AGE-FRIENDLY
Lessons CITIESfrom Seoul and Singapore AGE-FRIENDLY
LessonsCITIES from Seoul and Singapore For product information, please contact Project Team CLC Publications +65 66459576 Seoul Centre for Liveable Cities The Seoul Institute 45 Maxwell Road #07-01 Project Co-lead: Dr. Hyun-Chan Ahn, Associate Research Fellow The URA Centre Researchers: Dr. Chang Yi, Research Fellow Singapore 069118 Dr. Min-Suk Yoon, Research Fellow [email protected] Seoul Welfare Foundation Cover photo Researchers: Dr. Eunha Jeong, Senior Principal Researcher Seoul – Courtesy of Seoul Institute (top) Singapore – Courtesy of Ministry of Health, Singapore (bottom) Singapore Centre for Liveable Cities Project Co-lead: Elaine Tan, Deputy Director Researchers: Deborah Chan, Manager Tan Guan Hong, Manager Contributing Staff: Remy Guo, Senior Assistant Director
Editor: Alvin Pang
Supporting Agencies: Housing & Development Board Li Ping Goh, Director Yushan Teo, Deputy Director Tian Hong Liow, Principal Architect Yvonne KH Yee, Principal Estate Manager
Printed on Tauro, a FSC-certified paper. Ministry of Health Sharon Chua, Assistant Director E-book ISBN 978-981-11-9306-4 Daniel Chander, Assistant Manager Paperback ISBN 978-981-11-9304-0 People’s Association All rights reserved. No part of this publication may be reproduced, distributed or Adam Tan, Assistant Director transmitted in any form or by any means, including photocopying, recording or other electronic or mechanical methods, without the prior written permission of Urban Redevelopment Authority the publisher. Agnes Won, Executive Planner Juliana Tang, Executive Planner Every effort has been made to trace all sources and copyright holders of news articles, figures and information in this book before publication. If any has been inadvertently overlooked, CLC and Seoul Institute will ensure that full credit is given at the earliest opportunity. © 2019 Centre for Liveable Cities, Singapore and the Seoul Institute. All rights reserved. Contents Foreword by Seoul About the Centre for Liveable Cities Foreword by Singapore Set up in 2008 by the Ministry of National Development and the Ministry of the 1. Introduction 01 Environment and Water Resources, the Centre for Liveable Cities’ (CLC) mission is to distil, create and share knowledge on liveable and sustainable cities. CLC’s work 2. Ageing in Seoul and Singapore 09 spans four main areas: Research, Capability Development, Advisory Services and Knowledge Platforms. Through these activities, CLC hopes to provide urban leaders 3. Planning for an Age-Friendly City 17 and practitioners with the knowledge and support needed to make our cities better. 4. Ageing-in-Place and Active Ageing 39 www.clc.gov.sg 5. No Place Like Home: Ageing-in-Place Case Studies from Seoul and Singapore 49 • Housing for Seniors 50 - Seoul: Borin Housing - Singapore: Studio Apartment (SA) and 2-room Flexi Scheme
• Integrating Needs 63 - Seoul: Shinnae Medical Housing (SMH) - Singapore: Kampung Admiralty • Community-Based Support 80 About the Seoul Institute - Seoul: Reaching Out Community Service Center’s (ROCSC) Health Care Services - Singapore: Community Networks for Seniors (CNS) The Seoul Development Institute was established by the Seoul Metropolitan Government (SMG) in 1992 and was renamed as the Seoul Institute (SI) on 1 August • Inclusive Urban Design 99 2012. The Seoul Institute’s goal is to establish a medium- to long-term vision for - Seoul: Environmental Design for the Cognitively Impaired - Singapore: Innovative Planning and Design of Age-Friendly Neighbourhoods Seoul and propose social policies on welfare, culture, education and industries, and urban management policies on city planning, transportation, safety and the Time of Our Lives: Active Ageing Case Studies from Seoul and Singapore 111 environment. SI’s primary objective is to improve municipal administration through • Lifelong Learning 112 professional research, improve the quality of life in Seoul, and reinforce and sustain - Seoul: Seoul 50+ Foundation the competitiveness of Seoul. https://www.si.re.kr/ - Singapore: National Silver Academy (NSA) • Well-being and Wellness 129 - Seoul: Gwangjin Socio-Economic Cluster - Singapore: Wellness in Communities • Centres for Active Ageing 145 - Seoul: Senior Welfare Centers and Day Care Centers - Singapore: Senior Activity Centres (SACs) and Active Ageing Hubs (AAHs) • Local Initiatives 166 - Seoul: Open Kitchen - Singapore: Goodlife! Makan
6. Building Age-Friendly Cities: Lessons from Seoul and Singapore 173
Glossary 184 Endnotes 186 Bibliography 192 Image and Diagram Credits 197 less than a decade from now. It is usually a 2-room Flexi Housing Scheme, where FOREWORD BY the case that what is a problem in Korea FOREWORD BY seniors have the flexibility to choose the SEOUL is a very serious problem in Seoul. This is SINGAPORE length of lease based on their age, needs, particularly true for the ageing issue. Many and preferences. senior citizens in Seoul are not ready to live in an ageing society, either physically Our public housing estates are designed or financially. Many live alone. Many need to be barrier-free. Over the years we have jobs to make ends meet. It is often very been upgrading the neighbourhoods and difficult for them to find job opportunities. towns to provide direct lift access to every Ageing is a critical concern in Seoul, and floor, and incorporating elderly-friendly in Korea as a whole. designs in our flats and estates.
This publication emphasises the In a recent public housing project called importance of ageing issues in our Kampung Admiralty, we integrated public I would like to express my appreciation cities. At the same time, this book offers We often think of cities as buildings and housing flats for seniors with a continuum to Seoul Institute (SI) and the Centre for comprehensive perspectives and ideas to infrastructure. But cities are as much about of social and health facilities. In this way, Liveable Cities (CLC) for their continuing policymakers by comparing in-depth how the people, as it is about the hardware. residents have easy access to a full range and successful research collaboration, and ongoing efforts are being made in Seoul A liveable city is also one that is socially of services, which enable them to age- to congratulate them on the publication and Singapore. We may be a long way inclusive—a place that embraces diversity, in-place, and to participate actively in of their third joint research study Age- from solving the ageing issue. However, and ensures citizens of all ages enjoy a the community. We are honoured that Friendly Cities: Lessons from Seoul and by learning from each other, we can better high quality of life. this project recently won the award for Singapore. understand where we are and where World Building of the Year at the World we need to go in the process of finding Today, Seoul and Singapore are amongst Architectural Festival 2018. For the past three years, the two creative solutions to population ageing the fastest ageing cities in Asia. Both cities institutions have been collaborating to in Seoul and Singapore. This book is the have put in place a range of programmes These are just a few of the many initiatives compare policies in Seoul and Singapore. beginning. and initiatives for seniors. We both we have embarked on for our seniors in Their efforts have greatly improved our share the same aspiration—to make our Singapore. We remain committed to mutual understanding and the relationship Once again, I would like to express my cities age-friendly, and to build inclusive strengthening both the physical and between the two cities. Their open sharing gratitude to SI and CLC researchers communities where our seniors can age the social infrastructure for an ageing of innovative policy initiatives and the trial for their great efforts in producing this with dignity and grace. population, and making Singapore a and errors of implementation will provide publication. liveable city for all ages. useful insights into issues all cities around In the case of Singapore, one in four the world are facing. citizens will be aged 65 years and above Age-Friendly Cities: Lessons from Seoul by 2030. That is why we are taking and Singapore is a timely publication to Ageing issues are ever more pertinent Park Won-soon proactive steps to prepare for an ageing distil the experiences of both Seoul and in our cities. As we know, there are Mayor of Seoul population. Our urban planning has taken Singapore in planning age-friendly cities commonalities in the range of concerns South Korea into account the needs of the elderly and inclusive communities. I hope this in Seoul and Singapore, as a result of our through the implementation of universal third collaboration between the Centre rapid growth and high population density. design guidelines, the provision of for Liveable Cities and the Seoul Institute Now both our societies are ageing. How elderly-friendly features and facilities, and provides useful insights for cities in their to overcome the challenges from ageing the planning and design of our homes journey of supporting and empowering societies will be an important priority that and environment that are conducive for seniors. calls for much consideration. ageing-in-place.
In terms of the ageing phenomenon, both We also recognise the importance Lawrence Wong Singapore and Korea are on a similar of tailoring our efforts and providing Minister for National Development & trajectory, with about 14 percent of our housing, lifestyle and care options to Second Minister for Finance total populations above the age of 65. meet the diverse needs of our seniors. Singapore Korea will be a super-aged society in 2026, In public housing, for instance, we offer 04 CASE STUDIES ENVIRONMENTAL DESIGN FOR THE COGNITIVELY IMPAIRED INTRODUCTION 01
1. INTRODUCTION
Population ageing—the increasing more accessible and more liveable for share of older persons in the older persons also makes it much more population—is growing in tandem liveable for everyone else. For example, with urbanisation around the world. providing safe, well-lit, even pavements These two global trends are tightly and streets would encourage older intertwined. By 2050, it is projected that persons to head out without fearing 68% of the world’s population will be for their safety. This would also benefit living in cities, and most regions in the persons with physical or cognitive world will have nearly a quarter or more disabilities, parents with strollers, of their populations aged 60 years and children, cyclists, and even the general older. 1 public.
Cities have a huge impact on older Until now, the common narrative on persons, who have to navigate the ageing has largely been framed around urban environment to carry out their declining health, physical and cognitive day-to-day activities. The urban capacities as one ages. This narrative environment can play a part in makes the ageing experience a private adapting to the changing needs of “problem” for older persons, instead the ageing population; it can also be of seeing ageing as a natural process. improved to offer better liveability.2 In As ageing populations become a fact, planning a city such that it is safer, global phenomenon, it is important to 02 INTRODUCTION INTRODUCTION 03
underscore that ageing is natural, and are already fast-approaching an aged super-aged societies.10 Many middle- that a city should adapt its physical and Ageing in Seoul and society; by 2030, both Seoul and income countries like China, Cuba social environment to accommodate its Singapore Singapore will be super-aged as Seoul and Thailand are expected to join citizens’ changing needs over time.3 expects 23.5% of its population to be high income countries such as Japan, Seoul and Singapore are among the top elderly, close to Singapore’s projected Italy and Germany in becoming super- 7 11 Cities, communities and governments cities in Asia experiencing an ageing 25% or 900,000 seniors. aged. More countries are expected to are increasingly aware of the urban population. make the transition from aged to super- environment’s impact on ageing, and While countries like Japan took 36 years aged in the coming decades, and urban vice versa. The next few years present an The proportion of elderly populations to transit from an ageing to a super- areas will be where ageing populations opportunity for cities to invest towards are similar in both Seoul and Singapore: aged society, South Korea and its capital cluster. An examination of efforts and adapt to future needs before 13.1% of Seoul’s 9.8 million population city, Seoul, will make that transition at in Seoul and Singapore to address exponential growth in population are aged 65 years and older (1,295,000 a much faster rate: it is expected to population ageing is thus timely and ageing takes place. This is especially persons) while 14.4% of Singapore’s 5.6 take just 26 years to transit from 5.3% useful. 8 so for cities in Asia as the region will million population are aged 65 years in 2000 to 20.2% by 2026. Likewise, become the oldest region in the world, and older (440,000 persons).5 Singapore will make the transition in 27 Recognising these phenomena, the with some 922.7 million elderly aged 65 years, going from 7% in 1999 to 20% of Seoul Institute (SI) and the Centre 4 9 years and above. A society is often defined to be an the population being elderly in 2026. for Liveable Cities (CLC) undertook ‘ageing’, ‘aged’, and ‘super-aged‘ when This means a shorter time to plan and this collaborative research study to the proportion of its population that prepare infrastructure, healthcare and explore how Seoul and Singapore, two is 65 years and older exceeds certain social institutions. high-density cities with rapidly ageing thresholds, namely 7%, 14% and 20% populations, are responding to and respectively.6 Seoul and Singapore Global estimates show that by 2030, engaging with this important urban a total of 34 nations will be classed as challenge.
Elderly Populations in Seoul and Singapore Today
13.1% of 14.4% of Seoul’s Singapore’s 9.8 million population 5.6 million population are aged are aged
Both Singapore and Seoul share common aspirations towards becoming age-friendly cities. 04 INTRODUCTION INTRODUCTION 05
Both Seoul and Singapore share Research Approach and common aspirations to build Process supportive, enabling and friendly environments for their seniors. It is Age-Friendly Cities hoped that the knowledge gleaned from this collaborative research study Many cities around the world have furthers Seoul’s and Singapore’s efforts responded to population ageing by in planning for an ageing population adopting or adapting the concept of an and provides learning points for other ‘age-friendly city’. cities experiencing population ageing.
