Your Expensive Golden Years Bill

Which is more expensive? 

(1) The senior person's stroke/cancer/heart bypass treatment in the hospital, OR
(2) Taking care of the elderly after the hospital treatment

Insurance only covers (1), and not (2). Go figure.

How much does it cost to take care of an elderly who requires constant medical and sustenance attention? 

This means the elderly is unable to take baths on his own, needs to be fed, receive medical attention regularly etc.

After looking at some figures, I figured that it would cost S$4,000 to $5,000 per month. This includes a bed in an open ward, food, and medical care. No frills. So, if you have 1 elderly in this condition for 1 year, it would cost the family S$60,000 per year. By the 5th year, it would have been as much as the price of a HDB flat, i.e. S$300,000.

What is the median household income in Singapore now? 

S$4,850

It's quite clear that the average Singaporean family cannot support an elderly who requires such care on its own, without significantly compromising the quality of life for the other family members.

So, what do average Singaporean families do when such a situation happens? 

First and foremost, they would try to 'cope' with it. That usually means keeping the elderly at home, and having someone in the family to help to take care of him full-time or part-time. These individuals are known as 'care-givers'. As the senior's health deteriorates, he is shuttled to and fro the hospital and home.

Then when it's clear that the family is unable to cope without jeopardising the fragile condition of the elderly, he is checked into a hospice or nursing home. Meanwhile, there is a huge build-up of guilt, anguish and fatigue.

These families do not always pay the full amount of S$5,000 per month for the hospice stay. It depends on their income brackets. 

If the family is not paying in full, who is picking up the bill now? 

The donations secured by these hospices and/or their parent charity organisations. The government subsidises part of the bill. The families may end up paying a few hundred to a couple of thousand of dollars per month.

As long as donors and government are picking up the tab, we should be ok, right?

But this is not a sustainable solution, because:

• The number of elders requiring such a care level is increasing.
• There are limited number of beds which these hospices and charity organisations can supply. In other words, there aren't enough of such service providers around.
• There are also clear shortages of healthcare workers, especially those interested in taking care of the elderly. These include doctors, nurses, therapists, counsellors, social workers etc. 
• And in such a situation of limited supply, the cost of elderly care will become even higher. 

How do families in other developed countries cope with this?

In the US, the elderly care industry is highly developed.

As an elderly, you can choose to stay at home (with or without your family) and opt for a package where someone would come to your home to take care of you. This could cost you a few thousand US dollars a month.

Or you could choose to move into a community home, where you will have your own room or apartment, and can opt for medical care, food, laundry etc. So, you can sell your house and move into one of these communities, paying US$5k to US$10k per month (depending on frills or no frills). Till you finish the journey.

Why isn't the average Singaporean elderly doing the same?

1. There are little or no such services available in Singapore. Remember Minister Khaw once suggested for our elders to retire in JB to many's displeasure? He wasn't saying it for fun, or to murder his political career. He and his officers in Ministry of Health and probably MCYS know how big the elder care bill is. But whoever wrote his speech was really unskilled in getting such a sensitive message across.
2. He can't afford it. Even if there were such services available in Singapore, the average Singaporean senior's wealth is locked up in the HDB flat, which may still house his children and grandchildren. The flat cannot be sold in exchange for elderly care services. 
3. He doesn't want to do it. Even if the services were available and that he could afford it, the Singaporean elderly wants to stay on his own or with his family. He does not want to move into a home. He feels that there is a stigma.

Please! If this was really such a huge problem, it would have already been taken care of. So, this can't be such a huge problem, right?

Wrong. This is a fucking stressful issue for all involved, i.e. from the elderly person, to his family, to the maid hired to act as his personal nurse, to the current hospice providers/staff etc. Most people don't talk about it, because it's sensitive. E.g. You don't wanna complain/talk to a friend about the difficulties you are facing as a care-giver for your mother because you don't wanna come across as unfilial.

And this is a problem which is right at our doorstep. It's not like it'll only be due in a few decades like how Saving Our Earth has been pitched to us since we were kids. No. This issue is right before our noses, staring at us.

If you really need to know the total figure, the total bill (taking into account the CURRENT number of seniors = 350,900, assume 5% (stroke/cancer/accidents) + 5% (dementia) will require such care for the last 5 years of their lives) comes up to be more than S$10.5BILLION. That's like 6% of our current GDP.

In 20 years, the seniors population will be at 900,000 or 1 out of 5. Imagine the elder care bill then, and who would be bearing the load of this bill.

And this is a lowest cost + conservative estimate with limited overview of population, aging/morbidity trends etc. Only the government has a good overview.

What can we do about it?

There are 3 ways to go about mitigating this elder care problem:

 (1) Prevention of Demand
"Healthy Living! Active Aging!"
The terrible pressure of elder care explains why SINGOV is always promoting healthy living and active aging. It has even announced a SGD100Million budget to 'support seniors.

However, this S$100mil budget is not to directly subsidise elder care, i.e. not used to fill the bottomless pit. Instead, the money is spent on prevention of a bottomless pit and promotion of healthy living and active aging. While S$100M sounds like a lot of money, but take a closer look and you'll realise that it is nothing compared to S$10B.

SGD100mil = Wellness Programme (SGD77mil) + Promotion of Active Ageing (SGD20mil) + Centre of Enabled Living (SGD3mil)

(2) Catering to Demand
This includes ensuring that (i) people have enough money for old age, (ii) there are enough elder care service providers, and (iii) improve awareness and image of using such services.

And if the elder care industry in Singapore just doesn't take off sufficiently, I believe, allowing for your CPF to be used in Malaysian hospitals is a supplementary step.

Why SINGOV has not actively dangle 'seed money' to grow the elder care industry, I do not know. Perhaps because the problem is too acute.

Or perhaps, SINGOV is acutely aware that even if there are service providers, the average Singaporean families cannot afford to pay for their services.

In addition, SINGOV ensures that if you cannot pay for your old age, your kids will HAVE to pay for you, i.e. Maintenance of Parents' Act. This Act has been tightened once again recently. In effect, SINGOV is preventing the family unit from passing further burden to the state. Though this may not sound like much for you (my readers), imagine the burden on the average Singaporean family with a household income of S$4,850 per month, trying to support a bed-ridden senior at the cost of up to S$5,000 per month.

(3) Reducing Demand
We are all gonna live longer. But longer lives may not mean quality lives for some of us. Towards the end, some of us will be suffering and demanding for medical care and attention over sustained periods.

One clearcut way is to allow for assisted suicide. Such sensitive topics do not make their way to mainstream media for no purpose. I personally believe this is a reasonable way out for all involved, especially the suffering senior and his family.