Ageing with grace: Redesigning senior living in Singapore

18 Mar 2022

Straits Times, 18 Mar 2022, Ageing with grace: Redesigning senior living in Singapore

It may take a village to raise a child, goes the popular proverb said to originate from ancient Africa. But in Singapore, it takes a village to help and house its seniors.

More "vertical kampungs" are expected to be completed in the coming years, in the wake of the award-winning Kampung Admiralty, which was completed in 2018.

The 11-storey public housing development in Woodlands is the first integrated development to promote active ageing for Singaporeans in their silver years and encourage their social interaction with the larger community. It features childcare, healthcare and wellness facilities in an inclusive, connected community hub amid lush gardens.

Led by the Housing Board (HDB), the project corralled the know-how of six other government agencies such as the National Parks Board and the Ministry of Health.

But besides integrated developments such as Kampung Admiralty and the upcoming Heart of Yew Tee in Choa Chu Kang, there are now also more public housing choices for seniors.

They include Community Care Apartments (CCAs) - which provide assisted-living facilities - such as HDB's pilot Harmony Village @ Bukit Batok and the recently announced CCAs in Queenstown.

An assisted-living facility is a type of housing for people who need help with daily routines and easy access to medical attention in an emergency.

Harmony Village @ Bukit Batok was launched in February 2021 and is for Singapore citizens aged 65 and above. The units come with customisable care support such as housekeeping services and round-the-clock emergency medical attention.

The 15-storey block houses 169 units which are retrofitted with senior-friendly fittings such as a wheelchair-accessible bathroom.

Prices for Harmony Village @ Bukit Batok range from $35,000 to $64,000 for a 32 sq m unit, with flexible leases of between 15 and 35 years. The flats are expected to be completed in 2024.

At Heart of Yew Tee, HDB's second "vertical kampung", housing for seniors is co-located with social, healthcare, communal, commercial and retail facilities.

When it is completed in 2027, it will offer about 70 units of two-room Flexi flats, measuring 36 and 46 sq m, with elderly-friendly fittings such as grab bars.

Heart of Yew Tee distils lessons from Kampung Admiralty, such as having extensive greenery and generous community spaces which promote active living and provide opportunities for people to get together and bond.

Kampung Admiralty, designed by home-grown architectural practice Woha, received the Global Award for Excellence given by the Washington-based research and education non-profit Urban Land Institute last year - one of several awards it has garnered since its official opening.

According to the Urban Redevelopment Authority (URA), it considers evolving trends in its land-use planning to ensure that Singapore's urban plans meet the changing needs of the city and its people.

A spokesman says: "With a rapidly ageing society, URA and partner agencies are focused on creating a more age-friendly built environment."

URA has commissioned two studies to better understand the relationship between ageing, health and the built environment.

The first was with the Singapore University of Technology and Design. Completed in 2019, it assessed the age-friendliness of three HDB neighbourhoods - Hong Kah North, MacPherson and Toa Payoh West - and involved architectural firms and residents in co-creating measures to make the estates more conducive for older adults.

The second study, completed in 2021, was done with the National University of Singapore (NUS) and proposed innovative designs to promote person-centric care models and better integration of nursing homes into the community.

At Kebun Baru in Ang Mo Kio, an assisted-living facility for seniors, including persons with dementia, was launched in March 2022 as part of a pilot programme between Kebun Baru Grassroots Organisations and social service agency Dementia Singapore.

Called Integrated Dementia (Home-based) Assisted Living, the facility aims to help vulnerable and frail seniors, including those with dementia, to age in place with dignity through coordinated support and monitoring.

It takes up four units on the second level of a block of rental units at Block 115 Ang Mo Kio Avenue 4. The free programme caters to 40 residents in the block.

Assistive technology - such as tracking devices, fall-detection devices and remote monitoring - is also used, so that seniors can continue to stay in a familiar, safe and secure environment at home.

Such dynamic community engagement with seniors is key to the future of ageing in place, says Associate Professor Fung John Chye of NUS' department of architecture.

Ageing in place is a concept where seniors can live independently in their homes or community yet have access to social support including friends and family.

It is why Prof Fung wants to see changes in the nursing home model in Singapore.

In 2020, there were 31 private nursing homes and 24 public ones in Singapore, according to global market and consumer data company Statista.

Prof Fung says that while nursing homes are the primary form of institution-based long-term care in Singapore, they operate on the basis of efficiency because of the organised collective care and living arrangements, where residents stay with strangers instead of family members or neighbours.

"Strictly speaking, they do not constitute a form of ageing in place," says Prof Fung, who is also the director at the Centre for Ageing Research in the Environment at NUS School of Design and Environment.

"The recent Covid-19 restrictions that disallow family members from visiting their loved ones in nursing homes made the distinction between growing old (and dying) in an institution and in one's home more acute.

"Despite the efforts by nursing homes to create a comfortable home-like environment, the familiarity of one's home - its cosiness, familiar spaces and objects, memories as well as the convenience of common amenities - can never be well replicated in an institutional setting simply because of the sheer density of users."

He says that although the aim of a nursing home is for its residents to eventually return home, the institution is where many spend the last years of their lives.

That is because most nursing-home residents here are physically frail and unable to perform common activities of daily living, and often do not recover sufficiently to return home.

"This raises the important question of how can nursing homes replicate the desirable attributes of a 'community ageing with place', which is my preferred term instead of the commonly used 'ageing in place'," says Prof Fung.

His concept comprises three interrelated aspects - community (social relationships), ageing (individual biophysical process) and place (a familiar environment).

He calls for a fundamental rethink of the concept of nursing homes by moving towards an integrated community-based care.

"Deep community engagement is an important part of this paradigm shift because a convivial community offers normality and familiarity, which are crucial to seniors, especially persons living with dementia," he says.

He adds that a proper environment for seniors should evoke a sense of security and safety, and offer basic support such as neighbourliness, comfort, convenient access to amenities and ease of navigating through the design of the spaces and proper use of signage. Ideally, such support should be integrated seamlessly without altering the neighbourhood's character. He says: "This is where good design is crucial because many of the desired features can be thoughtfully integrated in street furniture, materials and other elements of the landscape."