A term first used by the World Health Research Process Organisation (WHO) in 2005, an ‘age-friendly city’ is defined as one The joint SI-CLC team embarked on a which “encourages active ageing by 6-month research process to examine optimising opportunities for health, ageing-related initiatives in both Seoul participation, and security in order to and Singapore. Planning for population 12 enhance quality of life as people age”. ageing involves many stakeholders: from the seniors themselves to the wider With a focus on planning for seniors, SI community, government officials and city The research team on a learning journey to Singapore’s Kampung Admiralty. and CLC both adopted the concept of leaders. The research process engaged ‘age-friendly cities’ for this study. This a diverse range of stakeholders in order study sites, and carried out in- is because the concept encapsulates to gain a comprehensive understanding depth discussions with site directors, both physical infrastructure and of relevant programmes in both cities. community leaders and the users of social services, and emphasises the age-friendly facilities. enablement and empowerment of The joint research team comprised seniors as they age. The team also members from the SI and Seoul Welfare Each trip was also paired with a noted that an age-friendly city is also a Foundation, as well as Singapore’s roundtable discussion involving friendly city for everyone. As WHO has CLC, Ministry of Health (MOH)’s experts, city officials, policy-makers and highlighted, “in an age-friendly city… Ageing Planning Office, Housing & academics from Singapore and Seoul. the natural and built environment… Development Board (HDB), Urban Participants discussed the thought anticipates users with different Redevelopment Authority (URA) and processes behind each city’s ageing- capacities, instead of designing for People’s Association (PA). related master plans, identified similar the mythical ‘average’ (i.e. young) challenges faced, and exchanged person. An age-friendly city emphasises Study Trips and Roundtable ideas on learning opportunities from enablement rather than disablement; Discussions each other’s initiatives. The discussions it is friendly for all ages, and not just centred on inclusive infrastructure 13 ‘elder-friendly’”. To understand each city’s age-friendly design and provision, the sustainability initiatives in context, researchers of programmes, the engagement of Although the definition of an elderly conducted a short exchange seniors, as well as social welfare policy person is not fixed, initiatives explored programme between Seoul and and financing. in this study were primarily targeted Singapore in May and June 2018. Participants from Singapore and Seoul exchanging ideas on initiatives. at persons aged 65 years and above, Researchers visited selected case unless otherwise specified. 06 INTRODUCTION INTRODUCTION 07 SEOUL SINGAPORE
GENERAL POPULATION GENERAL POPULATION DENSITY DENSITY (2017) LAND AREA LAND AREA (2017) 16,728 (2017) 7,796 605 km2 per km2 720 km2 per km2 TOTAL POPULATION GDP PER CAPITA TOTAL POPULATION (2017) GDP PER CAPITA (2017)
9,774,088 (USD 30,000) 5,612,300 (USD 58,339) (2018) KRW 33,996,000 SGD 79,697
POPULATION ELDERLY IN SEOUL POPULATION ELDERLY IN SINGAPORE MEDIAN AGE (2018) LIFE EXPECTANCY POPULATION OF ELDERLY 65 & ABOVE (2018) MEDIAN AGE (2017) LIFE EXPECTANCY POPULATION OF ELDERLY 65 & ABOVE (2017) AT BIRTH (2016) AT BIRTH (2017) 42 years old 1,405,404 40.5 years old 516,700 79.9 80.7 RETIREMENT AGE (2017) TOTAL FERTILITY RETIREMENT AGE TOTAL FERTILITY RATE (2017) RATE (2017) 84.8 Official Actual 85.2 Official Re-employment Retirement Age Retirement Age Retirement Age Age 0.84 60 years old 52.6 years old 1.16 62 years old 67 years old
OLD-AGE SUPPORT RATIO OLD-AGE SUPPORT RATIO (2017) POPULATION PYRAMID (2010) (number of residents POPULATION PYRAMID (2018) 5.6 aged 15-64 per resident (number of residents Male Female aged 65 years and older) Male Female 5.1 aged 20-64 per resident >85 y/o >85 y/o 80-84 80-84 aged 65 years and older) 75-79 75-79 70-74 LIVING ARRANGEMENTS 70-74 65-69 65-69 60-64 60-64 LIVING ARRANGEMENTS (2017) 55-59 Where one household member is aged 65 55-59 50-54 years and over 50-54 Where head of household is aged 65 years 45-49 45-49 Single-member: and over 40-44 138,825 40-44 35-39 Single-generation: 35-39 Couple-based with children: 30-34 168,455 30-34 74,100 25-29 Two-generation: 231,465 25-29 Couple-based without children: 71,500 20-24 20-24 Three-generation: Lone-parent: 12-19 164,926 12-19 23,100 10-14 Four or more genration: 10-14 Living alone: 5-9 2,058 5-9 47,400 0-4 No-kin: 3,856 0-4 Others: 33,000 08 AGEING IN SEOUL AND SINGAPORE 09
2. AGEING IN SEOUL AND SINGAPORE
Population ageing brings both they have a growing proportion of challenges and opportunities. older persons in their populations, they are also experiencing a shrinking Both Seoul and Singapore are seeing workforce and decreasing total fertility longer life expectancies and an increase rate. The old-age dependency ratio in in average healthy years among their both cities—the number of citizens in growing elderly populations. With the the working ages of 20–64 years15 for average life expectancy in Seoul at 82.4 each elderly citizen—is thus declining. years and in Singapore at 81.7 years,14 Presently, Seoul’s old-age dependency the increased longevity and improved ratio is 5.6 while Singapore’s is 5.116 health empower seniors with more and both cities have projected that opportunities for personal fulfilment the old-age dependency ratio could and growth. Older persons are also a drop to as low as 2.8 for Seoul and dynamic and growing talent pool that 2.1 for Singapore by 2030.17 Coupled can be empowered as jobs and the with low fertility rates of 0.84 and 1.16 economy restructure to adapt to the respectively,18 there will be a smaller needs of older persons. base of economically active citizens to support the ageing population in both Seoul and Singapore both face a similar cities if economic and social structures demographic challenge: not only do remain the same. 10 AGEING IN SEOUL AND SINGAPORE AGEING IN SEOUL AND SINGAPORE 11
When discussing the trends and Baby boomers in both cities also have While the rise in seniors living alone with mortality.26 For example, the same opportunities of an ageing population higher incomes and greater financial can be attributed to changing lifestyles study found that a higher proportion in Seoul and Singapore, two similar security: many of them were able to preferences, desire for more personal of elderly Singaporeans who live with trends in Seoul and Singapore stood take advantage of rapid economic space and independence, one key children or other (non-family) household out for the researchers—the changing growth in the late 1970s to early 1980s. concern is the risk of social isolation— members have expressed more feelings profiles of seniors and the rise in seniors In the past decade, economic activities seniors living alone may tend to keep of loneliness compared to those living living alone. and employment for senior citizens to themselves and may not be able to alone.27 in Seoul have also continued to grow, receive help from the larger community Notwithstanding the similarities, from 2.16% in 2005 to 26.7% in 2015. should they need it. Correspondingly, Seoul is not only researchers also recognised trends As of 2015, one in four people aged seeing a rise in seniors living alone, that are particular to each city: 65 or older were engaged in economic However, it is important to distinguish but also a high percentage of two- Seoul is faced with the challenges activities. Among the OECD countries, between loneliness (a perceived feeling) generations living under one roof: a of early retirement of seniors and Korea (31.5%) ranks second in a living alone (a living arrangement), household of senior citizen(s) living intergenerational conflict, while comparison of elderly participation in and social isolation (a possible with unmarried children.28 Because Singapore is faced with the challenges economic activities.21 outcome of this living arrangement). of the economic downturn in Korea, of increased chronic disease burden The international literature on the it is not uncommon nowadays to find and issues of caregiving. Rise of seniors living alone link between seniors living alone and families where adult children are looking mortality is mixed. Some find that living for employment opportunities. Seniors Another trend common to both alone is associated with increased then have to continue supporting the Similar Trends in Seoul Seoul and Singapore is a change risk of mortality, while others find household by working longer or finding and Singapore in family structures, resulting in a decreased mortality risk or no effect. A part-time work after retirement. There is greater occurrence of single elderly study in Singapore found that it is the thus the challenge of supporting seniors Changing profiles of seniors households, elderly living alone or experience of loneliness and not living through re-employment and continued elderly having to continue supporting arrangements per se that is associated social engagement. The profiles of seniors in both cities the household. are changing. For one, seniors— particularly the baby boomers, broadly The number of seniors living alone defined as those born in the 1940s to continues to grow in Seoul, standing 1960s following the Second World at 27.7% in 2015.22 Singapore too sees War and Korean War—are more highly 43,000 seniors living alone at present;23 educated and have higher incomes this group is projected to number 83,000 than previous generations for their age by 2030.24 In both cities, more elderly group. Almost 45.5% of the 1.44 million women live alone compared to men, baby boomers19 in Seoul have attended likely due to the longer life expectancy technical college or higher, compared for women. In particular, of seniors to only 16.1% of pre-boomers. living alone in Seoul, males accounted Correspondingly, 58% of the 1 million for 31.5% (88,549) and females 68.5% baby boomers in Singapore have had (192,519). Of seniors living alone in at least secondary school education, Singapore, males accounted for 6.1% compared to pre-boomers.20 and females 11.2%.25
Both cities face a rise in seniors living alone. 12 AGEING IN SEOUL AND SINGAPORE AGEING IN SEOUL AND SINGAPORE 13
While there has been social consensus Singapore: Growing chronic is estimated to rise to about 300,000 Distinct Trends 32 on providing care to the elderly, a disease burden, dementia and by 2030. FDWs will continue to play a worsening unemployment rate for the challenges of caregiving role in supporting families with elderly younger generation in Seoul, set against household members as family sizes While Seoul and Singapore share similar a rise in the number of working seniors, shrink, while working adults have to trends and challenges, each city has to With a rapidly ageing population, has surfaced intergenerational conflict. juggle multiple responsibilities such grapple with some issues particular to Singapore is faced with a growing As some seniors are not ready for life as caregiving of young children and its context. chronic disease burden. About 3 in after retirement and are determined to 4 Singapore residents aged 65 and tending to aged parents. To provide work for as long as their health allows, above are affected by diabetes, high more options and better support for Seoul: Early retirement age; there is growing competition between cholesterol or hypertension, or a households, Singapore is expanding Intergenerational conflict these seniors and younger people for combination of the three.30 community-based healthcare and available jobs in the market—the young eldercare. In Seoul, seniors retire at the age of 52.6 want the same comfortable, high- years: earlier than the national average, The proportion of seniors with paying jobs as seniors do. Another related trend in caregiving for and earlier than most cities around the dementia is also increasingly rapidly, in the elderly in Singapore is the rise in world. Retirees may face a gap of years tandem with the growth of the ageing This intergenerational conflict also plays the number of older caregivers. While in which they have no income: between population. 1 in 10 persons above the out in daily life in Seoul. For example, the majority of family caregivers are the retirement age of 52.6 years and age of 60 is estimated to suffer from many seniors staying in the university middle-aged children, a survey showed the start of pension payouts at age 65. dementia, which is the gradual decline districts depend on the rental income that 20% of family caregivers providing This is a phase during which the mature- of cognitive abilities such as thinking, from leasing out their properties. As 31 care to elderly persons aged 75 years aged could fall through the cracks in the memory and judgement. such, these seniors are opposed to the and above are themselves above the social security system, and be financially construction or expansion of university age of 65 years old.33 There is thus unprepared for retirement. According to It takes continued focus and effort to dormitories. The SMG and Local District the complication of older caregivers a 2015 study by the Seoul Metropolitan ensure that seniors with a diverse range Gu Governments (LDG) have attempted dealing with the complex health needs Government (SMG), many individuals of needs—including those with chronic to resolve this issue through dialogues, of their elderly care recipients, even as over 50 years of age are highly anxious diseases and dementia—can continue but some seniors are unwilling to they are themselves getting older and about and unprepared for life after early to age well in the community. Singapore compromise and want the projects to less healthy. retirement.29 continues to explore innovative be scrapped. solutions for high quality healthcare services at affordable cost. Singapore Although there has not yet been also recognises the importance of any case where young people have preventive care, and has been investing systematically organised in opposition heavily in health promotion, early to the elderly, the risk of unexpected vaccination, and screening for diseases. intergenerational friction has risen. There have been efforts to initiate In contrast to Seoul, engaging foreign policies in local communities to socially domestic workers (FDWs) for caregiving integrate the old and the young, but help is common in Singapore. While Seoul faces a difficult dilemma since Singapore is expanding centre-based many citizens do not work where they and home-based care facilities and Local residents in Seoul protesting against the live. services, the total demand for FDWs building of rental apartments for young people. 14 AGEING IN SEOUL AND SINGAPORE AGEING IN SEOUL AND SINGAPORE 15
SEOUL SINGAPORE
Similar Trends Similar Trends Changing Profiles Changing Profiles Declining Old-Age of Seniors: Higher Rise of Seniors Declining Old-Age of Seniors: Higher Rise of Seniors Dependency Ratio Education and Living Alone Dependency Ratio Education and Living Alone Higher Income Higher Income
27.7% 8.9% (2015) (2015) TODAY TODAY
66% 68.5% female female 5.6 (2015) 5.1 (2010)
2030 2030 34% 31.5% male 45.5% male 58% (2010) of baby boomers (2015) of baby boomers have attended technical at least secondary 2.8 college or higher 2.1 school education
Distinct Trends Distinct Trends
Increasing Chronic Disease Early Retirement Age Intergenerational Conflict Issues of Caregiving Burden and Dementia About 3 in 4 seniors are While Singapore is Financially Increased affected by diabetes, expanding unprepared for competition high cholesterol and/or centre-based and retirement due between hypertension. home-based care to gap period seniors and facilities and services, between retirement younger 1 in 10 persons aged the total demand for age (52.6 years old) people over 60 years and above is foreign domestic pension payouts available jobs estimated to have workers is estimated age (65 years old). in the market. dementia. to rise to about 300,000 by 2030. 16 CASE STUDIES ENVIRONMENTAL DESIGN FOR THE COGNITIVELY IMPAIRED PLANNING FOR AN AGE-FRIENDLY CITY 17
3. PLANNING FOR AN AGE-FRIENDLY CITY
Both Seoul and Singapore have taken ways to meet the anticipated challenges steps to plan and design their city to of an ageing population in Singapore.34 ensure that seniors continue to enjoy a good living environment, with access This evolved into the present day to adequate levels of care and social Ministerial Committee on Ageing support, as they age. (MCA) which currently provides Whole-Of-Government leadership in Interestingly, planning for an ageing tackling ageing, anticipating shifts and population in Singapore began as early coordinating a national response. as the 1980s, long before the city started experiencing population ageing. In line Given the corresponding demand on with Singapore’s approach of long- healthcare services from an ageing term planning, then-Prime Minister population, Singapore is committed Lee Kuan Yew decided that a Whole- to making three key paradigm shifts to Of-Government approach was needed bring healthcare closer to home and to understand and plan for a greying support Singaporeans to age well in population. He appointed a Committee their community, make healthy lifestyle on the Problems of the Aged in 1982 to choices, and get good healthcare at the study trends and recommend possible best affordable value:35 18 PLANNING FOR AN AGE-FRIENDLY CITY PLANNING FOR AN AGE-FRIENDLY CITY 19
Beyond Hospital to Community Seoul was relatively late to recognise the • Singapore’s government spending ageing phenomenon as a major policy Seoul: Age-Friendly Seoul Master Plan on primary care and intermediate/ issue. It was only in the early 2000s that Based on the concept of an age- plan to become age-friendly. The new long-term care sectors has increased the central government as well as local friendly city proposed in the World plan was targeted at the mid- to long- from S$1.3 billion (FY2007–2011) governments in Korea started paying Health Organisation (WHO) Guide, the term, and consisted of workable tasks to S$5.1 billion (FY2012–2016). These attention to ageing. A committee was Seoul Metropolitan Government (SMG) that could be implemented within a investments reflect a priority to formed in the central government to drafted the “Seoul Comprehensive 3-year time frame (2013–2015). anchor care firmly in the community. discuss issues related to ageing in 2004. Seniors Plan” in 2012 as its first action Singapore continues to invest in The discussion, however, was heavily community care by bringing social geared towards addressing low-birth and healthcare services closer to the rates rather than ageing. people. This has led to the formation of the Silver Generation Office (SGO), The first plan to tackle the ageing issue
as well as an expansion of the in Seoul was the ‘2020 Aged Society E Community Networks for Seniors Master Plan’ drafted in 2010. This plan (CNS) programme. was significant for being the first of its kind to paint a picture of an ‘age-friendly Evaluation Report on Age-friendly Seoul Beyond Quality to Value city.’ However, few of its proposed
• This shift plays a pivotal role in goals were realised. Nonetheless it is The 1st Action Plan ensuring sustainability. Singapore important to note that this master plan adopts a multi-pronged approach laid a foundation proposing the way 2013-2015 in managing healthcare costs and forward for an age-friendly Seoul. has consistently reviewed its healthcare financing policies to More recently, Seoul and Singapore ensure that it remains affordable have launched master plans that guide through targeted subsidies. their planning for an ageing population. This section offers an overview of these Beyond Healthcare to Health master plans, highlighting how each city • This shift focuses on creating a has incorporated considerations of an supportive environment to encourage ageing population in its urban planning and support Singaporeans in leading and development, and how each city healthier lifestyles. is adapting its approaches in light of prevailing trends and anticipated challenges.
Singapore’s Approach: The 3 ‘Beyonds’
Age-Friendly Seoul Master Plan. Beyond Hospital Beyond Quality Beyond Healthcare to Community to Value to Health 20 PLANNING FOR AN AGE-FRIENDLY CITY PLANNING FOR AN AGE-FRIENDLY CITY 21
Seoul Comprehensive The eight themes were not directly Seoul’s Age-Friendly Master Plan Seoul’s focus on an Age-friendly Seniors Plan: Significance and adopted in the Seoul Comprehensive Environment is an integration of WHO’s Achievements Seniors Plan, however. Seoul reviewed Seoul’s plan differs from the WHO three thematic areas concerning the its own characteristics and conditions Guide, and from the approaches of physical environment. The plan was to An age-friendly city upholds active and came up with six topical areas for other cities, in its consideration for see how Seoul could enhance housing ageing, ageing-in-place, and generational its first Action Plan: (1) Support for Baby baby boomer support. When the first and local community environments integration as its key values. The Boomers, (2) Community Care, (3) Age- action plan was under development, for seniors. The process of exploring WHO’s Global Network of Age-friendly Friendly Environment, (4) Leisure and baby boomers (born between 1955 different programmes under this Cities and Communities (GNAFCC) Culture, (5) Respect and Integration, and 1963)36 accounted for 14% of the concept was significant because a wide has proposed eight themes to enable and (6) Customised Employment. city’s population, i.e. they were more range of projects have since been put these values. These are grouped populous than senior citizens over into action locally. Some examples into two major spheres: physical and The three GNAFCC-proposed themes age 65 at the time. However, there include the pilot age-friendly business social environments. Three themes— to do with the physical environment was no plan to support them in their project which was launched in 2016 to (1) Outdoor Spaces and Buildings, were combined into one topical area: preparation for retirement and old age. make local stores more age-friendly; (2) Transportation, and (3) Housing— “Age-Friendly Environment”. The Based on such observations, the Seoul the list also includes a pilot project cover the physical environment, while GNAFCC-proposed social themes implemented in 2017 to offer housing five other topical themes—(1) Social of ‘Respect and Social Inclusion’ and Metropolitan Government (SMG) made services to senior citizens, i.e. Borin Participation, (2) Respect and Social ‘Communication and Information’ support for baby boomers, to help baby Inclusion, (3) Civic Participation and were also combined into one in Seoul’s boomers design the next stage in their Housing. Employment, (4) Communication Seniors Plan. Seoul also added one lives, its top policy priority. Basic tasks and Information, and (5) Community more theme to its Plan: Support for were developed in this process, to which Tasks proposed in the areas of Support and Health Services—address Baby Boomers. goals implemented through specifically Leisure and Culture and Respect and the social environment. refined policies were added. Today, the Integration were an opportunity to SMG has 50+ Centers, a 50+ Campus, remind public and private service and other infrastructural facilities providers that leisure facilities for seniors are important and that these 6 Areas of Seoul’s 1st Action Plan designed to assist baby boomers with a wide array of services on offer. facilities should be developed into something local residents can also
Social Participation Outdoor spaces Customised employment has not share and enjoy. Seoul understands New and building performed as well as other areas in that it is important to disseminate Leisure Support terms of meeting its goals. To make information in an age-friendly way to and Culture for Baby Boomers Transportation structural improvements, further efforts engage mature-aged citizens. The city
Respect and have since been made to upgrade regularly publishes newsletters and social inclusion facilities and restructure relevant guidelines to keep seniors informed. Seoul 1st Age-friendly organisations to offer greater support Respect Action Plan: Environment towards employment. It is worth noting that the six areas Communication and inter- 6 Areas generation and information Housing proposed in the Seoul Comprehensive To ensure Community Care, a Seniors Plan realise the principles of certification system was enforced for active ageing and ageing-in-place, Customized Employment long-term care facilities, while systemic which are key to WHO’s concept of Community support Community Civic participation and health services Care and employment support was instituted to assist an age-friendly city. In other words, caregivers so as to improve the quality Seoul’s plan demonstrates the of care given to senior citizens. In the city government’s commitment to meantime, support continued to be incorporating WHO’s key concepts of offered to relevant projects. 22 PLANNING FOR AN AGE-FRIENDLY CITY PLANNING FOR AN AGE-FRIENDLY CITY 23
Age-Friendly Seoul Project process encourage different departments to work together more closely. Examples communicate and collaborate regularly. of this might include instituting an One practical option would be to official framework with which to check Establishment of mid- and long-term develop an umbrella plan and ensure the progress of projects regularly, or strategies in preparation for the Aged society 2010 that all the departments working on incentivising ideas and achievements to Establishment (2020 Aged Society Master Plan) of Strategies matters related to the senior population promote and extend relevant projects. 2011 are able to implement this plan. Establishment Establishment and Announcement The SMG has endeavoured to of Foundation of the 1st Action Plan During the development of the Seoul understand what the GNAFCC hopes 2012 (Seoul Comprehensive Plans for Establishment Senior Citizens)(in November) Comprehensive Seniors Plan, the Senior to realise in an age-friendly city. Composition of of Plan promotion system Citizen Support Division, which is in Seoul carefully studied the GNAFCC and enactment of 2013 Annual Evaluation charge of making the city age-friendly, guidelines and knowledge resources Joining of WHO of the 1st Action ordinance GNAFCC Plan, Study on led the way in investigating, sharing in order to upgrade its own ageing (Basic Senior Welfare Membership Act for an Age-friendly International Age- and discussing projects launched by policies and to develop better plans Seoul City) Joined 2014 friendly Practices, the different SMG divisions (e.g. public in the future. Seoul has continued the WHO Annual Creation of Seoul Evaluation GNAFCC as a Senior Policy health, transport, housing, park, design, to share such information with other member city 2015 Monitoring Group etc.) that would impact senior citizens. cities, deepening the GNAFCC’s (in June) Improvement Efforts Relevant officials from these divisions understanding of the Korean urban came together to share work done and context. Seoul is now poised for its Final Final evaluation of the 1st Action Plan, future plans, discuss improvements, second Action Plan. While the new plan nd Evaluation gathering of opinions for the 2 Action and confirm progress in each project. is set to be implemented in the next Plan, cooperation with domestic cities This approach is likely to continue if it is five years, the SMG needs to focus its not feasible to create a comprehensive interventions on the local community, active ageing and ageing-in-place in its the process became an opportunity for umbrella organisation: in which case in order to ensure that that citizens policies in order to respond effectively the SMG, and its internal policymakers it is imperative that support be given do indeed experience improvements to ageing issues. and partners in the public and private to ensure that the different divisions brought on by age-friendly initiatives. sectors, to appreciate what it takes to The Way Forward and Challenges be an age-friendly city. for Age-friendly Seoul Within the SMG, this understanding While establishing or improving of what it takes to be an age-friendly policies and services targeted at city resides mainly among city officials seniors is important, the SMG knows in the senior welfare divisions and that it is also vital that all of its policies related organisations. To develop and environments are designed from effective senior policies and plans in the a fresh perspective, and take the future, it will be important not only to senior population into account. This maintain this understanding, but also view has been profoundly influenced ensure that it is incorporated into other by the guidance and activities of the government policies as well. Seoul’s GNAFCC, of which it is a member. SMG experience suggests that it would be established and pursued the ‘Seoul best to establish an overarching task Comprehensive Seniors Plan’ as part force to supervise all matters pertinent Since 2014, the Senior Policy Monitoring Group has been evaluating the Seoul Master Plan and proposing of its bid to join the global network; to making the city age-friendly, and to improvements. 24 PLANNING FOR AN AGE-FRIENDLY CITY PLANNING FOR AN AGE-FRIENDLY CITY 25
learning, for work and for personal for a more inclusive society in which Singapore: Action Plan For Successful Ageing interest. They also wanted a greater the young respect and care for the old. range of activities to keep their In 2015, the MCA launched the S$3 and “listening points” at public spaces minds and bodies active, and desired The discussions also sought to billion Action Plan for Successful like libraries, shopping malls, and more volunteering opportunities that understand how seniors can be Ageing, which serves as Singapore’s universities. interest them, through which they can supported to remain independent blueprint to prepare for population apply their skills and expertise. and to age in the community. Seniors ageing. A wide range of topics were discussed highlighted the value and convenience at the public consultations. On Seniors also discussed what matters of having eldercare centres and primary The Action Plan was developed employment and lifelong learning, to them as they age, and what they care services like general practitioner following a series of consultations for example, seniors expressed their need in order to age well, such as clinics and polyclinics nearer their involving over 4,000 Singaporeans aspirations to work beyond the official good health and intergenerational homes. They also hoped to see more from all walks of life, through focus retirement age to remain financially interaction. They sought more access senior-friendly urban infrastructure, group discussions, online consultations independent. They wanted to keep to information on health issues, health such as public spaces or transport, checks and exercise opportunities near that would allow them to make their their homes or at their workplaces. They way around Singapore more easily also wanted more social spaces near and safely. Caregivers wanted greater their homes to be made available so assistance in caring for their loved that they can interact more frequently ones, such as respite care and financial with others. They voiced their hopes support.
