstream solution” to ageing.

“In our Asian culture, we value caring for our seniors at home. Our seniors also prefer to age in a familiar environment. We should not lose this,” he said.

SUPPORT ELDERLY TO LIVE INDEPENDENTLY

Instead, Mr Ong said that Singapore must support as many seniors as possible to continue to live among the community and have a full social life with friends and family.

He referred to a piece of research that estimated that the equivalent health impact of loneliness for the elderly is akin to smoking 15 cigarettes a day.

He said that currently about 97 per cent of those above 65 can live in the community, either independently or with some help.

“We must maintain or improve that share, and not inadvertently give them that equivalent of 15 cigarettes a day, and weaken their health and ability to live independently,” he cautioned.

“For the large majority of seniors, what they need most is social care, more than just healthcare. And the way to deliver that is to enable ageing in communities.”

To enable ageing in the community, Singapore must tap a range of solutions such as building more community care apartments and releasing land for private assisted-living facilities, said Mr Ong.

Community care apartments are senior-friendly housing integrated with care services, and were launched by the Government in Bukit Batok in 2021.

The minister added that HDB estates is Singapore’s greatest asset to manage ageing, highlighting how most estates have shared spaces for interactions and activities, including Eldercare Centres.

In an earlier speech on Wednesday, Second Minister for Health Masagos Zulkifli said that the second batch of community care apartments will be launched in Queenstown in the November 2022 Build-to-Order (BTO) exercise.

He added that by 2025, the Government will double the number of Eldercare Centres, enabling eight in 10 seniors to access activities near their homes.

The Ministerial Committee on Ageing is also refreshing the Action Plan for Successful Ageing, said Mr Masagos, referring to a master plan launched in 2015 covering 70 initiatives across 12 areas.

Following engagement sessions with more than 5,000 residents, the committee is finalising its report to refresh the plans and will launch it early next year, he added.

Rounding up his speech, Mr Ong said: “Ageing in communities will be the next major area of change and reform in healthcare that we need to work on.”

Population ageing is an issue that all societies have to confront at some point, he said, adding that it is an urgent and stern test that has bankrupted some healthcare systems.

“We are determined to overcome this test. We have the resources, ability, organisation and determination to do this.”