With the Community Care Apartments, proposed retirement villages and an ageing population (plus an increasing concern towards the elderly with dementia), there are some considerations when it comes to how housing projects are planned – today and in the future. 99.co explores this increasingly challenging and stigmatising landscape among this unique group in our population and how housing considerations are changing to provide some measure of dignity to our senior folks.
Singapore has one of the fastest ageing populations in Asia, with 15 per cent of residents aged 65 and over currently, a demographic that has steadily risen from 9 per cent in 2010. By 2030, almost a million Singaporeans will be aged 65 and above, nearly double the figure recorded in 2017. In March 2020, Senior Minister of State for Sustainability and the Environment, Dr Amy Khor said the number of home and day-care places to support seniors ageing-in-place had also increased by 70% since 2015.
With ageing, comes added medical conditions such as dementia and the inability for an independent, dignified living. The knock-on effects of ageing on Singapore’s property market are thus creating an immediate, rising need for affordable housing and better care for the elderly. Bed capacity at nursing homes has also increased by 30% over the same timeframe, highlighting the need to enhance the scope of services, and to better address the spectrum of care needs. This means doubling the number of eldercare centres to provide an expanded suite of baseline support services for all seniors.
It is still common to see ageing as negative, so authorities are also rolling out a new HDB housing type called assisted living flats to expand the housing options for seniors, to provide seniors with a housing option for independent living, with care available if needed. For instance, the new assisted living units planned for construction in Bukit Batok are a chance to make growing older much more meaningful.
In an attempt to meet the rising demand for better dementia care, at least 11 government-funded nursing home facilities are underway, in addition to the 17 that have been launched since 2015. On the opposite end of the spectrum though, private-sector residential care has not been successful yet, as seen last year when a tender for Singapore’s first dementia care village at Gibraltar Crescent in Sembawang ended fruitlessly after it drew just one bid of S$15 million.
The sale for the site was launched in July 2020 to pilot a new residential care community concept for people with varying stages of dementia. The rejected offer (S$1,392.76 per sq m) was rejected by authorities as too low according to the URA on behalf of the Ministry of Health, despite the site being specially designed to provide a safe, home-like environment where residents are assisted to live independently.
In addition to dementia care, other property measures include launching new public housing flats for the elderly with a subscription to care services and senior-friendly design features.
The HDB developed Kampong Admiralty in 2017 as the first integrated housing for the elderly with a range of social, healthcare, communal, commercial and retail facilities. It features 100 flats, a two-storey medical centre, and a hawker centre. HDB plans to have more public retirement villages similar to the one at Kampong Admiralty in other housing precincts.
Launched for sale earlier in February’s Build-to-Order (BTO) exercise, these flats, known as Community Care Apartments are located at Bukit Batok West Avenue 9, specially designed for homebuyers aged 65 and above (with an average gross monthly household income not exceeding S$14,000). This envisioned private assisted living flats pilot for seniors would plug the gap in the housing market, and fulfil various needs, all under one roof, unlike previous two-room flexi-flats, which were also targeted at seniors.
Buyers have the flexibility to choose a lease ranging from 15 to 35 years to cover themselves (and their spouse, if applicable), until they are at least 95 years old, in five-year increments. Indicative prices for the Community Care Apartments go upwards of S$62,000 for the shortest lease of 15 years. This compares to MOH’s Agency for Integrated Care estimates that the basic cost to stay in a nursing home, before subsidies, ranges from S$2,000 to S$3,600 a month. At the premium end, this might be in the range of S$7,000 to S$8,000.
“There will be 160 flats up for sale, housed in a single block with 14 units on each floor to offer seniors aged 65 and above an affordable housing option which integrates senior-friendly design features with care services that can be scaled according to care needs,” said the Ministry of National Development (MND), the Ministry of Health (MOH) and the Housing and Development Board (HDB), which jointly developed the housing concept.
“With the new Community Care Apartments, our seniors can look forward to living independently even as their care needs change, and enjoy more opportunities to stay active and take charge of their health,” said then Health Minister Gan Kim Yong. Authorities added that priority will be given to seniors with more pressing care needs, such as in cases where one applicant or occupier needs permanent assistance with daily living activities. Under the model, eligible seniors can buy a variable housing lease and subscribe to a compulsory basic care package, with the option of adding on more advanced care services as required.
Furthermore, the assisted living package also comes along with communal services and programmes to enable meaningful participation and social interactions amongst residents.
In her Committee of Supply speech earlier in March, Senior Minister of State for Health Amy Khor said focus groups will allow MOH and MND to better understand Singaporeans’ aspirations and “to fine-tune this new option for ageing-in-place before going to market”. She added that the development could comprise flats with senior-friendly features, complemented by communal spaces like recreation cum dining rooms to encourage interaction.
With the mandatory basic service package, residents have access to 24-hour emergency monitoring and response, key card access to their flats, basic health checks and simple home fixes, all facilitated by an onsite community manager. “This pilot will broaden today’s options for seniors who require some care and support within their homes, but are still able to and wish to live on their own,” said National Development Minister Desmond Lee.