ACTION PLAN FOR SUCCESSFUL AGEING Vision for a Successfully Ageing Singapore
OPPORTUNITIES KAMPONG CITY FOR ALL AGES FOR ALL AGES FOR ALL AGES Singapore will be a Singapore will be a Singapore will be place where everyone, caring and inclusive distinctive globally including seniors, society that respects not just for its can continually learn, and embraces seniors economic success, grow and achieve their as an integral part but also as a model fullest potential. of our cohesive for successful ageing. community.
Singapore’s Action Plan for Successful Ageing. 26 PLANNING FOR AN AGE-FRIENDLY CITY PLANNING FOR AN AGE-FRIENDLY CITY 27
These ideas and aspirations informed city through a range of initiatives and the Action Plan for Successful Ageing improvements in healthcare, housing, Factsheet on the Action Plan for Successful Ageing and its corresponding focus areas. transportation, parks, and research on ageing. WHAT WE HAVE ACHIEVED SO FAR The Action Plan seeks to build “A As of December 2017 unless otherwise specified Nation for All Ages” through more At the community level, Singapore In 2015, the Ministerial Committee on Ageing announced a S$3-Billion Action Plan for Successful Ageing covering over 70 initiatives in 12 areas to help Singaporeans age than 70 initiatives in 12 areas: health aims to encourage the community confidently and lead active lives, with strong bonds with family and community. and wellness, learning, volunteerism, to come together and build a employment, housing, transport, public Kampong For All Ages; the vision INDIVIDUAL LEVEL NATIONAL LEVEL spaces, respect and social inclusion, of a “kampong” (a Malay term for OPPORTUNITIES FOR ALL AGES CITY FOR ALL AGES retirement adequacy, healthcare and ‘village’) underscores the focus on Longevity is opportunity. Seniors can continue Live well and age confidently in place. Transform aged care, protection for vulnerable strengthening community support working, learning and growing as they enjoy Singapore into a city where Singaporeans can age seniors, and research. and care for the seniors and many more years of healthy life. gracefully and confidently. Seniors’ Health Programme enabling cohesive homes and inter- Research on Ageing Over 400,000 seniors reached 6 grant calls launched in home care, cognition, ageless generational harmony. through health talks and exercise Overview of the Action Plan for workplaces, assistive devices, frailty prevention and falls programmes. Successful Ageing prevention. At the individual level, Singapore is Workplace Health 44,000 mature workers reached in 7 sectors. Singapore’s vision of an age-friendly committed to enabling Opportunities Housing • 1st Active Ageing Hub at Kallang/Whampoa started city works on three levels: national, For All Ages, seeing longevity as an Learning in July 2017. Over 21,000 places across 900 courses provided under community and individual. opportunity and enabling seniors to National Silver Academy, benefitting close to 13,000 • 2nd Active Ageing Hub at Kampung Admiralty started in February 2018 continue working, learning, growing participants. At the national level, Singapore aims to as they enjoy many more years of Volunteerism Over 2,200 new senior volunteers as of Dec 2017. be a City For All Ages, transforming the healthy life. Aged Care Facilities (Increase from end-2015 to end-2017) Employment +23% nursing home beds From July 2016 to November 2017, 600 companies +16% home care places applied for the job redesign grant under enhanced +43% centre-based care places WorkPro, benefitting more than 9,500 older workers aged 50 and above. Parks COMMUNITY LEVEL • Parks incorporating more senior-friendly amenities KAMPONG FOR ALL AGES (e.g. senior-friendly fitness corners) • 3 therapeutic gardens opened at HortPark, Cohesive home with inter-generational harmony. We will Bishan-Ang Mo Kio Park and Tiong Bahru Park. involve the public, people and private sectors to strengthen community support and care for our seniors. • NParks’ “Design Guidelines for Therapeutic Gardens in Singapore” launched in Dementia Friendly Communities September 2017. 6 Dementia Friendly Communities in Yishun, MacPherson, Hong Kah North, Bedok, Queenstown and Fengshan. Reached out to over 23,000 individuals to support persons with dementia and their caregivers.
Inter-generational Harmony Over 15,000 students participated in inter-generational learning programmes. Transport 14 Silver Zones completed, 804 Green Man Plus crossings, >96% bus services made wheel-chair accessible.
A focus group discussion on the Action Plan. 28 PLANNING FOR AN AGE-FRIENDLY CITY PLANNING FOR AN AGE-FRIENDLY CITY 29
Summary of Seoul’s Age-Friendly Seoul Master Plan Summary of Singapore’s Action Plan for Successful Ageing
Developed based on World Health Developed by the Launched Launched Organisation (WHO) ‘Global 2012 Ministerial Committee on 2015 Age-Friendly Cities: A Guide’ Ageing (MCA). The Action in an effort to join the Global Network for Age-Friendly Plan serves as Singapore’s Cities and Communities blueprint to prepare for (GNAFCC) population ageing.
Kampong City for All Opportunities (village) for Vision Ages for All Ages All Ages
Age-Friendly City Active Ageing Ageing-in-Place Generational Key Concepts Integration
Employment Lifelong Volunteerism Health and Social learning wellness engagement and inclusion
Support Community Age-friendly Leisure and Respect and Customised Focus Areas for baby care environment culture integration employment Focus Areas boomers Aged care Housing Transport Public spaces Research services on ageing
Engagement Engagement 2nd Action • Via the Seoul Senior Policy Plan Monitoring Group since 2014 • Groups of about 50 people including youth and seniors • Review different aspects of the plan Engaged over Almost every year through discussions and “Listening points” Online 4,000 50 focus at public spaces like consultations site inspections group libraries, shopping nd Singaporeans • 2 Action Plan in preparation discussions malls and universities 30 PLANNING FOR AN AGE-FRIENDLY CITY PLANNING FOR AN AGE-FRIENDLY CITY 31
an Asian context. Academics from of recovering: as citizens grow older, Age-Friendly Cities: Seoul, Singapore and Beyond Seoul and Singapore—Dr. Miree Byun, their sense of loneliness increases as Director, Seoul Institute and Dr. Belinda they feel less empowered particularly Yuen, Director, Lee Kuan Yew Centre for after retirement. get a sense of what an age-friendly city Insights from the World Cities Innovative Cities, discussed current and means to comparable cities, other than Summit (WCS) 2018 Panel future research as well as challenges for Dr. Kiyota shared the example of her Seoul and Singapore, which have also Discussion Seoul and Singapore’s age-friendliness. community programme, Ibasho, which adopted or adapted an age-friendly The panel was also joined by Dr. Eric sees seniors empowered to plan and approach to planning holistically for The concept of ‘age-friendly cities’ has Chu, Mayor of New Taipei City, who develop a self-sustaining café and population ageing. been central to Seoul’s and Singapore’s provided insights from another swiftly day-care centre, fully run by seniors development of their master plans. ageing city in Asia, and Dr. Emi Kiyota, for the rest of the community. Elders The joint research team organised It was important for the team to an environmental gerontologist and come together to discuss disaster risk a high-level panel discussion at the understand how both cities assess their Founder of Ibasho, who provided global management and draw up their own World Cities Summit (WCS) in July progress to date in building an age- perspectives on age-friendly cities. evacuation maps in light of potential friendly city, and what they regard as 2018, in which representatives from earthquakes and flooding. Through Seoul, Singapore as well as New Taipei current and future challenges. It was Over 250 participants attended the Ibasho, seniors take ownership of a City discussed age-friendly cities in also useful for the research team to panel, from members of the public community resource and are drawn out to international delegates. The panel of their homes, thus preventing social discussion drew out several key isolation. characteristics of what it means to be an age-friendly city: Community support is key to an age- friendly city An age-friendly city empowers and enables its seniors An age-friendly city not only has to empower seniors, but also needs to The panel emphasised the importance leverage community support. Tapping of not seeing ageing as a problem on the community, for activities to be solved. Rather, problems arise such as befriending services or even when a city and its functions cannot having neighbours check in on elderly accommodate the physical and social neighbours, can help ensure a safer and needs of the elderly in the society. In the more liveable city for seniors. same vein, it is important not to treat seniors solely as recipients of policies Dr. Eric Chu, the Mayor of New Taipei and initiatives: they should be enabled City, shared about his city’s Time to be part of the solution as well. Dr. Banking initiative which lets seniors Miree Byun noted the importance of and citizens volunteer their services empowering seniors to help minimise to others in the neighbourhood, in risks of social isolation and perceived exchange for time credits that can be loneliness. She pointed out that the drawn on in future for their own needs. happiness index starts to decline in the Volunteers are trained by professionals Panel discussion at the World Cities Summit 2018. From left to right: Dr. Emi Kiyota, Dr. Eric Chu, Mayor of New Taipei City, Dr. Belinda Yuen, Director, Lee Kuan Yew Centre for Innovative Cities and Dr. Miree Byun, mid-40s, and continues to do so instead for 40 hours before they go into the Director, Seoul Institute. 32 PLANNING FOR AN AGE-FRIENDLY CITY PLANNING FOR AN AGE-FRIENDLY CITY 33
field. The time banking scheme has Using technology to build an age- should be on using technology to create much more inclined to sit at void decks seen 2,500 volunteers—most of them friendly city and sustain meaningful relationships with their friends than go to a senior seniors themselves—and over 272,304 that can support seniors. centre. Dr. Eric Chu concurred, noting hours deposited. While this has saved The impact of technology in creating that elderly males in New Taipei City are the government some resources and an age-friendly city emerged as a topic Gender disparity in participation less predisposed to participate in the manpower, it has more importantly of interest. Panelists discussed how activities, with only 10% of active senior helped nurture a community that can technology can alleviate some issues Panelists and participants also discussed citizens being male seniors as of 2011. care for its own seniors. such as rising healthcare costs, and the the persistent gender disparity in The discussion noted the importance of growing strain on manpower. Mayor participation in age-friendly initiatives. continuing to raise awareness, but also Another citywide dining programme, Chu called for private companies to Dr. Belinda Yuen noted that some elderly suggested redesigning programmes to ‘Dining with Seniors’, has also worked step up and experiment with innovative males in Singapore have expressed cater to elderly males, who wish to be through community support to help solutions, particularly in the healthcare disinterest in the programmes or seen as useful, such as by having them elderly citizens find companionship: at sector. Dr. Kiyota noted that while activities in the senior centres and are teach a craft or repair old appliances. 900 sites across the city, seniors can find technology is helpful, the emphasis others to eat a meal with.
Attendees ranged from members of the public to international delegates. 34 PLANNING FOR AN AGE-FRIENDLY CITY PLANNING FOR AN AGE-FRIENDLY CITY 35
Singapore: Innovative Planning and Design of 37 Age-Friendly initiatives in New Taipei City Age-Friendly Neighbourhoods
As part of the joint CLC-SI Panel on New Taipei City is Taiwan’s largest real success of New Taipei’s ageing began a campaign offering free Age-Friendly Cities at World Cities city, surpassing neighbouring initiatives lies in their management reading glasses to those aged 65 Summit (WCS) 2018, the Mayor of Taipei in both area size and of the ‘software’: changing attitudes, and older. Publicity materials were New Taipei City, Dr. Eric Chu was population. Since its establishment improving caregiving support and designed akin to a fashion spread, invited to share about New Taipei in 2010, New Taipei City’s focus working with stakeholders and drawing in seniors and challenging City’s population ageing and age- has shifted from creating jobs to community partners. perceptions of the elderly as passé friendly initiatives. retain and attract young people or disempowered. to addressing its rapidly ageing A main trope in New Taipei City’s No region will be more impacted demographic. ageing policy messaging is that New Taipei City also understands by population ageing than Asia.38 seniors are energetic, fashionable, that increased demand for care work Taiwan, South Korea and Singapore In 2012, the government formed a stylish and confident. Messages is intrinsically linked to population are ageing at a similar rate, with Senior Population Strategy Group work to remove the association of ageing. It works closely with its each expected to progress from with the aim of making New Taipei ageing with disease and disability, people to improve community an ‘aged society’ to ‘super-aged City more age-friendly. Similar fighting existing stigmas against support for caregivers. New Taipei society’ in about 7–8 years.39 In to actions taken by cities around seniors and nurturing inclusiveness. City pioneered a ‘Volunteer Time New Taipei City, Taiwan, seniors the world, New Taipei City has New Taipei City even finds Banking’ programme in 2013, currently make up 12.6% of citizens, since carried out infrastructural innovative ways of incorporating training participants to be voluntary a comparable proportion to Seoul’s improvements such as upgrading positive messaging into disease caregivers for current seniors. and Singapore’s percentage of public transport and making public management initiatives. In a bid Participants clock in caregiving hours seniors in the population. spaces barrier-free. However, the to encourage seniors to check and in ‘volunteer time accounts’ and treat presbyopia, New Taipei City can redeem these hours from other
Mayor Eric Chu dining with seniors at the Joint Dining for Seniors programme. Campaign advertisement on free reading glasses for those 65 and older. 36 PLANNING FOR AN AGE-FRIENDLY CITY PLANNING FOR AN AGE-FRIENDLY CITY 37
volunteers when they themselves entities. New Taipei City attributes share food and make friends. After Despite being a relatively ‘new’ grow old. Mobile Caretaker Cafes much of the success of its age- it was initiated by the government, city, New Taipei City’s experience also provide venues for caregivers friendly initiatives to autonomous many local communities, religious and dynamism in programming to rest, share experiences and seek community partners. An example groups and private entities took it for their ageing population offers professional advice on caregiving. of this is their popular ‘Joint Dining in stride to adapt the idea to their interesting insights for other for the Seniors’ programme where contexts, with some even pairing Asian cities on how to leverage on Finally, New Taipei City leverages seniors can visit 900 sites citywide to it with local farming initiatives. As society’s strengths to come up with the vibrancy of Taiwanese civil of 2017, the programme counts innovative and context-appropriate society, NGOs and private entities over 1.5 million participants; the solutions. to sustain and improve initiatives. initiative is also being adopted by In creating an age-friendly city, other Taiwanese cities. the New Taipei City government takes on the role of initiator and facilitator, allowing communities and private entities to take the lead in maintaining programmes. In addition, New Taipei City recognises that fiscal resources are limited; it thus channels efforts to building strong partnerships with private Caregivers resting at a mobile caretaker cafe.
