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Commentary: Age Well Neighbourhoods to plug gap in senior services, but what’s next?

Uncle Tan*, who is in his early eighties, lives alone and has difficulty standing up and walking around the house. He does not use any home care services, such as for assistance with bathing or housekeeping. He also does not visit an Active Ageing Centre (AAC) regularly as he says that the nearest AAC is not very accessible.

Uncle Tan is one of many seniors who could benefit from the new Age Well Neighbourhoods initiative, announced by Prime Minister Lawrence Wong in his National Day Rally in August. The initiative supports ageing-in-place by providing more services to seniors in their existing homes, including home fixes, housekeeping, laundry, meal deliveries and AACs built nearby. Toa Payoh, where nearly a quarter of residents are aged 65 and above, will be the first town to benefit from this initiative.

The Age Well Neighbourhoods initiative will plug an important gap in senior services at the neighbourhood level. In a nationwide survey of 1,535 seniors aged 67 and above, THE SIGNS Study, conducted by the Centre for Ageing Research and Education (CARE), Duke-NUS Medical School from 2023 to 2024, 10.5 per cent lived alone (without family or a migrant domestic worker) and 13.2 per cent had difficulty with at least one Activity of Daily Living (such as bathing, dressing, or eating). However, only 1 per cent had used home personal care in the past year, and only 18 per cent attended activities (of any frequency) at an AAC or Senior Care Centre (SCC).

In particular, the push to launch more AACs will help to bridge the gap between seniors and services. Compared to the availability and accessibility of general amenities like hawker centres, supermarkets, public transport, and clinics in their neighbourhood, which 9 in 10 seniors in THE SIGNS Study rated “Good” or better, AACs or SCCs only received “Good” or better ratings from 6 in 10 seniors. In addition, 1 in 5 seniors responded “Don’t Know” to the questions on availability and accessibility of AACs or SCCs, likely due to lack of awareness.

Age Well Neighbourhoods – A positive move, but more can be done

While the government has rolled out initiatives like Healthier SG and Age Well SG to ensure seniors receive care through a regular primary care doctor, access social programmes in the community to prevent social isolation, and improve care integration, not every senior may benefit from Age Well Neighbourhoods immediately, as these efforts will be progressively be rolled out across the country, in areas with higher senior density. This however presents an opportunity for variations of services to be trialled in other neighbourhoods and compared for efficacy.

In addition, the profile and aspirations of our seniors are evolving, and not all want the neighbourhood to be the central focus of their lives. It is also important to design support systems at the national level that can address seniors’ holistic needs. Here are four ideas for an age-friendly Singapore.

Idea 1: Place-centric and person-centric perspectives

The idea of “life space” envisions the area where individuals move around and engage in activities that enrich their lives. Some seniors are content to make the neighbourhood their life space, while others move far across the island based on their interests and commitments. Their health and mobility status as well as features of the built environment also influence the extent of their life space. Therefore, it is important that our national policies use both place-centric and person-centric perspectives. For example, although each AAC is primarily responsible for seniors living nearby, they also welcome participants from other areas. Similarly, under Healthier SG, seniors are encouraged to regularly visit the same polyclinic or General Practitioner (GP), but their health records will still be accessible via the National Electronic Health Record (NEHR) and HealthHub if they visit other clinics.

Building on the strengths of our health and senior care systems, we should continue to improve the way we engage with place-centric and person-centric perspectives. For example, based on CARE’s THE SIGNS Study, only 15 per cent of seniors have gone for a dental checkup in the past 6 months. Taking a place-centric perspective, we should consider which neighbourhoods have fewer dental clinics and aim to open new clinics within walking distance of most seniors. Taking a person-centric perspective, we should consider the study’s evidence that seniors living in smaller HDB flats and those who reported difficulty meeting expenses were less likely to go for regular dental checkups. This points to the importance of the government’s recent move to increase CHAS subsidies for dental care.

