SINGAPORE — Three years ago, Madam Beatrice Lopez hired a domestic helper after living alone in a condominium unit in Upper Bukit Timah for 13 years.
Her children live abroad, and with her hearing problems and deteriorating eyesight, she then became worried that her helper may not know what to do should something happen to her.
The 86-year-old was reluctant to check into a nursing home, but decided instead to move into something she considered to be a better alternative: An assisted-living facility.
Madam Lopez will move next March to the St Bernadette Lifestyle Village, a small bungalow off Bukit Timah Road where seniors may gather nightly in the living room to play mahjong, and are free to go out for meals at Serangoon Gardens, for example, or take supervised day-trips to Malaysia.
They get around-the-clock medical concierge services when needed, and professional medical and nursing care from the adjacent Good Shepherd Loft, a small private nursing home.
Ultimately, the place offers Madam Lopez the privacy and independence she fiercely values. “When you’re fit, you don’t want to go to a nursing home, where you’re just left there, (stuck) in a routine from day to night,” she said.
“At least here, your friends are fit to come and go, you’re free to do your shopping and all the little things you want to do ... It’s supervised independence.”
Madam Lopez’s story exemplifies Singaporeans’ growing dissatisfaction with conventional nursing homes, where controlled, efficient routines often come at the expense of privacy and freedom.
They are more willing to seek alternative care options, as shown in a recent survey by philanthropic organisation Lien Foundation and insurer NTUC Income.
The survey found that nearly 50 per cent of the 1,000 respondents were willing to live in assisted-living facilities, and would fork out S$1,386 to S$1,745 a month for the arrangement.
In an earlier report released this month, Lien Foundation, together with Khoo Chwee Neo Foundation, called for more support to build such facilities in Singapore.
While this issue has been raised over the past few years, such assisted-living facilities are still few and far between in Singapore, due to strict regulations and limited funding, not to mention the concerns over affordability.
Senior international business adviser Tan Kee Hian, 62, who has done in-depth research on alternative senior-living choices, told TODAY that the sheer lack of “in between” options means that a large group of relatively healthy seniors are being “forced into” nursing homes because there is nowhere else to go.
Nursing homes, which offer more intensive medical care, are more suitable for those who are largely dependent and with poor health conditions, he added.
There is also little headway in the development of better facilities due to the perceived cost issues, Mr Tan said, though he challenged views that single- or double-bedded rooms would be too expensive to build and that charges would be high.
He argued that the economies of scale saved from clustering residents in a retirement village would make more financial sense.
“The amount you pay is just one part of the equation. But (taken as a whole), you can save a lot of money as you’re giving up underutilised assets (your own property),” he reasoned.
“You save on travelling costs, as all the facilities are on-site, your friends are (there), and the doctor can visit ... (You) have a better quality of life, so it’s a real win-win.”
Tight regulations now have an impact on small players such as Good Shepherd Loft, also run by Dr Belinda Wee. Last November, it was fined S$12,000 by the Ministry of Health (MOH) for violating health and safety regulations, the Lien Foundation report stated.
This was because it updated patient notes only once instead of thrice a day, and it did not have a registered nurse on duty to supervise its nursing aides, among others.
The home said that the breaches were administrative and that the authorities did not find any lack of care.
Its co-founder, Dr Belinda Wee, said: “It’s important to ask the seniors if they’re happy about such a situation (where safety is the topmost priority) or if they’d rather take a little bit of risk and have a good quality of life.”
Last week, MOH said it would be reviewing the Private Hospitals and Medical Clinics Act, to look into tiering the regulatory requirements of healthcare institutions based on the nature and type of service.
Several groups approached by TODAY said they have plans to develop more varied senior-care facilities but were not ready to share details.
However, Associate Professor Fung John Chye from the National University of Singapore’s architecture department — who has worked with students to rethink nursing home design — said it is not simply a case of building newer types of facilities to offer a diverse range of intermediate and long-term care options.
There are many “complex, interrelated issues” involved in deciding if such options are appropriate.
“We would need a national conversation on this topic to seek the broadest opinions and preferences of Singaporeans. This discussion has to transcend academic research because it’s a national issue,” he said.
Funding models, manpower needs, proper care transitions and living arrangements for aged couples all need to be considered.
Dr Wee, who had difficulties having an open discussion with the authorities, said: “Our agencies are still focused on rules and regulations, and afraid to take a misstep.
“With the support of ministries, I think (these changes) can happen much faster in a better way ... But if we bury our heads in the sand, if we say this won’t work for us, then we’ll never move forward.”
CORRECTION: In an earlier version of this report, we stated that St Bernadette Lifestyle Village was fined by the Ministry of Health last year. This is incorrect. It was Good Shepherd Loft. We apologise for the error.