Seniors prepare food together as part of the Joint Dining for Seniors programme.
Volunteer Time Banking. 38 AGEING-IN-PLACE AND ACTIVE AGEING 39
4. AGEING-IN-PLACE AND ACTIVE AGEING
Throughout the comparative studies community—as opposed to moving between Seoul and Singapore, two to an institutionalised care facility— aspects of ageing were evident and comfortably and independently even consistent in both cities: the need for as one ages. Ageing in institutionalised seniors to continue ‘ageing-in-place’ facilities can be more costly and it and the need to encourage seniors may reduce seniors’ independence to continue to live productively and and autonomy. On the other hand, purposefully through ‘active ageing’. facilitating seniors to age in a familiar neighbourhood empowers them, and allows them to maintain their connection Ageing-in-Place to social support—particularly the social networks that they have built up in the community over the years. Housing is a fundamental need for all and it is much more than a physical An ageing-in-place approach requires space. A dwelling space functions the urban environment, housing and as a foundation for maintaining supporting services to be adaptable and physical and emotional health as responsive in order to enable seniors to well as social ties. Ageing-in-place is comfortably and safely remain in their commonly understood as the ability homes and communities for as long as to continue living in one’s home and possible. 40 AGEING-IN-PLACE AND ACTIVE AGEING AGEING-IN-PLACE AND ACTIVE AGEING 41
Ageing-in-Place in Seoul and Korea has focused attention on the provision shops. HDB neighbourhoods Singapore’s efforts to support ageing- Singapore fourth type rather than the first three. are planned to be walkable in scale, to in-place is reflected in the building of However, as of 2015, only 0.3% (19,909) promote familiarity among neighbours senior-friendly housing, and in initiatives Seoul’s living and housing environment of the entire senior population—a mere and facilitate community development to ensure accessibility in the built for the elderly lacks several desirable 5.3% of seniors on welfare benefits as over time. environment through building codes features. About 71% of all senior of 2014—lived in such care facilities. stipulating barrier-free accessibility residents in the city live in a single- This indicates that the policy has so Since the majority of Singapore’s elderly and universal design. In selected towns person or a two-person household. By far helped only an extremely small live in public housing, an ageing-in- with a higher proportion of seniors, housing type, 39.4% of Seoul’s seniors number of low-income senior citizens. place approach allows seniors to remain infrastructure is also retrofitted (for live in apartment housing, while 59.1% There have also been limitations to in towns where they have established example by installing handle bars or live in detached or multi-family housing policies that encourage the elderly bonds with neighbours and are familiar levelling uneven roads) to make the with relatively poorer access to heating, to live within their local community. A with their surroundings. These are built environment more senior-friendly, security, waste collection and other considerable number of low-income sources of emotional and mental allowing seniors to go about their day residential services. In short, Korea’s seniors live in poor conditions (e.g., support to seniors as they age. independently and safely. housing policy for the elderly has not basement, semi-basement, rooftop been adequate or timely enough to structures), compromising the effects of meet changing needs. the homecare service.40
The first law to recognise the The Seoul Metropolitan Government significance of housing for the (SMG) has recognised the significant elderly was the Welfare of the Aged limitations of its housing policies for Act enacted in 1981, but full-scale the elderly. After joining the Global discussions only began in the 2000s Network of Age-friendly Cities and when Korea began to experience Communities (GNAFCC), the SMG population ageing. A study identified sees the concept of ageing-in-place as four prominent types of elderly a guiding principle of housing policy housing welfare services. The first for the elderly in future. The SMG is type, ‘homecare service’, provides now actively pursuing housing policies housing benefits and improvement based on the concept of ageing-in- services necessary to maintain a house. place, although this is still in its early The second is ‘public rental housing’, stages. The SMG’s experts and officials which provides seniors with ordinary feel that the time is ripe for developing public rental housing. The third type ageing-in-place programmes in Seoul. is ‘serviced senior housing’, whereby group homes and local community care In comparison, more than 80% of services are matched for the benefit of Singapore’s population live in public low-income seniors. While these three housing flats built by the Housing & housing service types are provided Development Board (HDB). Each HDB for those who live within their local town is planned to be sustainable and Majority of Singapore’s population live in public housing flats. community, the fourth type, ‘residential self-contained, with flats situated within welfare facility for the elderly’, takes walking distance of a neighbourhood in seniors who cannot live on their centre offering day-to-day amenities own. In its elderly housing policies, such as clinics, wet markets, eateries and 42 AGEING-IN-PLACE AND ACTIVE AGEING AGEING-IN-PLACE AND ACTIVE AGEING 43
Active Ageing as well as centres that facilitate and encourage the social participation and support active ageing. The box stories inclusion of seniors. Ageing is a natural process that As such, Seoul and Singapore also showcase local initiatives that everyone goes through. While there have dedicated efforts to maintain is no universal consensus on the seniors’ participation in the community definition of active ageing, the concept through programmes to support re- is associated with an individual’s or employment, volunteerism and lifelong population’s continued involvement in learning. Both cities have also ensured Overview of Case Studies life and quality of life.41 Being active that seniors can access services for as one ages goes beyond physical or good health and well-being even Age-Friendly Cities economic activity: it also means one as they age and their physical or continues to participate in various cognitive capacities decline. Most aspects of social life, including but importantly, the active ageing approach Ageing-In-Place Active Ageing not limited to social, civic and cultural is reflected in efforts to maintain an activities. inclusive community, in which seniors are empowered, well-integrated and To support population ageing, policies respected. and programmes should enable seniors Housing for Lifelong to stay active and healthy, remain Seniors Learning physically and cognitively engaged, Overview of Case while staying connected to their loved Studies ones as well as to the wider community. To better appreciate how Seoul and Active Ageing for Seniors in Seoul Singapore have translated the ageing- Well-being and Integrating and Singapore in-place and active ageing approaches, Wellness Needs the next chapter shares a series of case While barrier-free buildings and studies that the research team has safe neighbourhoods enhance the documented and reviewed. mobility and independence of ageing populations, both Seoul and Singapore To examine ageing-in-place, case Community- Centres for recognise that to be an age-friendly city studies feature Seoul’s and Singapore’s Based Support Active Ageing goes beyond the built environment—it senior-friendly housing, integrated requires social infrastructure that is age- developments and community- friendly also. based support efforts. Box stories highlight local efforts from both cities Inclusive Urban The active ageing strategies in both to develop age-friendly and inclusive Local Initiatives Design Seoul and Singapore are similar in focus. neighbourhoods. Both cities adopt an approach that recognises and values seniors as they To look at active ageing, the case studies age, and ensures that seniors continue investigate Seoul’s and Singapore’s to have access to opportunities for initiatives on lifelong learning and health, participation and security. employment, health and wellness, 44 CASE STUDIES SEOUL CASE STUDY LOCATIONS CASE STUDIES SEOUL CASE STUDY LOCATIONS 45
Seoul Case Study Locations
Shinnae Medical Housing (SMH) Reaching Out Community Service Center’s (ROCSC) Health Care Services
Open Kitchen
Seoul 50+ Foundation
Gwangjin-gu Socio- Economic Cluster
Environmental Design for the Cognitively Impaired Senior Welfare Centers and Day Care Centers Borin Housing 46 CASE STUDIES SINGAPORE CASE STUDY LOCATIONS CASE STUDIES SINGAPORE CASE STUDY LOCATIONS 47
Singapore Case Study Locations
National Silver Kampung Admiralty Academy (NSA)
Studio Wellness Kampungs Apartment (SA) and 2-room Flexi Scheme
Wellness Programme
Goodlife! Makan
Senior Activity Community Centres (SACs) Network for and Active Ageing Seniors (CNS) Hubs (AAHs) Innovative Planning and Design of Age-Friendly Neighbourhoods 48 CASE STUDIES ENVIRONMENTAL DESIGN FOR THE COGNITIVELY IMPAIRED AGEING-IN-PLACE 49
5. NO PLACE LIKE HOME: AGEING-IN-PLACE CASE STUDIES FROM SEOUL AND SINGAPORE
This chapter will examine how Seoul and Singapore enable ageing-in-place through senior-friendly housing and neighbourhoods, integrated medical and housing developments, strong community-based support systems and inclusive urban design.
Housing for Seniors Integrating Needs Seoul: Seoul: Borin Housing Shinnae Medical Housing (SMH) Singapore: Studio Apartment Singapore: (SA) and 2-room Flexi Kampung Admiralty Scheme
Community-Based Support Inclusive Urban Design Seoul: Seoul: Reaching Out Environmental Design Community Service for the Cognitively Center’s (ROCSC) Impaired Health Care Services Singapore: Innovative Singapore: Planning and Design Community Networks of Age-Friendly for Seniors (CNS) Neighbourhoods 50 AGEING-IN-PLACE AGEING-IN-PLACE 51
elderly, the young, and newlyweds. Eligibility for admission to HOUSING FOR Pursuant to the Special Act of Public Borin Housing: Housing, SH Corp purchases pre- • Geumcheon-gu resident existing houses and releases them • Aged 65 years or older SENIORS under a public lease scheme, so that • Lives alone citizens have access to a stable supply • Receives Basic Livelihood of housing. The SMG purchases 2,000 Security benefits units annually—1,500 units of multi- Seoul: Borin Housing family housing and 500 studio units. At Cost of living in Borin Housing: least 30% of purchased housing stock • Deposit: Background is allocated to seniors living alone, o KRW 10million (USD 9,040) young adults, newly-weds, artists, • Rent per month: Jointly supported by the Geumcheon- Since 2016, the concept has been single-parent families and women, on o KRW 60,000–70,000 (USD 55–63) gu district government, the Seoul implemented by local Gu governments a priority basis. • Maintenance fee Metropolitan Government (SMG), in Seoul and nationwide. and Seoul Housing and Communities The SMG decides on the supply Corporation (SH Corp), Borin Housing Geumcheon-gu, where the Borin of public rental housing to specific is a shared housing facility available Housing programme commenced, had target groups and borrows from on public lease for senior citizens over a significant number of low-income social investment funds to finance 65 years of age and living alone. seniors who lived alone in substandard the construction projects. SH Corp conditions. A Geumcheong-gu (1) proposes quantity and pricing The name Borin means ‘to protect government in-house survey in 2015 standards, (2) purchases new houses neighbours.’ The elderly in Borin found that 514 (31.8%) out of the 1,618 built by the private sector and (3) Housing live in a shared space so that older adults in the area lived on their oversees general maintenance and Eligibility and Cost they can protect and take care of one own in basement, semi-basement management. another. In a shared house, residents or rooftop units.42 Such units did not To be eligible for admission to Borin share a living room, kitchen and other receive sufficient daylight and were Community coordinators are Housing, a candidate must be a common areas but have their own often inadequately ventilated. Many of sometimes sent to support housing Geumcheon-gu resident aged 65 or bedroom and bathroom. While this the residents had to share a bathroom welfare services for the target tenants older who lives alone and receives type of housing is quite common in with other tenants. of shared accommodation. Private Basic Livelihood Security benefits. Europe and Japan, Seoul was the first contractors are responsible for general Pursuant to the National Basic city in South Korea to introduce such Based on this baseline data, the work related to construction, such Livelihood Security Act, benefit dwellings in 2013. Geumcheon-gu government proposed as the purchase of land, design, and recipients are defined as individuals a rental housing programme for elderly construction work. The Geumcheon- who earn no more than 30–50% of By accommodating multiple single-person households in the city. gu government selects tenants and the median income and the minimum households and sharing spaces, this This was accepted by the SMG and SH manages deposit loans along with cost of living. They are eligible for type of dwelling encourages and Corp. housing welfare services. The Happy livelihood, medical, housing and promotes community living. A fairly House Group at the Geumcheon education support provided by the new concept for the elderly in Seoul, The Borin Housing programme was Self-Sufficiency Center dispatches government. If the size and facilities all four Borin Housing projects (56 launched as part of a larger initiative managers to Borin Housing to support of the Borin Housing permits, households) are currently located in to provide public housing for lease to tenants and to source for external grandparents or single parent families Geumcheon-gu. target households, which include the programmes and resources. are also eligible. 52 AGEING-IN-PLACE AGEING-IN-PLACE 53
Demand for places is generally stable, It was found that many tenants had Overview of 4 Borin Houses with around 3 or 4 applications per lived in substandard housing with vacancy. As tenants are required to KRW 3–5 million in deposit and KRW share common areas and programmes 10,000–20,000 in rent. While the Borin Borin House Borin Haetsal with other tenants, they sign an Housing’s deposit is on average more agreement that establishes the rules expensive than tenants’ previous of shared living and maintenance. expenditure, it is approximately 30% The contract is renewed every two of local market rates for comparable Geumcheon-gu years. If eligibility conditions are accommodation. For those who satisfied, tenancy may be extended cannot afford the deposit, the for up to 20 years. Geumcheon-gu government offers a loan of up to 90% of the total Borin Dure Borin Hamgue Borin Housing tenants pay a deposit amount. Since most tenants are on of around KRW 10 million, rent of KRW welfare benefits, their monthly rent 60,000–70,000 per month, and an is paid with their housing benefits. extra amount as a maintenance fee. Borin Housing rents its parking space to neighbours for a fee; this is used to help tenants with their maintenance fees and to mitigate their financial burden. Location Doksan-2- Siheung-3- Doksan-2- Siheung-4- dong dong dong dong Advanced-age-friendly Spatial Design Land Area 217 m2 332.4 m2 202 m2 229 m2
As of 2018, there are four Borin Housing Total Building Floor Area 431 m2 623 m2 500 m2 497 m2 buildings in Geumcheon-gu. Buildings #1, #3, and #4 are primarily residential, Number of Floors Above Ground 5 4 5 5 and consist of studio units and a shared Interior of Borin House. community room on the ground level. Number of Households 16 10 14 16
Nationally Funded 1,040 1,040 910 1,120 Programme Cost City Funded (KRW 1 458 763 861 499 million) Total 1,498 1,903 1,771 1,619
DLIM Builder iBookee iBookee iBookee Architects
Completion Sep 2014 Sep 2015 Aug 2015 July 2015
Each unit has a folding chair for residents to wear Kitchen of Borin House. their shoes. 54 AGEING-IN-PLACE AGEING-IN-PLACE 55
The unit on the fifth floor of Building #1 tenants of a shared house to also Living Assistance and is allocated to one single parent family have sufficient independence and Management Bylaws (two residents) as it is relatively spacious privacy, iBookee made sure its for a one-person household. design incorporated studio units The Geumcheon-gu government has each with their own room, bathroom assigned Geumcheon Self-Sufficiency Building #2 was previously part of the and kitchen. Community spaces Center employees to Borin Housing SMG’s Dure Housing Program but have been included, to be used for as managers, to provide living was soon incorporated into the Borin meals together, meetings, welfare assistance to tenants. Managers check Housing system in collaboration with programmes or other events. The on tenants, accompany seniors to SH Corp and the Geumcheon-gu local entire building is designed to be medical clinics, maintain the building Painting activity organised for residents. government. Before Building #2 was barrier-free, to aid senior citizens and help seniors with their daily needs of limited local resources on Borin built, the area was occupied by a senior who are often limited in their physical and administrative issues. They also Housing, and the growing dependence community centre. To retain some of movements. Automatic sliding doors, work actively with local health and of seniors on the local government, this original purpose, the second floor elevators and handrails have been welfare services, managing resident managers and external resources for of Building #2 was converted to a senior installed. The floors of the common needs carefully to match public and help. community centre. Tenants have private areas and residential spaces have private resources. rooms, each with a kitchenette and been kept at the same height. Each In light of these concerns, seniors have bathroom. They share the living room unit features a folding chair (to help Personnel from public health begun to establish management rules and kitchen in the centre. residents to safely and comfortably centres visit the House weekly and take charge of their shared living wear/remove shoes) and a video to provide medical check-ups spaces. It started with Building #4 after According to iBookee, a social intercom for emergencies. A small while local government volunteer all the tenants had moved in. A conflict enterprise that built three of the garden has been built on the rooftop teams offer cleaning services. Local arose among tenants over the use of Borin Housing buildings, its design so tenants can grow their own organic volunteers provide services such as common areas and waste management. for the buildings focused on creating vegetables. Solar panels have also been acupuncture therapy and haircuts. The SMG sent in shared housing senior-friendly spaces. For example, fitted to reduce the shared costs of Local organisations, medical clinics and experts, who held four conflict resolution understanding that it is crucial for electricity and maintenance. businesses make other contributions workshops. in service and in kind. Such well- coordinated assistance has improved Apart from training in conflict the quality of life for tenants. resolution, other events were also held to bring tenants closer together, such A number of issues have emerged since as a bibimbap day. After numerous the establishment of Borin Housing. discussions, tenants finally established These include excessive concentration the ‘Geumcheon Borin Together House Management Rules’ in December 2016. The rules cover general principles that govern shared living at Borin Housing, including: the rights and responsibilities of tenants; tenant organisation and assembly; building maintenance and the use of maintenance fees; common areas and community programs; conflict