Residents may also opt for extra care services at an additional cost, including personal home care, medical transport, meal delivery, laundry and housekeeping. They will also get priority admission to the nearby Bukit Batok Care Home in future if needed, along with convenient access to a variety of retail, leisure, healthcare and public transport amenities to support their daily needs, including a hawker centre, community garden, the Bukit Batok polyclinic, malls and wet markets.
Each 32 sqm flat is designed with an open layout, with sliding partitions separating the living room and bedroom space, comes with senior-friendly fittings, including wheelchair-friendly doors, large bathrooms, grab bars and slip-resistant flooring. Also thoughtfully included are built-in wardrobes and cabinets, along with a furnished kitchen so that minimal renovations will be needed before seniors can move in.
However, there are a few eligibility criteria that apply. For instance, only families with at least one Singaporean applicant, and singles who are Singapore citizens may apply; those who have previously received two public housing subsidies and who bought HDB Studio Apartments or short-lease two-room Flexi flats in the past are not eligible, and those who already own private property or HDB flat must sell the property within six months of collecting the keys to their Community Care Apartments.
The price of the apartment includes both the cost of the unit and the subscription for the basic service package. Applicants must pay for the flat lease fully upfront, using cash and/or their Central Provident Fund balance. Buyers will also have to pay stamp, legal and other fees for the flat purchase (adding up to approximately 2 per cent of the flat price). For the basic service package, they can choose to pay either fully upfront or partially upfront while paying S$50 a month throughout the flat lease.
While the apartments cannot be resold or rented out, owners who no longer need the flats can return them to HDB for a refund on the value of the remaining lease. Because the pilot is a very new system, its success could mean possible expansion to cater to elderly residents with different needs and health issues. The launch of the public housing project in Bukit Batok is a step towards dignified ageing, bundling homeownership with domiciliary care services, compared to earlier projects like Kampong Admiralty and Heartbeat@Bedok which offered seniors the option of purpose-built public housing with co-located healthcare facilities and community spaces only.
Back in 2019, then National Development Minister Mr Lawrence Wong said that such retirement housing models are also being explored for private residential sites for assisted living typologies, including the option of converting vacant school sites into retirement homes.
According to Huttons Asia’s head of research Lee Sze Teck, these CCA flats fill a gap in the housing market for seniors, being a step up from the short-lease, senior-friendly two-room Flexi flats (addressing the need for requiring a helper); but are one step below nursing homes or dedicated care institutions.
Given Singapore’s rapidly ageing population, much higher demand for nursing homes in the future is also expected. And the perception of being the first-stop option needs to change.
Nursing homes have to support three major age groups: the Pioneer Generation who are the predominant current users of nursing homes; the young-old, or the Merdeka Generation who may in five to 10 years’ time consider using nursing home facilities; and the future old or the Millennial Generation who may need to use the nursing home in 30 years’ time. Nursing homes that are being developed today will need to be flexible and adaptable in order to respond to future changing needs, with each community hopefully having a nursing or care hub within each HDB neighbourhood to look after the elderly in the future.
According to Sing Tien Foo, director of the NUS Institute of Real Estate and Urban Studies, it’s time for HDB to shift gears from ramping up housing supply to rethinking sustainable, highly liveable housing that promotes social goals. Back in 2018, studies showed that the future of Singapore housing lay in bigger or jumbo HDB flats (147-199 sqm) to encourage multi-generational living. Such jumbo flats were a one-off plan by HDB to clear unsold flats in the 1980s and such a similar large-scale conversion has not been undertaken by HDB since, as they command a high price premium, ranging from S$650,000 to S$950,000.
Existing flat owners can still apply to the HDB Conversion Scheme to combine two adjoining 3-room or smaller flats bought in the resale markets. But these are ad hoc and rare. However, in an attempt to help more young couples to stay in bigger flats with their ageing parents, the government recently reintroduced multi-generation living and brought back a batch of 84 three-generation (3Gen) flats (at least 115 sqm) in 2013, providing an extra 5 sqm space (more than most 5-room flats), to help promote multi-generational living.
A move to build more 3Gen flats would also complement the Extended Proximity Housing Grant (PHG) which offers S$20,000 to encourage families to buy resale flats and live in close proximity to their parents. However, without government intervention, private developers will continue building smaller shoebox apartments to meet the needs of financially constrained buyers and investors in response to high psf prices.
The Bukit Batok development introduces an entirely new but essential component into the country’s care eco-system at the health systems level, hopefully being the start of future sustainable, long-term care options. Dr Belinda Wee, director of the Assisted Living Facilities Association of Singapore (ALFA), says that assisted living facilities, where residents are not wholly reliant on caregivers, provide a tailored level of support between that of community-based care support and nursing home care.
Another successful ageing project was by the Tsao Foundation with its ground-breaking project, the Community for Successful Ageing (ComSA) in Whampoa in 2013. Within its premises at the Whampoa Community Club, ComSA houses a primary healthcare clinic integrated with care management and counselling services, a daycare centre and a training centre, all serving primarily older people.
Community-based care, as opposed to institutionalised living arrangements, is the lynchpin of the health ecosystem, as viable assisted living options will be a critical part of its improved building infrastructure.
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