Lessons Learnt for Ageing in Singapore Thelma Kay ACHA , Kuching , October 2017

Demography/Ageing Landscape of Singapore Total Population : 5.78 million Total fertility rate: 1.2 Life expectancy: Males 80.6 Females 85.1 Smaller household size Increasing number of older old – frail, vulnerable Feminization of ageing >90% in high-rise housing, 82% in public housing <0.3% of 65+ in institutional care

Singapore’s Ageing Landscape Old Age Support Ratio* Elderly Persons : Persons of Working Age 2010 2020 2030 One in five residents will be over 65 in 2030 *Definition of old age support ratio should be re-examined

Principles and policies Whole of government approach (multisectoral, multiagency) Older persons as resource/asset not burden/problem Culture and tradition – filial, social piety (Pioneer Generation Package) Building blocks at different levels (many helping hands)- self, family, community, government Inclusive society – greater collective responsibility and social solidarity, co-create society

Institutional Framework Ministerial Committee on Ageing (multisectoral) Age Planning Office - under Ministry of Health Agency of Integrated Care (AIC) – coordinates and integrates long-term care ,under Ministry of Health Action Plan for Successful Ageing (2016) Healthcare 2020 Masterplan Smart Nation ( digitally enabled population) Laws: Maintenance of Parents Act Mental Capacity Act Elder/family friendly provisions in other laws eg. income tax

Economic policies Social security policies: - Central Provident Fund : Mandatory comprehensive savings schemes used essentially for retirement, healthcare , housing Employment and labour market policies: - Extend retirement age ( Reemployment Act 2012) Tax policies Immigration policies esp. for foreign domestic workers, care staff

Infrastructure polices (housing) Universal design for all government housing Falls prevention programme (screening, workshops) Home modification - Enhancements for Active Seniors (EASE), now nationwide -Subsidized elder-friendly home modifications to improve home safety e.g. anti-slip floor treatment, grab bars for falls prevention.

Health and care policies Promoting a healthy body and mind - Health screening with follow-up Health counselling Community nurses Link to neighbourhood doctors - Mental First Aid Kit – to reduce risk of mental illness - Involving young generation School health promotion programme Health promoting schools (youth ambassadors) Healthier food options in food outlets (Healthier Hawker Centre initiative) Health Promotion (exercise stations,walking trails, interest groups ) National Seniors’ Health Programme Workplace health programme

Social Policies Community based support Family friendly policies Community facilities ( community club, senior centres, etc) Activities (e.g. sports - activeSG , courses - course Xpress etc Neighbour help neighbour, befriending and monitoring network. Family friendly policies Tax relief for parental support, more for living together Priority given to multigenerational housing Family life education Maintenance of Parent Act Social assistance programmes Comcare schemes (benefits and transfers) etc…

Coordination and cooperation Coordinated at high level - Ministerial Committee on Ageing Holistic, multisectoral and integrated - economic, health, housing/infrastructure, and social services Plan, process, implement Design actual and specific services Establish quantitative outcome indicators Assign interministerial responsibilities “Many helping hands” - web of support from family, community, VWOs, private and public sector Learning from other countries e.g. intergenerational contact zones (playgrounds, childcare/eldercare centres, Project Spring-Winter)

Implementation and monitoring Ministries and agencies in their respective sectors NGOs as service providers Community-based delivery by location/shared affiliation (e.g. faith-based) Task forces to supplement or course-correct eg. task force on transport Monitoring in accordance with KPI Periodic review by Ministerial Committee on Ageing Reporting to parliament ( especially Committee on Supplies), ASEAN , United Nations and other bodies

Issues for further action Co-ordination between Health and Social Ministry (even intraministry) Insufficient involvement of Finance Ministry and Social security office Over-reliance on NGOs for delivery of services Life course approach not reflected in ageing plan (education, savings, health) New old , better educated, still healthy – higher expectations but more ready for self-care, ageing in place, technology, new economy Avoidance of hard truths – need for nursing homes, inadequate retirement income, future of work, LTC, dementia