Dementia-prevention programmes are carried out resolution; and action in the event of rule Rooftop gardens allow residents to grow their own organic vegetables. at Borin Houses. violations. 56 AGEING-IN-PLACE AGEING-IN-PLACE 57
the elderly, which focuses on providing that this approach will help the Borin decent rental housing to low-income Housing programme go beyond its families. initial success and help make the entire local community age-friendly. Few or none of the Seoul’s current housing programmes specifically deal However, several issues remain to be with low-income senior citizens. Local addressed. Gu governments used pre-existing programmes and resources to provide The first is to encourage senior tenants adequate incentives for the private to stay independent. Comprehensive sector to build senior-only houses. In living assistance has indeed enhanced turn, private contractors have proposed their quality of life, but tenants have a safe and economical housing model grown increasingly dependent on quite unlike pre-existing group homes. external sources and service providers. It is tailored towards its intended target group of seniors, and balances shared The second issue is the equitable Residents get their hair cut by volunteers every month. living with privacy. It is also significant distribution of limited local resources. in combining housing cost assistance, There is concern that the concentration A good example of such collaborative • a cleaning leader, who inspects the living assistance, and management of local public and private resources efforts by seniors is a new system that cleanliness of the waste and recycling rules into one package to improve the on Borin Housing might deprive other assigns each tenant as a ‘leader.’ A area and common areas. overall quality of life for seniors. low-income senior citizens of benefits. leader is “a representative elected It may be worth considering opening by tenants to manage and maintain According to one expert who helped Borin Housing is an exemplary model up the common areas and programmes building, tenant health, and other given establish the rules, “seniors can often of ageing-in-place. It is based on to local low-income senior citizens. areas”. At Building #4, the tasks to be be stubborn, have strong personalities the approach of purchasing existing carried out by these ‘leaders’ are shared or are not used to discussion. The properties to be converted to rental The third issue is to ensure the among tenants. These roles include: leader system assigns small roles so that housing for seniors. Senior housing can continuity of housing and care, by seniors can share the responsibilities thus be provided in areas where the going beyond the Borin Housing • a liaison leader, who contacts external and make decisions together. It was elderly already live. programme to address elderly housing institutions in case of emergency; designed to give them a sense of needs in a broader context. The current belonging to the community.” This Smaller houses, with a capacity eligibility criteria for admission to • a visiting leader, who visits each management approach was also to hold up to 20 households, are Borin Housing does not consider the unit to see how tenants are doing applied to other Borin Housing more advantageous than larger health conditions of the elderly. There on weekends and holidays when the buildings in 2017. A satisfaction survey facilities. It is easier for tenants to is no specific plan to take care ofa manager is absent; conducted in 2018 aims to confirm the form a tight-knit community. Local tenant if one falls ill or is involved in efficacy of this system. • a rooftop leader, who manages the neighbours are less likely to protest an accident. More specific guidelines use of the rooftop and garden; against accommodating the socially should be established as to when and Conclusion vulnerable in their neighbourhood. on what basis a certain type of housing • a safety leader, who inspects the is matched with a senior citizen, based Borin Housing is a shared living space building facilities regularly and While the SMG does not provide on their individual age or health. It is leased by the public sector to low- reports any issue to the manager; seniors with assistance in going about also crucial to develop a good system income senior citizens living on their their day-to-day living, such support has of cooperation among the relevant own. It was established to overcome the been made available using local public authorities. limitations of Seoul’s housing policy for and private resources. It is expected 58 AGEING-IN-PLACE AGEING-IN-PLACE 59
Singapore: Studio Apartment (SA) and
2-room Flexi Scheme Pull cord
To better cater for independent elderly The SAs come in two sizes (35/36 living, the Housing & Development m2 and 45 m2) and can comfortably Board (HDB) unveiled the Studio accommodate a one- or two-person Apartment (SA) Scheme in 1998 as an household. The apartments are sold Support additional housing option for elderly on a 30-year lease, with the option to hand 43 bar flat owners aged 55 years and above. extend for another 10 years. Lever taps The SA Scheme enables seniors, who The units are in ready-to-occupy were mostly living in 3-room and 4-room condition: toilet and kitchen are fitted flat types, to unlock their housing equity with wall/floor tiles, window grilles, a Studio Apartment of 45 m2. by selling their existing flat and moving wardrobe, lighting, kitchen cabinets, into smaller senior-friendly flats. a cooker hood and hob and a water heater. Elderly-friendly features in the Generally, the elderly preferred SAs in SAs include lever taps, rocker switches, mixed rather than stand-alone blocks, Customised for independent non-slip tiles, levelled flooring between and the larger (45 m2) apartments over elderly living, the SAs allow different parts of the flat, a bathroom the smaller (35/36 m2) ones. seniors to: with support hand bars, an Alert Alarm Elderly-friendly features. System (AAS), an enlarged door eye • have easy access to amenities The SA Scheme was found to be a give priority to the elderly buying an and elderly support services viewer and support hand bars along relevant housing form for the elderly. SA near their married children or their • stay close to their children corridors. existing home. It also sets aside half the and friends Some 95% of the existing SA residents • continue living in familiar have expressed satisfaction with flat supply for those eligible under the The SA projects also feature an on-site surroundings their living environment.45 Half were scheme. drop-in centre for vulnerable seniors motivated to buy an SA because they living in the SA flats. These centres could realise financial gains from selling In the span of some 18 years, HDB has have basic alert alarm monitoring and their previous homes: usually a 3- or offered 72 SA projects, comprising over emergency response during operating 4-room HDB flat.46 Right-sizing from 11,900 units across Singapore. hours. These facilities are mainly a bigger flat to a smaller SA allowed operated by commercial operators them to unlock the value of their 2-room Flexi Scheme To facilitate ageing-in-place, the SAs or Voluntary Welfare Organisations existing properties. This often yielded were located in estates with well- (VWOs). substantial net proceeds averaging In August 2015, after incorporating established transportation networks, around $200,000 after (a) paying off public feedback, Ministry of National as well as easily accessible facilities Many seniors have taken advantage of outstanding housing loan for the Development (MND)/HDB announced and amenities. Nestled within the SA Scheme. It was found that two- existing flat, and (b) fully paying for the the new 2-room Flexi Scheme to cater established public housing blocks with thirds of them were below 65 years of to the diverse needs of families, singles 44 new SA. bigger flat types, seniors who were age. Half were living alone, being and the elderly. right-sizing to the SAs could continue divorced, single or widowed. 22% In 2013, the Studio Apartment Priority living in their familiar neighbourhood had remained in the same HDB town. Scheme (SAPS)47 was introduced to The scheme merged and replaced the and surroundings. 60 AGEING-IN-PLACE AGEING-IN-PLACE 61
it to HDB and be refunded the value The Future Ahead of the remaining lease of the flat. In the unfortunate event that the senior As society ages and more elderly passes away during their stay, the flat stay on their own, housing will be passed to their estates. Family for the elderly will need to go members, if eligible, can continue beyond infrastructural changes (i.e. living in the flat for the balance of the “Hardware”). Complementary social, lease. Alternatively, HDB will reimburse custodial and care services (i.e. the beneficiaries based on the value of “Heartware”) are also needed to the remaining lease of the flat. enable seniors to remain active, mobile and healthy. To ensure an adequate supply for the elderly, at least 40% of the 2-room Singapore’s concerns have primarily Flexi flat supply is set aside for seniors. to do with continuing to provide Half of this quota is allocated under accessible, quality and affordable care the Seniors Priority Scheme (SPS) to to seniors in a landscape with shrinking those who are right-sizing in a familiar family sizes and weaker caregiver environment or are applying to stay support for frail seniors. There is thus near their married child. a need for eldercare services to better integrate social and health aspects to Playground with fitness equipment. Unlike SAs, HDB will no longer provide meet seniors’ needs more holistically. fixed pull-cord alarm systems, as their SAs (specifically targeted at the elderly) • Flexible choice of fittings. positions are fixed. Instead, HDB has Nevertheless, as illustrated by the and 2-room flats (catered to general been working with partners to explore evolution of the SAs to 2-room Flexi buyers including families and singles),48 Elderly buyers of short lease flats electronic communication devices flats, supplying senior housing options which were similar in size. It offered flat can choose from three Optional and smart alert systems to monitor that meet changing lifestyles and buyers, including the elderly, increased Component Scheme packages. the safety and well-being of elderly preferences is a priority in Singapore’s flexibility through the following three These include flooring, sanitary HDB residents. Trials have already housing planning. MND and HDB features: fittings, built-in kitchen cabinets49 been conducted in some estates. continue to work closely with the with induction hobs and cooker Moving forward, residents will be able public and relevant stakeholders • Catering to the diverse housing hood, kitchen sink, water heater, to subscribe to smart alert systems to ensure housing provisions are needs of different flats buyers, i.e. window grilles and built-in available in the market directly from a responsive to present and upcoming the elderly, families and singles. wardrobe. service provider. HDB and the Ministry ageing trends. of Health (MOH) are also working • Flexible lease terms for senior The new 2-room Flexi Scheme supports together to provide elderly facilities citizens aged 55 and above. inclusive living by bringing together strategically in selected Built-To-Order people of different demographic (BTO) projects. Instead of a fixed 30-year lease profiles within the same estate. under the SA Scheme, the elderly The 2-room Flexi Scheme has seen can choose to buy a 2-room Flexi Similar to SAs, the short lease 2-room a higher take-up rate by the elderly 50 flat on short lease from 15 to45 Flexi flats cannot be sold or rented out (>90%), compared to the average years (in five-year increment), as long on the open market. If the elderly no take-up rate for SA projects (79%) as it covers them and their spouses longer need the flat, they may return launched in the first half of 2015. up to the age of 95 years. 62 AGEING-IN-PLACE AGEING-IN-PLACE 63
Singapore’s Public Housing Policies and Schemes for Seniors INTEGRATING Studio Apartment Scheme 2-room Flexi Scheme Smaller apartments with elderly- Under this scheme, NEEDS friendly features for seniors aged 55 seniors have the years and above. flexibility of choosing the length of lease for their 2-room Flexi flat Seoul: Shinnae Medical Housing (SMH) based on their needs as long as it covers Background them and their spouses up to the age of at Shinnae Medical Housing (SMH) required SMH to be located within least 95 years. is a public rental housing scheme a 500-metre radius of any municipal tailored to meet the medical needs hospital, community health centre or of the disadvantaged elderly. As part national medical institution. As the of Seoul Metropolitan Government’s first example of the project, SMH was (SMG) policy to provide 80,000 units located opposite the Seoul Medical of rental housing, SMH is a project to Center in Shinnae-dong, Jungnang- provide medical, welfare and healthcare gu. It opened in August 2015 with two services by combining the public rental buildings (B1–7th Floor) housing 222 housing facilities with the functions of households in total (92 households in public healthcare and medical services. 18 m2 units and 130 households in 29 m2 units). Households are spread over a Lease Buyback Scheme (LBS) To afford people with impaired mobility total ground area of 13,099.58 m2. Seniors may sell part of their flat’s lease to HDB and retain the length of lease based easier access to hospitals, the project on the age of the youngest owner. The proceeds will be used to top up their Central Provident Fund (CPF) Retirement Account (RA), and they will use their RA savings to join CPF LIFE for a lifelong monthly income.51 Furthermore, they will receive an additional cash bonus of up to SGD 20,000 (USD 14,607). The seniors can continue to stay in their flat after joining the scheme.
Enhancement for Active Seniors (EASE) EASE allows improvement items to be installed in the flats to make it more elderly- friendly. Eligible households enjoy subsidies of up to 95%. Depending on their flat type, the share of cost ranges from SGD 125 to SGD 312.50 (USD 91 to USD 228) for 3 improvement items, namely slip-resistant treatment to existing floor tiles, installation of grab bars and ramps.
Silver Housing Bonus (SHB) Up to SGD 20,000 (USD 14,607) cash bonus is given if the senior right-sizes to a smaller flat (up to 3-room) and uses some of the net sale proceeds to top up their CPF RA, and joins CPF LIFE for a lifelong monthly income.
Front view of Shinnae Medical Housing. 64 AGEING-IN-PLACE AGEING-IN-PLACE 65
SMG set up a Task Force to build as high blood pressure and diabetes Overview of Shinnae Medical Housing housing based on the medical needs or uses a wheelchair, can live in SMH. of residents in Korea. The Task Force Of the 212 units available in SMH, 70% Roles of Organisations established design requirements (147 households) were provided to and guidelines, bearing in mind elderly residents in Jungnang-gu. The Jungnang-Gu Local District Office potential residents such as the elderly remaining 30% were provided to Seoul Management and programming of community welfare SH Corp and people with disabilities. Publicly citizens who lived outside Jungnang- centres and community health centres. Construction of SMH and appointed architects provided advice gu. 10 housing units were set aside as housing management such on the project in general. Government a special provision for Seoul Medical Seoul Medical Center as building maintenance Provision of healthcare programmes for departments responsible for healthcare Center staff in charge of responding to and living support services. residents together with community health policy, the welfare of senior citizens and emergency situations. centres. Community health centres offer support for the disabled also provided residents free health consultation twice a active assistance in the planning and The residential costs of SMH are month and operate an emergency hotline implementation of the project. relatively lower than for public housing service to medical centres. in general. The rental cost for an 18 On July 28, 2015, the Jungnang-gu m2 unit for single-person households local district office, the Seoul Medical is KRW 120,000 a month with KRW 9.1 Center and the Seoul Housing and million in deposit; a 29 m2 unit for two- Communities Corporation (SH Corp) member households is KRW 190,000 a —three organisations in charge month with KRW 14 million in deposit. of operating and supporting the medical housing project—signed an Living Support Services agreement. The Jungnang-gu district government would be responsible for The superintendent’s office, operated operating senior community centres, by Dongdaemun Housing Welfare and managing community welfare Support Center under SH Corp, centres as well as community health oversees the maintenance of SMH and centres. Seoul Medical Center would provides support for the residents. On Eligible Residents Average Cost provide healthcare programmes for 21st April 2016, business agreements residents, in cooperation with the were signed with 8 different agencies Any resident of Seoul who is older than community health centres. The Center including: Municipal Senior Care 65, with a chronic disease, such as high offers a free health consultation twice a Center in Central Seoul, Shinnae 2 For single-member blood pressure and diabetes, or uses a 18m month, with a hotline to an emergency Municipal Senior Welfare Service households wheelchair medical centre. SH Corp would be Center, Wongwang Welfare Center KRW 120,000 (USD 107) a month with responsible for constructing the for the Disabled, Yeongan Welfare KRW 9.1 million (USD 8,136) deposit SMH, and for housing management: Foundation, Jungnang Fire Station, including maintenance and living Jungnang Police Station, Yongma support services. Municipal Senior Welfare Center and 2 For two-member the Seoul Kkottongnae Maintenance 9.5 29m households Qualifications and Residential Costs Foundation. These agreements provide for a range of senior welfare KRW 190,000 (USD 170) a month with KRW 14 million (USD 12,512) deposit Any resident of Seoul older than 65 programmes such as knitting, ping- years of age, with chronic diseases such pong, health consulting, health 66 AGEING-IN-PLACE AGEING-IN-PLACE 67
education, tests for dementia, haircuts, Place Design The 1st floor consists of the more spacious area for receiving visitors gardening classes and movie events superintendent’s office, restaurants, in lieu of the small studio units. It also as well as services such as preventive The two SMH buildings surround an cafés, care centre and welfare facilities. has a rest area connected to a nearby patrols, fire and safety training, inner court. The 1st and 2nd floors are Since the law limits what areas can be park. The hobby centre is intended for companion services and the offering of community spaces and the 3rd to 7th used for medical treatment, not all residents who share the same hobbies goods to residents. floors are residential areas. medical services are available in SMH. to exchange information and ideas. The care centre on the 1st floor offers Each facility is connected directly to simple medical services such as check- the residential area, and equipped with ups and physiotherapy. The SMH also a ramp for wheelchairs and a hand rail Neighbourhood Park carries a range of equipment such as for better access by residents. a blood pressure gauge, a diabeto- graph and emergency kits. This allows The rooftop, named the “Sky Rooftop Garden residents to monitor their health by Garden”, accommodates 80 sectors themselves. It also features a small- of vegetable gardening lots. Here, sized bathhouse for the elderly and residents can farm till November, Neighbourhood Building #1 Courtyard and Building #2 Parking Lots Park disabled with impaired mobility, as well after being randomly assigned a lot in as fitness centres. February. Having the residents grow a variety of vegetables and fruits and Rooftop Garden The community zone on the 2nd floor sharing their produce with neighbours is divided into a guesthouse and a promotes community spirit as well as hobby centre. The guesthouse is a emotional health. Entrances
Road (20 m)
Seoul Medical Center
Plot plan of Shinnae Medical Housing.