Idea 2: From “ageing in place” to “ageing in networks”

The idea of “ageing in place” stems from a desire to avoid excessive institutionalisation and enable seniors to age and receive care in their own homes and communities rather than going to a hospital or nursing home. This ideal has served Singapore well in the past decades, but it also makes some implicit assumptions that seniors prefer to stay in one familiar area and are passive recipients of care rather than actively taking ownership of the ageing process.

Promoting care at home can lead to family caregivers bearing a large burden of responsibility. In a survey of 278 caregivers in 2019 to 2020 conducted by CARE, family caregivers of older adults spent on average 33 hours a week on care tasks. Among full-time working caregivers, 55.1 per cent had to leave work in the past 6 months to bring their care recipient to the doctor. Thus, while “ageing in place” may sound comfortable for older adults, it can also be disruptive to family caregivers’ life and employment prospects. The home personal care and community health posts announced under Age Well Neighbourhoods will bring support even closer to seniors in an area that they are comfortable with, especially for those who are unable to move about and access care conveniently. This is a welcome step to reduce the burden on family caregivers.

At the same time, according to a study led by Professor Elaine Ho from the National University of Singapore, discussion on “ageing in place” should be complemented by “ageing in networks”, which is the idea that seniors are able to participate in society and access social support beyond their neighbourhood. This really widens the options for supporting our seniors.

By recognising seniors’ agency in their social lives, we can give them the space to be more self-sufficient and move from restrictive forms of care to facilitative forms of support. For example, we can promote programmes that bring together older adults not just by where they live, but by shared interests, values or life experiences.

Idea 3: From digital challenge to digital resilience

In the National Day Rally, Prime Minister Wong spoke at length about the digital resilience of the young. We should also consider the digital resilience of the old. This is where cohort and educational inequalities make a big difference. In THE SIGNS Study, 76.3 per cent of older Singaporeans used smartphones, but among those aged 80 years and above, it was only 40.9 per cent. Considering how pervasive technology is in Singapore society, we must ensure that older Singaporeans are not alienated because they cannot access digital services.

In THE SIGNS Study, only 26.2 per cent of older Singaporeans had ever used the internet to access health information. Apps should be designed simply and campaigns such as “Seniors Go Digital” should continue to run to help seniors learn to use technology. When seniors master technology, it will cease to be a challenge and transform into an opportunity for social connection beyond the neighbourhood, further supporting the concept of “ageing in networks”.

Idea 4: From “hardware” to “heartware”

Prime Minister Wong mentioned that much has been done, and is being done, to upgrade our neighbourhoods and make the infrastructure senior-friendly, ranging from wheelchair accessible walkways to safer road crossings. In THE SIGNS Study, 9 in 10 seniors found it easy to access the destinations they needed to go to, indicating that the “hardware” is in good shape.

However, we must also have the “heartware” to be considerate to seniors. For example, pedestrians should give way to wheelchair-bound seniors when using the lift, and cyclists and Personal Mobility Device (PMD) users should limit their speed on shared walkways.

In a study on ageing in the urban environment, in 2022 to 2023, that CARE contributed to, some seniors shared their experiences of cyclists and PMD users who speed on walkways, which discouraged them from utilising these routes. Such behaviour can make it more difficult for seniors to access the services they need, and cause family members to restrict seniors’ independent lifestyle for fear of them getting hurt. If Singaporeans can step up to become more considerate road users, this will help to assure family members that their loved ones can navigate the neighbourhood safely on their own.

Conclusion: Working towards a “Singapore for all ages”

While it is useful to identify specific neighbourhoods to test bed new ideas, opportunities and services should be available to seniors regardless of whether they stay in existing towns, move to new towns or are simply roaming around the island. Having a healthy distribution of age groups in each neighbourhood has a lot of benefits. Ultimately, our vision is that of a “Singapore for all ages”, where every neighbourhood has a good mix of old and young who can complement and support each other. 

*Names in this commentary are pseudonyms. 

Jeremy Lim-Soh is Senior Research Fellow and Rahul Malhotra is Executive Director at the Centre for Ageing Research and Education, Duke-NUS Medical School.