Residents getting their health check-ups. Community Zone.
Rendering of Shinnae Medical Housing. Equipment is provided for residents to monitor Each resident is assigned a lot at the rooftop Sky their own health. Garden. 68 AGEING-IN-PLACE AGEING-IN-PLACE 69
In addition, the interior and exterior SMH features a large entrance to of the SMH is designed as a barrier- ease access for wheelchairs and free zone. Differences in floor levels moving beds. There are patio chairs have been removed for easy access and handles so that the elderly with to the complex. The corridor width back pain can easily put on or take has been expanded to 2.1 m so that off their shoes. There are also special two wheelchairs can use it at the storage spaces for wheelchair-bound same time. In addition, the number residents. The threshold of each of ramps have been minimised. bathroom has been reduced to level Hand rails have been installed on the floor. A folding chair is installed the wall, to aid the elderly with in each bathroom, so that residents impaired mobility. Each unit in the can take a shower while seated. Interior of a unit. Toilet fitted with grab bars.
Ground plan of a 18 m2 unit.
Emergency alarm installed in the bathroom. Folding patio chairs with handles for residents to put on their shoes.
Ground plan of a 29 m2 unit. 70 AGEING-IN-PLACE AGEING-IN-PLACE 71
A significant feature of SMH is the life Conclusion rhythm checking system. A motion Singapore: Kampung Admiralty detector is installed in each unit, SMH is significant because it is the so that if any resident fails to use first project in which housing and the entrance, bathroom or any such medical services are integrated to facility for 24 hours or longer, the allow the elderly to live independently. superintendent will automatically However, some challenges remain. be notified. By doing so, the SMH managers can monitor the health First, medical service is not provided condition of residents and ensure that within each housing unit. While there the elderly who live alone do not die are national hospitals or public health alone. Moreover, emergency alarms centres within 500 metres of SMH, they are installed in several places in each are limited to providing emergency housing unit: such as in the bathroom medical services. At the very least, and living room. An emergency-bell amenities for providing first aid should necklace is provided to each resident: be available within individual homes. if they push the bell at any time, the superintendent will attend to Second, it is beneficial for the elderly them immediately. When necessary, to have stable housing for the long- residents can be referred to the 119 term. However, the SMH programme centre or Seoul Medical Center’s is limited in being able to cope with emergency room, under the ‘two-way the elderly who cannot live on their safety system.’ own. There is no plan to extend The first of its kind, Kampung Admiralty offers a wide variety of amenities for the Woodlands community. housing service to senior citizens who cannot carry out daily activities As part of the Singapore Government’s The location of the site, in the northern without caregivers. Eventually, the Two-Way Safety System effort to transform housing and part of Singapore next to Admiralty SMH programme should be linked to healthcare, Kampung Admiralty Mass Rapid Transit (MRT) station related services such as nursing care is the nation’s first public housing in Woodlands town, presented an Emergency facilities, so that the elderly can make Bell innovation for seniors aged 55 years opportunity to introduce innovative a smooth transition if needed. and above. It integrates residential land use strategies, such as the with healthcare, recreational and vertical integration of various facilities Third, senior housing in general is commercial facilities. Set amidst a under one roof. often not welcomed by the local lush green environment and offering 119 community, who adopt a ‘NIMBY’ Universal Design elements, this Design Concept (Not In My Backyard) attitude. modern kampung (a Malay word There needs to be good, ongoing 52 119 Superintendent’s Seoul which means village) serves as a Input from a range of public agencies Emergency Office Medical communication between the housing one-stop hub that helps senior led to the development of a robust Service Centre authority and local communities. citizens age-in-place, encouraging design brief, which emphasised them to live active and healthy tiered social spaces and the seamless lives through its innovative design, integration of uses. To accommodate communal spaces and sustainable various amenities within a tight site, features. the development was designed with facilities stacked up in layers. 72 AGEING-IN-PLACE AGEING-IN-PLACE 73
On the ground level, the brief called medical centre occupies the quieter 3rd for a large public space for community and 4th floors. A childcare centre and Unit Plans and List of Finishes and Fittings activities and interaction. For the mid- Active Ageing Hub (AAH) located on tier, a semi-public space was planned the 6th and 7th floors have been placed for residents and the community to next to each other to facilitate cross- exercise, relax, bond with neighbours programming. and friends, or participate in gardening activities at the community park and The studio apartments (of 36 m2 and farm. Studio apartments, beginning 45 m2) are housed in the two 11-storey from the 4th to 11th floors, constitute the blocks. Consisting of 8 units per floor, private spaces for residents. each studio apartment is designed to overlook the sky gardens. The Shops, a bank and a supermarket finishes and fittings have been carefully are located on the 1st floor and in the chosen to offer the elderly a safe and basement. A hawker centre on the 2nd comfortable living environment. floor overlooks the community plaza. A
Housing for Community the Elderly (2 Blocks) Garden
Community Park Community Active 2 2 Plaza Ageing Studio apartment of 36 m . Studio apartment of 45 m . Hub & Childcare
Floor plans of 36 m2 and 45 m2 units at Kampung Admiralty. Medical Centre At Kampung Admiralty, a total of 104 • Resilient (vinyl) strip flooring studio apartments are housed in two has been chosen for its slip- and 11-storey residential blocks. The floor moisture-resistant quality. It is plans of the 36 m2 and 45 m2 units are safe, durable and easy to clean. shown above. • Elderly-friendly and safety Shops/F&B Supermarket Hawker The units are in move-in condition, features, such as grab bars, a Outlets & Bank Centre complete with finishes and fittings ramp at the entrance of the carefully chosen to provide the unit and bigger switches, are Cross sectional perspective of Kampung Admiralty. elderly with a safe and comfortable also provided to aid mobility living environment. For example: and ageing-in-place. 74 AGEING-IN-PLACE AGEING-IN-PLACE 75
• The kitchen is fitted with cabinets, • A retractable clothes drying All the units were sold when they were Encouraging Active Living and a cooker hood and an induction rack is installed in the kitchen. first launched for sale in July 2014. Half Social Interaction hob. The induction hob was It can be swung out through of the flats were set aside for eligible chosen as a safer and cleaner the window to allow clothes to seniors under the Studio Apartment A key feature of this “vertical kampung” option for seniors. Unlike be dried outdoors. Priority Scheme (SAPS), which gives is the fully sheltered Community Plaza conventional gas or electric stoves, priority to elderly residents who want to on the ground level. The 1,000 m2 induction hobs do not involve age in place, or live near their parents plaza is an ideal venue for large scale open flames for cooking, thus or married children. About 6 in 10 of sports and fitness activities (such eliminating the risk of fire or gas those who bought a flat at Kampung as zumba, yoga or line dancing), leakage. The cooking zone also Admiralty were previously residents of educational events (such as cooking cools down faster and is easier to Woodlands or nearby towns such as classes, health talks, or handicraft clean. Sembawang or Yishun. workshops), performances (such as singing, cultural or talent shows), Besides optimising land use, the project festivities and so on. Such activities add was designed to achieve the following life and bustle to Woodlands town. objectives, through a combination of hardware, software and ‘heartware’:
• Encouraging Active Living and Social Interaction
• Promoting Intergenerational Bonding
Living room. Fitted kitchens come with an induction hob for safe cooking. Shelves in installed cabinets are • Facilitating Wellness and Care. adjustable, aiding individuals with limited reach. Residents contribute ideas for activities and events they would like to participate in at the Community Plaza.
Wheelchair accessible bathrooms fitted with Built-in cabinets and other fittings mean each grab bars. flat is ready to be moved into.
The Community Plaza is a vibrant spot where residents can enjoy events and activities all year round. For example, “Let’s Play @ Kampung Admiralty” is a community engagement effort that brings together residents of all ages through games and group activities. 76 AGEING-IN-PLACE AGEING-IN-PLACE 77
The tiered design of the community farm and gardens enables more greenery to be incorporated into the building, offering residents a lush and green environment which evokes the “kampung” feel of yesteryear. Seniors and children gardening together at the community farm.
At the high-rise Community Farm Promoting Intergenerational This helps improve the psychological Located on the 3rd and 4th level located on the rooftop, residents Bonding well-being of the elderly. of the complex, the Admiralty bond over gardening activities. The Medical Centre provides one-stop, 180 m2 community garden features Within the development, a childcare Facilitating Wellness and Care comprehensive medical services. more than 30 species of tropical centre is co-located with an AAH. Specialists from nearby Khoo Teck plants (such as fruit trees, herbs and The AAH promotes active ageing and At the AAH, active ageing programmes Puat Hospital deliver specialist spices, vegetables, and medicinal provides care services for seniors in (such as life skills courses for seniors) outpatient services, day surgery, plants), most of which are edible. the vicinity. The Community Park and a and preventive health programmes endoscopies, rehabilitation and playground are located in front of the (such as health checks and fall-risk diagnostic services to residents. An Through the National Parks Board two centres, so the young and old can screenings) help keep seniors in in-house Diabetes Centre provides (NParks)-led Community in Bloom interact and bond when using these the community healthy and safe. A care for complex diabetes patients. programme, residents harvest facilities. community nurse is on site to check To help residents stay healthy, the edibles from the Community Farm to the senior’s vitals and advise seniors, medical centre also provides a range use in their cooking. Such activities Weekly events such as musical referring them to specialised care if of community health education bring residents together through performances and outdoor gardening necessary. programmes and chronic disease a common hobby which also activities help to encourage inter- management. promotes health and well-being. generational bonding. Parents are A weekly Share-a-Pot® cooking session Besides outdoor gardening, indoor encouraged to be role models to their at the AAH mobilises the elderly to An on-site integrated pharmacy offers gardening workshops have also children, by visiting and delivering cook and partake in meals together. a range of personal care & wellness been organised to beautify the meals and groceries to seniors who are products, health supplements and indoor spaces at the AAH. less mobile or seniors who live alone. medication at affordable prices. 78 AGEING-IN-PLACE AGEING-IN-PLACE 79
Sustainable and Green Features and healthcare services, but also for Residents’ Wellness building strong community support for seniors and encouraging greater The lush greenery cascading from intergenerational bonding. the rooftop and throughout the entire development provide visual The approach in developing Kampung relief for both residents and visitors. Admirality was novel and holistic as it Rain gardens and bioswales to considered various facets of a senior’s treat surface water runoff further life—from living to health, family and “greenify” the landscape. community. Such a planning approach is needed for seniors to truly age in Other sustainable features include a place within their neighbourhoods. Pneumatic Waste Conveyance System which serves the entire development. The overwhelming interest from The system eliminates the need seniors to live in Kampung Admiralty Seniors whipping up a meal together during a “Share a Pot ®” cooking session at the Active Ageing Hub. for manual waste collection from indicates a large demand and individual refuse chutes. Solar panels preference for residing in such installed on top of the two residential integrated developments. The future blocks harness solar energy to power challenge then is in expanding and common services. adapting such developments to other neighbourhoods. HDB, together Conclusion with partner agencies, is currently exploring the feasibility of applying As Singapore’s first public the Kampung Admiralty model to integrated development, Kampung other towns, taking into consideration Admiralty is not only piloting a the particular needs of each town. new approach to integrate housing
Residents have easy access to specialist medical care services at the Admiralty Medical Centre.
To promote healthy eating, the centre are healthier choices. At the operators of the supermarket supermarket, there are dedicated and hawker centre at Kampung bays for products with the Healthier Admiralty have included healthier Choice Symbol, including organic options on their menus. Up to 50% products, brown rice and so on, to of food offerings at the hawker improve their visibility to shoppers. 80 AGEING-IN-PLACE AGEING-IN-PLACE 81
COMMUNITY- Spread of ROCSC Project in Seoul BASED SUPPORT
Dobong- gu Seoul: Reaching Out Community Service Nowon-gu Eunpyeong- gu Gangbuk- Center’s (ROCSC) Health Care Services gu
Seongbuk- gu Jungnang- gu Seodaemun- Jongno- Dongdaemun- gu gu gu
Gangseo-gu Jung-gu Mapo-gu Seongdong- Gangdong- gu Gwangjin- gu gu Yeongdeungpo- Yongsan-gu gu Yangcheon- gu Dongjak-gu Songpa-gu Gangnam- Guro-gu gu Seocho-gu Gwanak-gu
Geumcheon- gu Healthcare services provided at a senior’s home.
Reaching Out Community Service selective to universal, from application- All dongs of the local district Center (ROCSC) is a major project of based to discovery-based and from E.g. Gwangjin, Gangbuk, Yongsan the 6th democratically elected Seoul government-driven to public-private Metropolitan Government (SMG). With partnerships. The ROCSC project has Some dongs of the local district expanded personnel in each dong expanded from 80 dongs in 13 local E.g. Jung-gu, Jungnang, Seocho and Songpa office, the programme promotes citizen districts (2015) to 283 dongs in 18 local awareness of welfare and healthcare districts (2016) and to 342 dongs in 24 services and strengthens cooperation local districts (2017). Since August 2017, within the community. From the the national government has been 342 dongs in 24 local districts as of July 2017 (80% of the total) perspective of taking care of an ageing benchmarking the ROCSC project, population, ROCSC has revolutionised which has received ever more public services for elderly welfare and attention. healthcare, shifting the paradigm from 82 AGEING-IN-PLACE AGEING-IN-PLACE 83
Reaching Out Community Service offices. However, the reorganisation Seoul launched the ROCSC project as Third, SMG built a one-stop Center of the welfare delivery system by the a welfare programme to realise this service through cooperation with central government was hampered plan. It conducted a major reform of other agencies. Under Korea’s A number of welfare benefits are by a lack of manpower. Moreover, the dong offices, which are at the forefront welfare delivery system, the central distributed by local governments. national government’s broad approach of the welfare delivery system, with the government manages over 360 These include cash benefits, such to implementation did not fully reflect following steps: projects, while local governments as basic living assurance, and other local contexts. It only focused on oversee 170 projects. These are service benefits for the elderly, people improving service accessibility for the First, SMG increased the public carried out to different standards, with disabilities, children and youth. poor. workforce to a large extent. From 2011 making it difficult for the projects to to 2014, the number of beneficiaries benefit people in need. However, the In Seoul, these are administered by Mayor Park Won-soon, who took who receive benefits under various ROCSC system facilitates coordination the Gu district governments. Most office in 2011, has sought to expand systems had increased by 79%. between the administrative, welfare of these services are performed the welfare budget and policies of However, the public workforce had and health sectors at the dong office after applications are received at a Seoul, which had been considered increased by only 18%. The workforce level, so that a range of residents’ dong office. The dong is the smallest weak to date. SMG put forth its 3rd had to grow in order to ensure the issues (such as poverty, jobs and administrative authority in Seoul’s community welfare plan (2015–2018) smooth functioning of welfare systems. health) can be reviewed at once, and municipal system, and the role of each with an increased budget; its strategic In the past, the central government a comprehensive response provided. dong office in the welfare delivery goals were to strengthen universal and other municipalities had not been system is vital. Since the 1990s, the welfare, mitigate social polarisation, able to make much headway because Korean government has tried to revitalise local welfare community and they had not applied the appropriate improve the standard of public welfare strengthen the welfare delivery system. metrics whenever they attempted to through the reorganisation of dong reform the welfare delivery system. SMG increased the average number of welfare officers in each dong office by Changes in the Social Welfare Budget of SMG 5.8, and the number of visiting nurses by 1.2. As a result, a total of 2,450 2012 2013 2014 2015 2016 welfare workers and visiting nurses Total Budget have been added in Seoul from 2015 (KRW billion) 217,829 235,069 244,133 255,184 275,038 to 2017.
Second, SMG undertook an Net Budget administrative revolution: citizens (KRW billion) 199,496 206,287 215,498 228,427 242,350 would not need to go to public officials but public officials would reach out to them instead. Public social workers and Social Welfare nurses would visit not only the poor 51,658 60,285 68,425 78,349 83,452 Budget and vulnerable, but also all newborns (KRW billion) (25.9%) (29.2%) (31.8%) (34.3%) (34.4%) and the elderly, to ascertain their health and well-being. Public officials The ROCSC system facilitates coordination would also provide information and between the different sectors so that a range of residents’ issues, including health, can be services appropriate to each situation. reviewed at once. 84 AGEING-IN-PLACE AGEING-IN-PLACE 85
Fourth, SMG worked to create a Reaching Out Health Care multi-layered determinants: from aims to strengthen capacity not only health and welfare ecosystem in Services individual biologies and lifestyles to at the individual level but also at collaboration with private institutions national socio-economic conditions. the community level, with resident and community groups. This is In terms of Seoul’s efforts to be a There are also community-level factors participation and cooperation across because it is difficult to cope with the senior-friendly city, what is most such as the environment, economy, each sector. To accomplish this, SMG welfare and health needs of the local remarkable about the ROCSC project as well as the cultural contexts and set up a promotional strategy based community with only public resources. is its ‘Reaching Out Health Care social networks of the areas in which on the three values of Accessibility, Towards this end, ROCSC reformed Services’ initiative. The ROCSC’s people reside. In order to promote Sustainability and Integration along the system to facilitate cooperation vision for the healthcare sector is elderly health, the ROCSC project with eight detailed projects. between public and private “to live a long and healthy life in the organisations, in order to address community”—which aligns with the blind spots. At the same time, SMG principles of “Ageing-in-Place” and Vision System of the ROCSC Project for the Health Sector also promoted a supporting scheme “Active Ageing” in the World Health that allows the community to gather Organisation’s (WHO) guidelines for Vision resources through initiatives such an age-friendly city. Health promotion To live a long and healthy life in the community as community funding, community is essential for successful ageing, but planning and a vibrant community it needs to take into account complex, centre. Values (Strategies)
Accessibility Sustainability Integration Resolving blind Health promotion throughout Integration with the spots/health gaps the entire life cycle community
Projects
• Universal health • Health promotion • Integrated health- management visits for infants and young welfare services children • Intensive • Public-private management of • Health promotion cooperation high-risk groups for the elderly • Linking the • Provision of health resources of the information to community entire generations Health education class conducted under the Reaching Out Health Care Services initiative. 86 AGEING-IN-PLACE AGEING-IN-PLACE 87
The model to achieve accessibility Second, the government visits Fourth, a re-assessment on health system, public healthcare institutions and sustainability is the ‘Reaching the family and conducts a health levels is conducted annually. Each —such as the community health Out Health Care Service’. The elderly assessment. Consent to carry out elderly person’s management type centre, dementia supporting centre, over 65 years of age are visited by continuous management is obtained is re-adjusted according to the mental health promotion centre a public social worker and a visiting from the elderly person. Then they assessment results. If the subject and integrated support centre for nurse. So far, most public welfare are registered as a subject. Next, is able to manage their health by addiction management—are linked services have been means-tested, i.e. comprehensive health evaluation themselves or if the total period with private medical institutions provided based on residents’ wealth. and counselling are used to identify of non-visits exceeds two years, such as private clinics or hospitals However, services in the ROCSC risk factors and health problems for the registration of the subject is and “safe pharmacies”.53 Integrated project are provided universally to the target group. This evaluation cancelled. case management is provided by all the elderly regardless of their includes basic measurements such the dong as well as public welfare income level. Age 65, which marks as any degree of weakness, a To integrate service provision with programmes including long- the onset of senescence, tends geriatric depression scale the community, visiting nurses term medical treatment services. to indicate greater welfare needs. assessment, a suicide tendency provide healthcare services in Each dong office coordinates this There is tremendous room for test, a dental check-up, a screening collaboration with a range of local integration, taking into consideration improvement in health behaviours for dementia (MMSE-DS), and organisations and community their local context. for this segment (compared with the alcohol dependency. According groups. Under this cooperative elderly of a greater age), in terms to the results and health risk of providing health education and levels, subjects are divided into Cooperation System for Provision of Comprehensive Health information. It is meaningful for the intensive management group, Management Services public health and welfare officers to regular management group or the visit applicable households in this self-capacity supporting group. Private clinics/ Community Dementia age band, because it has turned In addition, an individual health hospitals health centres supporting the application-based approach of management plan for the elderly and branch centres current public welfare programmes is designed. Information, training offices into a discovery-based one. or services that could help them improve their health behaviours— Mental health promotion centres The Reaching Out Health Care such as quitting smoking, eating less Safe pharmacies Services are provided as follows: salt, taking medication or regular First, the government finds out exercise—are provided directly or ROCSC Integrated who it needs to visit. Based on indirectly. supporting resident registration information centres for or introductions by residents, all Third, different services appropriate Municipal Visiting nurses addiction management elderly persons between 65 and to each type of management hospital 301 for the elderly network 70 years old are identified. Then group are provided. The intensive the government schedules a visit management group is visited once Relationship by phone. In consultation with the a week or every other week. The with welfare National Health Service, health regular management group is Long-term and community information is used only for elderly visited once in 2–6 months. The self- medical support Biotope health treatment (case persons who have agreed to follow- capacity supporting group is visited ecosystem services management) up management during their health once in 4–12 months to receive examinations. health management services. 88 AGEING-IN-PLACE AGEING-IN-PLACE 89
How Reaching Out Health Care Services are Provided
DISCOVERY OF SUBJECTS In consultation with the 65 years old: National Health Service, A plan established by health information is the welfare planner List of eligible residents is compiled from: used only for elderly • Data in the Livelihood Welfare Comprehensive persons who have Information System 70 years old: agreed to follow up A plan established by • Dong residents registration network management during this the visiting nurse Happiness e-eum System health examination. • Neighbourhood officials
Health assessment REGISTRATION OF SUBJECTS The elderly Health risk factors and health AND HEALTH EVALUATION problems are identified from a Classification of Groups subjects are sorted into an intensive basic research table management group, and a health regular management consultation. Intensive Regular Self-capacity group or self-capacity Registration of supporting group. subjects 65 years old
Not vulnerable
Gave consent
CONTINUOUS HEALTH • The intensive management group: Should HEALTH REASSESSMENT MANAGEMENT be visited once every week or every other week • The regular management group: Should be visited every 2–6 months (working staff visits homes or external community A reassessment is conducted annually if the healthcare centre is referred to residents) subject is able to manage their health by JUNE • The self-capacity supporting group: Should themselves. If the total period of non-visit be visited every 4–12 months. exceeds 2 years, the registration is cancelled. 90 AGEING-IN-PLACE AGEING-IN-PLACE 91
Major Achievements of the Reaching Out Health Care Services First, the registration rates of the project, 6,461 senior health education Reaching Out Health Care Services in sessions were held, for 53,276 The health sector of the ROCSC project, with 80 dongs in the first year and 283 2017 were 53.8% for the elderly aged participants—a significant increase dongs in the second year, achieved the following results: 65 years or older, and 50.1% for those from the first year. aged 70 years or older. This indicates that services have been universally The Reaching Out Health Care Classification The 1st Year The 2nd Year provided to over half of the total elderly Services initiative has been very population under consideration. The successful in uncovering blind spots. Period July 2015 – July 2016 – visiting rate was 384.4%, meaning Through comprehensive tests for June 2016 June 2017 that nurses visited a patient about senior depression, suicidal tendencies, 3.8 times in a year. 25.0% of the cases dementia and weakness, 4.3% to 33.4% received continuous management. of elders in high-risk groups were Executing Dongs 283 dongs 80 dongs (including 80 dongs This shows that a regular healthcare discovered. Since seniors have impaired in the 1st year) programme has been implemented, mobility and lack health information, in lieu of a trend of one-off visits.57 In it is difficult for them to be examined terms of linking up health and medical through direct visit by the institutions. Elderly at the 63.4% 53.8% resources, there were 110,701 cases Hence, it is a significant achievement to age of 65 (10,405 persons) (34,618 persons) where public health and medical have found these subjects who might Registration Rate resources were linked together in the have otherwise been missed. community. In the second year of the Elderly at the 58.5% 50.1% age of 70 (7,327 persons) (28,488 persons) High-Risk Groups Discovered
Test High-Risk Persons Visiting Rate Subjects 650.5% 384.4% Discovered Senior Depression Test 3,700 persons 54 85,785 persons Continuous Mangement Rate (4.3%) 22.6% 25.0%
Suicide 2,119 persons Cases linked 22,036 cases 110,701 cases Tendency Test 14,124 persons (15.0%) Health & Medical Percentage 55 of seniors Resources 81.1% 102.9% Selective Test 41,411 persons 3,042 persons registered who for Dementia (7.3%) were linked56
35,684 persons 106,798 persons Number Weak (33.4%) Senior Test Senior 1,528 cases 6,461 cases Education Number of participants 13,049 persons 53,276 persons 92 AGEING-IN-PLACE AGEING-IN-PLACE 93
Users generally felt that the services were helpful to their own health management. Many dongs have actively conducted senior health promotion projects. The satisfaction rate for ROCSC has secluded seniors. It helps seniors who have brought healthy rice porridge to First, the purpose of visits is still focused been high. Of those who have used spend their elderly years at home lead 40 vulnerable households, including on resource input and service delivery. the services, 700 elders aged 65 years healthy and happy lives, by helping seniors and persons with disabilities, It is a bureaucratic process headed and 300 elders aged 70 years were them to engage with other people and once a month. These visits also keep by a dong office. This process needs surveyed on a scale of 1 to 5. The with the world outside their homes. It the elderly company, relieving them to become one in which residents’ respondents said they received the consists of three detailed programmes of their loneliness. This meaningful organisations can act independently healthcare and information they for physical activity, cultural experience collaboration between the public and to ensure that the visiting service can needed (3.93), the consultations and nutrition management. the private sectors resolves a welfare offer continuous management at the with visiting nurses were easy to blind spot, mitigating the elderly’s community level. In particular, there understand (4.23), the services Healthy food provision for seniors with loneliness and sense of alienation with should be caution about regarding the were helpful for their own health feeding difficulties and households regular communication and visits. community as a way to mobilise private management (3.82) and they were with persons with disabilities: Of resources to supplement insufficient satisfied with the quality of services in the 165 single households who are Conclusion public resources. The ROCSC project general (4.11). beneficiaries of the Basic Livelihood should also recognise that community Security allowance in Haengdang The ROCSC project aims to raise members are not merely the subjects of In addition, many dongs have actively 2-dong, 98 households (59.4%) are the minimum level of welfare and problems for the public sector and that conducted senior health promotion elderly persons who live alone. After health for Seoul citizens through knowledge and experience should be projects with community participation observing that some of the elderly had administrative innovation and public- shared with each other so that creative and cooperation. Some examples difficulty in eating, a community activist private cooperation. In particular, it solutions can be sought.58 include: in Haengdang 2-dong thought that has sought to implement community- healthy and digestible rice porridge based integrated care for the elderly Second, there should be better “Depression Out”: The disease should be provided. through the Reaching Out Health Care connections between healthcare and prevention department of Seongdong- Services and a variety of local resource welfare, and with higher healthcare gu operates a healthcare programme Since January 2016, the dong office partnerships. institutions. At present, horizontal called “Depression Out! Let’s meet and 7 members of the community cooperation between the health and outside the house” for depressed or association in Haengdang 2-dong However, the ROCSC initiative still has welfare sectors at the dong office level significant areas for improvement. remains low. Vertical cooperation in 94 AGEING-IN-PLACE AGEING-IN-PLACE 95
healthcare fields—such as community Institutional support is needed to health centres, municipal hospitals, prevent any potential adverse effects, Singapore: Community Network for private medical institutions and long- even while continuing to promote close Seniors (CNS) term care for the elderly—has not been collaboration between the public and elaborated in terms of respective roles. private sectors.60 Current segmented welfare health Given a rapidly ageing population voluntary welfare organisations, services have yet to be sufficiently Notwithstanding these issues, over the and smaller family sizes, Singapore grassroots organisation, regional health integrated and coordinated. In order past four years, the ROCSC project recognises the need to build a strong systems and government agencies. The to improve this situation, the dong has transformed dong offices—a front- community-based support system to objectives are to promote active ageing office should increase opportunities line administrative institution—into a support seniors as a complement to among seniors to keep them well, for mutual understanding and promote community-level health and welfare family-based support. Singapore’s extend befriending services to seniors approach has three aims: First, to keep living alone, and sew up health and joint activities between these sectors, service platform. With the dong office seniors physically healthy for as long social support for seniors with needs. such as through database sharing as a hub, other entities and resources as possible, enabling them to enjoy and community joint diagnoses. For for welfare, health and the community longer healthy life years. Second, Through CNS, Singapore is working the health sector, phased goals and support can now be concentrated to keep them socially engaged, towards a system with four layers of a process to collaborate with other and connected. It is highly likely minimising social isolation. Third, to community care: institutions and systems should be that Seoul’s age-friendly community enable them to age well in place for (i) outreach 59 set up. strategy will henceforth be centred on as long as possible, and minimise (ii) keeping seniors well the dong offices. New elderly services unnecessary acute care episodes (iii) community support Third, there is a need to maintain and programmes can be added to the or premature institutionalisation in (iv) senior-centric help. a balance between active state ROCSC project, instead of being nursing homes. intervention and the protection of operated independently. Efforts Outreach individual rights. The ROCSC project to integrate other groups such as The Community Networks for Seniors risks leaking personal information or women and children can also be (CNS) initiative brings together One goal of CNS is to put in place infringing privacy due to an excessive carried out through links with other different stakeholders in a community a basic system of “preventive health accumulation of sensitive personal projects under the ROCSC initiative. to jointly engage and support home visits” for seniors. A lead agency health and welfare information. Sharing This is why policies to make Seoul an Singapore’s seniors—these include in this effort is the Silver Generation such information with other public and age-friendly city should pay attention private organisations calls for caution. to the ROCSC project in future.
Befrienders are deployed to support seniors at higher risk of social isolation. 96 AGEING-IN-PLACE AGEING-IN-PLACE 97
Office (SGO). A community-based involved in following up with organisation, it honours seniors support include: the Social Service through face-to-face, personalised Office (SSO) for financial assistance, outreach and works with partners to Housing & Development Board (HDB) help seniors age gracefully. Since for home modifications under the SGO (formerly known as the Pioneer Enhancement for Active Seniors Generation Office) was established Programme (EASE), HPB and PA in 2014, it has trained over 3,000 for active ageing programmes Silver Generation (SG) Ambassadors and health screenings, Agency for and successfully engaged over Integrated Care (AIC) for home-based 420,000 seniors. In addition to or centre-based aged care services, communicating government policies, and relevant voluntary welfare SG Ambassadors play expanded roles organisations (VWOs) for community as frontliners of the community care befriending or family services. system to look out for health risks among the senior population and to Keeping seniors well A strong community-based support system allows seniors to age-in-place. encourage them to stay healthy. Another goal of CNS is to bring may have functional decline in vision, seniors. Using this data, the Ministry To help SG Ambassadors persuade basic healthcare services to seniors’ hearing, and oral health. Seniors with of Health (MOH) and AIC work with seniors to be active and socially doorsteps. This is similar to how abnormal screening results are given community befriending providers engaged, they carry tablets which healthcare was delivered to students appointments to mobile eye, hearing and PA to: (i) mobilise existing pools contain customised flyers on senior- via the School Health Service in the and dental services operated by our of befrienders and neighbour helpers, centric programmes within walking past. Periodic health checks were Regional Health Systems (RHS). This and (ii) systematically match seniors distance of their homes. These conducted for schoolchildren, and means that seniors can enjoy follow-up who live alone to befrienders and programmes, which are organised free follow-up treatment was given to care in community settings near their neighbour helpers. by the People’s Association (PA) those who needed it. Schoolchildren homes. or Health Promotion Board (HPB), also benefited from free immunisations • Befrienders: Seniors living alone include physical exercises, health and health education (e.g. proper To date, more than 300 functional who have consented to being talks, health coaching sessions and techniques of brushing teeth). A screening sessions have been referred to befriending services healthy nutrition classes, as well school-health equivalent programme completed. As part of building a will receive these services from as chronic health and functional for seniors would reinforce preventive community support system, SG Senior Activity Centres (SACs) if they screening sessions that can help to health strategies to promote general Ambassadors will help sign-up seniors stay in rental flats, or VWOs prevent frailty among seniors. health and wellness, and detect for functional screening during their appointed under the Community chronic diseases and decline in seniors’ door-to-door engagements. RHS and Befriending Programme (CBP) if After their door-to-door visits, SG functional abilities (i.e. vision, hearing CNS will then call seniors nearer to they stay in other areas. Befrienders Ambassadors complete a Post- and oral health and frailty) early, so the date to remind them to go for under SACs will make regular visits Engagement Form on the senior’s that timely intervention can be given to follow-up. to seniors’ home and invite them social, health and financial situation delay senescence. to join the daily activities in the and refer consenting seniors to active Community support SACs. Befrienders under CBP will ageing, befriending or care services. Preventive health screenings have make at least two home visits and Full-time SGO staff then follow up already been started island-wide in CNS also aims to build a network of two phone calls per month to with government agencies and community nodes such as Senior befrienders within the community to seniors and encourage them community partners to provide Activity Centres (SACs), Community ensure a pair of eyes for every senior to step out of their homes and join support for seniors with needs, closing Clubs (CCs) and Residents’ Committee who lives alone. Today, SG Ambassadors PA/HPB active ageing programmes the last mile of care. Organisations (RC) Centres to identify seniors who are already trained to identify such within the community. 98 AGEING-IN-PLACE AGEING-IN-PLACE 99
active ageing activities in their • Neighbour helpers: As a complement area, and provides information to family support, MOH/ about programmes. As of 31 INCLUSIVE AIC is also working with PA to December 2018, 2,900 seniors have identify neighbours to keep an eye been enrolled onto Care Line. URBAN DESIGN on seniors living alone staying within the same block/precinct. The Senior-centric help vision is that this network of neighbours will become the first line For seniors with complex needs, CNS responders to support seniors in the seeks to develop a network system on 61 event of an emergency (e.g. if a the ground to get help quickly and in a Seoul: Environmental Design for the Cognitively Impaired senior falls at home), and alert the coordinated manner. Social and health family as well as relevant agencies. needs are closely linked. For example, home to the largest number of the health outcomes of seniors may be The Challenge people diagnosed with dementia • Care Line: Seniors can also tap adversely affected by a lack of social of any local government in Korea: on Care Line for a baseline level support or when the “social last mile” is For a neighbourhood to be age- 64,178 as of 2015.64 of social support. Care Line is a not closed (e.g. no transport to attend friendly, it must have housing for 24/7 senior call centre operated by medical appointments). CNS links up senior citizens and appropriate Changi General Hospital. It healthcare services, social assistance outdoor amenities. Ageing-in- Senior citizens with mild dementia supports seniors in the community and community support so that the place supports senior citizens to who do not need to be admitted by providing urgent assistance to seniors benefit from a more holistic care go beyond the bounds of their to a care facility often refrain from seniors in distress, as well as tele- plan for their needs. home and into community spaces normal daily routines, or do not care services such as medication to be involved in diverse social leave home, due to fear of what reminders and tele-befriending. activities despite declining physical might ensue. This exacerbates their Care Line also alerts seniors on strength. According to the Seoul symptoms. According to the Seoul Metropolitan Government’s (SMG) Dementia Centre (2014), 62.7% Senior Population Survey (2016), of the city’s aged population with older citizens spend 7.6 hours of dementia do not move into a care their day outdoors.62 To ensure that facility but stay at home even after they enjoy and spend more and their symptoms worsen. Designing not less of such time, the outdoor better age-friendly outdoor spaces environment must be improved in therefore also means taking into age-friendly ways. account characteristics of cognitive impairment so that the affected Since elderly persons with dementia elderly can go about their daily lose their way easily due to cognitive routine. impairment, they are in more need of age-friendly outdoor spaces. In Cognitive Health Design as a South Korea, the number of persons Solution known to have dementia grew from 219,414 in 2008 to 323,858 in 2016— In light of this need, the SMG an increase of more than 100,000 became the first local government in persons in eight years.63 Seoul is Korea to introduce a ‘Pilot Program Existing stakeholders are brought together to support seniors. 100 AGEING-IN-PLACE AGEING-IN-PLACE 101
on Cognitive Health Design’ in occupants in public rental housing if they wished. Short bollard lighting 2014. It is designed to improve built in Shingil were at least 65 years of has been added for walking at night. environments and to encourage the age—twice the percentage of that The second design is ‘Memory elderly with deteriorating cognitive age group compared to the entire Ground’, an exercise area installed health to get out of their homes, city. As Cognitive Health Design for in a neglected basketball court at interact with neighbours and engage outdoor spaces is still in its infancy the rear of the complex. On one in physical activities. As part of the and high-rise apartment housing is wall, seven exercise routines to programme, the SMG selected the most common type of housing promote cognitive health have local Gu-district governments with a in Seoul, the Shingil apartments been painted for residents to try. higher percentage of senior citizens were the most appropriate testbed. The area has also been designed and demographic groups at greater to promote light physical exercise, risk of dementia. After a preliminary Seven design features for improving with painted lines inviting people study involving experts, residents the outdoor space have been to walk on them while maintaining and design workshops, plans were incorporated into this apartment their balance. One corner features drafted to make improvements to complex. Each design follows the a path studded with pressure points the outdoor environment. overarching concept of ‘Creating a for people to walk on and stimulate Memory-Building Community’. their feet at the same time. These One of the most noteworthy features help boost physical activity outcomes is a high-rise public rental The first design is ‘Memory Lane’, and improve health. housing project in Shingil-dong, a 220 m walking path around the Yeongdeungpo-gu. In Korea, the apartment complex. The pedestrian The third is ‘Memory Space’. maximum duration that residents path is coloured green while bumps Two pagodas rarely used by can stay in public housing is 50 years. are marked in yellow for high Benches are placed every 100 m for residents had been frequented Over time, the age of occupants only visibility. A bench has been installed pedestrians to rest. increases. As of 2016, 26% of the 851 every 100 m for pedestrians to rest
Underutilised basketball court transformed into a Memory Ground where residents can engage in 220 m Memory Lane walking path around the apartment complex. light exercises. 102 AGEING-IN-PLACE AGEING-IN-PLACE 103
The fourth design addition is The fifth design is ‘Memory ‘Memory Signs’. Signs on each Milestone,’ which involves floor lobby have been improved identifying three different parking in terms of contrast, brightness lots and entrances according to and saturation to help seniors who different themes proposed by are often confused by the low- occupants: Sun, Moon, and Stars. visibility of signs and identical- For instance, residents can easily looking entrances. Highly visible identify where they are to meet one colours have been used to mark another: “Use the Sun entrance”, the corresponding floors on the or “I’ll see you at Moon parking.” walls. Signs with unit numbers and Handrails, slip-proof floor features, directions have been installed at benches, and lighting have also floor corners to guide the elderly to been added. their homes.
by non-residents, leading to many complaints. The two pagodas have been improved and named ‘Sun Space’ and ‘Moon Space’. In Sun Space, a sundial has been painted on the ground; anyone standing can tell the time by their shadow. In addition, a layout of the complex and a compass have been added to enhance orientation, along with digital clocks showing the time and date.65 Moon Space has been fitted with a device that plays old pop music for senior citizens at the push of a button. Flower beds have been added to stimulate the senses and cognition.
Brightly coloured Memory Signs with all unit Moon-themed Memory Milestone carpark and numbers listed aid elderly residents to their entrance. Moon and Sun Spaces. homes. 104 AGEING-IN-PLACE AGEING-IN-PLACE 105
The sixth addition is ‘Memory days’ seem to help the elderly Effects and Outcomes outside their homes five times or Gallery,’ a place to remember the maintain cognitive health. They more a week, and another group old days and chat with others in also spark communication between In the pilot project with the Shingil that did so five times or more per the ground-level common area. the generations and with other public rental housing, these spatial day, increased by 6.7% and 16.2% The space has been decorated, by neighbours. improvements had empirically respectively. The percentage of residents from senior community significant effects. A survey those who use the outdoor space centres and the resident council, The seventh design feature is conducted on 53 residents aged 40 in the apartment complex for get- with props and photos harking ‘Memory Mailbox.’ The mailboxes or older to compare the outdoor togethers also increased from 49.1% back to the 1960s and 1970s. of 387 households have been space before April 2016 and after to 69.8%. There was a significant Such reminders of ‘the good old painted in different colours May 2017 yielded the following increase in the number of visits according to their floors, marked results:66 residents made to spaces inside the in large, highly visible numbers. complex that had been improved For 50 applicants, their favourite The serviceability levels of all seven by the programme: Memory Lane artworks were painted with the help outdoor space designs were rated (32%), Memory Space (20.4%) and of illustrators to create their own more highly than before.67 Some Memory Ground (18.5%). This ‘Memory Nameplate’. Thanks to of the changes indicated as most shows that such improvements these unique nameplates, senior effective were: improved visibility have indeed encouraged residents citizens are no longer confused by from Memory Milestone, floor signs to ’get out of the house’ more often. identical doors and unit numbers in the elevators (50%), and signs on when they come home. This has units and their respective directions The SMG has published and Memory Gallery with props and photos from helped them cognitively and has (50%) in the lobby area on each distributed guidebooks to further the past. also boosted their self-confidence. floor from Memory Signs. Other disseminate good cognitive health improvements to serviceability designs. The first, published in pointed out by residents included: 2016, is titled “Guide to Living slip-proof features on slopes Environments for Cognitive Health”. for Memory Lane and Memory It deals with interior design for Milestone (47.6%), and benches senior citizens. The following installed as part of Memory Space year, the SMG published three (42.9%) and Memory Lane (41%). guidebooks on residential, outdoor and facility environments. These Occupants were also found to be books have been distributed to more satisfied with the outcomes relevant institutions and other local of the seven design features. governments in the country. The Satisfaction was highest with the outdoor environment guidebook benches in the “Sun” Space of is now used in the pilot Memory Space (40.9%); Memory programme for Cognitive Health Mailbox (36.1%); the “Moon” Design. The facility guidebook Space (33%) of Memory Space; and offers guidance to those Memory Signs (31.9%). responsible for the city’s senior facility improvement projects, As for changes to social activities, such as Senior Welfare Centers the percentage of elders who went and Day Care Centers. Customised Memory Nameplates help residents distinguish doors that are otherwise identical. 106 AGEING-IN-PLACE AGEING-IN-PLACE 107
Singapore: Innovative Planning and Design of support or hinder mobility in older grab bars, slip-resistant treatment to Age-Friendly Neighbourhoods adults and their daily outdoor existing floor tiles and ramps in the activities. The provision and design homes of elderly. This retrofitting of social spaces, accessibility to is subsidised and aims to improve The Challenge Healthy ageing is defined as these spaces, and factors such mobility and comfort for elderly the process of developing and 69 as gradient, walking surface and residents. Singapore’s population is ageing maintaining the functional ability visibility can affect an older adults’ rapidly, and the changing that enables well-being as mobility and outdoor experience. Similarly, the Building and demographics will have significant one ages.68 Degeneration that For instance, a risk of falling at a Construction Authority (BCA) implications for the way we accompanies ageing will have certain location is likely to create has introduced a Universal plan and design our city and a negative influence on one’s Design guide to promote a built fear for older adults who frequent neighbourhoods. As Dr. Belinda mobility as it leads to problems with environment which addresses this path. A non-sheltered fitness Yuen, Research Director of the balance and walking. At the same the needs of seniors and people corner that is tucked away from Lee Li Ming Programme in Ageing time, there is research evidence of different abilities, such as sight is likely to be underutilised. As Urbanism at the Lee Kuan Yew to suggest that maintaining one’s wheelchair users. The guide gives such, it is important to create a built Centre for Innovative Cities mobility for as long as possible is urban design recommendations for environment that is age-friendly, (LKYCIC), Singapore University of beneficial in enhancing cognition, barrier-free accessibility that are which supports older adults’ Technology and Design (SUTD) improving physical performance, applicable not only to commercial movement, allows for outdoor points out: “An ideal ageing and preventing physical disability. buildings but also a wider range recreational and leisure activities, friendly neighbourhood should of building types, including and encourages them to interact be welcoming (inclusive for all), Planning, design, and management residential buildings as well as with people. 70 walkable, wonderful (with attractive of outdoor spaces in the public and community facilities. spaces) and warm (with human neighbourhood, where older The Land Transport Authority (LTA) interactions). The task is clear— people spend the majority of their Current State of Play has also piloted Silver Zones— to provide the opportunities that time, are important for healthy In Singapore, a number of neighbourhoods with specific encourage older people to get out ageing. The spatial qualities of built initiatives by multiple agencies and traffic policies, road infrastructure of the house and to support them environment have an important practitioners have been introduced and other design features to in their capacity to use the spaces influence on older people’s health to develop age-friendly schemes encourage motorists to slow around them.” and well-being, as they can either and design guidelines at the scale down and pedestrians to exercise of the home and buildings. For caution, given the high proportion example, Housing & Development of seniors living and travelling Board (HDB)’s Enhancement for in that neighbourhood.71 Other Active Seniors (EASE) programme age-friendly initiatives include provides retrofit features such as the introduction of therapeutic
HDB’s EASE LTA’s Silver BCA’s Universal NParks’ Seniors relaxing around the neighbourhood hawker centre. Scheme Zones Design Guide Therapeutic Gardens 108 AGEING-IN-PLACE AGEING-IN-PLACE 109
gardens in public parks by the Development (MND). The study, led environment in their residential the proposed design interventions National Parks Board (NParks). Four by Dr. Belinda Yuen from SUTD, is a neighbourhoods through various will be tested via the installation of such therapeutic gardens have multi-agency and multi-disciplinary qualitative and quantitative methods temporary prototypes at selected been piloted. They feature design project involving government including surveys, interviews, focus sites within the neighbourhoods. elements, based on the science of agencies such as the Urban group discussions and community Eventually, if deemed useful in aiding horticulture therapy, which have been Redevelopment Authority (URA), workshops. the mobility and outdoor activities shown to help improve the mental HDB, Ministry of Health (MOH), of older adults, these design health and well-being of the elderly, BCA, Agency for Integrated Care For instance, three community interventions may be adopted in and support the care of seniors with (AIC), and industry partners such as engagement workshops were other parts of the neighbourhoods. dementia and post-stroke patients.72 the Geriatric Education & Research carried out in June–July 2018 for A post-implementation review will each of the three neighbourhoods also be conducted to measure the Institute, CPG Consultants Ptd However, there are no overarching selected, with many residents aged impact of the design interventions Ltd, LEKKER Architects, and Tierra ‘age-friendly guidelines’ that 55 years and above. Through these on the overall physical, social and Design. unify different technical design workshops, the residents were able mental health of older residents. specifications for more efficient to share detailed aspects about The project concentrates on three downstream implementation. There the existing built environments Other key deliverables of the neighbourhoods in Singapore: Hong has also been limited research done that support or hinder their daily research study include the Kah North, MacPherson, and Toa to understand how older people movement and outdoor activities development of a Guidebook Payoh West, which were identified experience their neighbourhood within their neighbourhoods. for Planning and Designing Age as having a high percentage of older built environment as they go about Friendly Neighbourhood, as well adults aged 55 years and above, their everyday lives, and how the With the findings, the architectural as an Environmental Audit Toolkit, with buildings across different ages firms (CPG Consultants Ptd Ltd, which can be used by planners, built environment in turn influences and typologies. LEKKER Architects and Tierra architects, local town councils the older persons’ physical, social Design) will be coming up with or even residents themselves to and mental health and well-being. To better inform the planning creative design interventions for assess the age-friendliness of their Further research is therefore needed and design of age-friendly their assigned neighbourhood to neighbourhood spaces. in these areas, in order to develop neighbourhoods, the study seeks make it more age-friendly. Some of appropriate planning guidelines and to understand the physical, social, contextualised design interventions. cognitive and psychological dynamics of older adults and their ‘Innovative Planning and day-to-day interaction with the built Design of Age-Friendly Neighbourhoods in Singapore’ research study
The ongoing ‘Innovative Planning and Design of Age-Friendly Neighbourhoods in Singapore’ research study, which commenced in July 2017, is an 18-month project funded by the National Research Foundation and Ministry of National Community engagement workshops. Community engagement workshops. 110 ACTIVE AGEING 111
5. TIME OF OUR LIVES: ACTIVE AGEING CASE STUDIES FROM SEOUL AND SINGAPORE
This chapter will look into how Seoul and Singapore enable active ageing through efforts to promote lifelong learning, well-being and wellness as well as centres for active ageing. It also features two local initiatives—Open Kitchen in Seoul and Goodlife! Makan in Singapore that support active ageing in their respective cities.
Lifelong Learning Well-being and Wellness
Seoul: Seoul: Seoul 50+ Gwangjin Socio- Foundation Economic Cluster
Singapore: Singapore: National Silver Wellness in Academy (NSA) Communities
Centres for Active Ageing Local Initiatives
Seoul: Seoul: Senior Welfare Open Kitchen Centers and Day Care Centers Singapore: Goodlife! Makan Singapore: Senior Activity Centres (SACs) and Active Ageing Hubs (AAHs) 112 ACTIVE AGEING ACTIVE AGEING 113
Cross Sectional Perspective of Seoul 50+ Campus LIFELONG Computer LEARNING Room Auditorium
Counseling Seoul: Seoul 50+ Foundation Center
Background
Seoul citizens retire at the age of of age are highly anxious about, and 52.6 years, earlier than the national unprepared for, their lives after early average. The Seoul 50+ Foundation retirement. This ‘50+ generation’ wish was established to address the gap to keep working, so as to be financially Co-working Space between this early retirement age of independent and have a place outside 52.6 and the beginning of pension their homes that they can go to as part payouts at age 65. This is a period of of their daily routine. This generation is time in which mature-aged retirees with also motivated by a desire to explore insufficient income could fall through possibilities, fulfil their potential, and be the cracks in the social security system involved in society. They seek a good and be left financially unprepared for work-life balance and want to use their retirement. talents to give back to the community. They also want to be part of a social According to a 2015 study by the network based on common interests. Studio Above all, they yearn for a ‘space’ in Seoul Metropolitan Government Workshop (SMG), many individuals over 50 years which they can pursue new activities and challenges.
Yoga Room Open Garden
When the 50+ Campus is made available, it will be spatially significant. The over-50s really need their own space as much as they need work. For them, the 50+ Campus is simply indispensable as it offers the space they need.
Yu-mi Son The 50+ generation yearns for a ‘space’ in which they can pursue new activities and challenges. at the 2014 SMG Expert Meeting 114 ACTIVE AGEING ACTIVE AGEING 115
The Seoul 50+ Foundation was set up six regions across Seoul, and designs The Seoul 50+ Western Campus, in May 2016 for its education courses, as a think tank and a hub of networks and implements a range of 50+ job the first campus directly run by the heralding the official launch of the committed to helping the 50+ programmes. The Foundation also Foundation, began to recruit students SMG’s 50+ policies. generation create a new vision for the supports activities and community second half of their lives. As a control events proposed by those over age 50. tower for the SMG’s 50+ policies, the Furthermore, it helps local 50+ Centers Foundation uses its research activities implement their programmes in a more to propose policies. It offers education professional and effective manner. As they say, “when an old man dies, a library burns to the and counselling at 50+ Campus sites in ground.” That is how much experience and wisdom one person attains throughout their life. If we were to lose such experience and knowledge of baby boomers who flourished through the dynamic modern times, it would simply be a sheer loss to our country… 50+ Implementation System
Mayor Park Won-soon of Seoul from the 50+ Policy Master Plan announcement in June 2016
50+ Foundation 50+ Campus 50+ Center A control tower of 50+ A regional hub for 50+ An activity space and a policies life transitions guide for local 50+
It is a comprehensive The 50+ Foundation support centre that The Center fosters develops and offers systematic a local community disseminates education programmes where members of the 50+policies to expand and employment 50+ generation live infrastructure, mobilise opportunities for the active and meaningful resources and develop 50+ generation. It is lives through customised 50+job also a cultural space to social participation models. nurture a new mature programmes. adult culture.
Seoul 50+ Campus. 116 ACTIVE AGEING ACTIVE AGEING 117
Aims of the Seoul 50+ Foundation As part of strategies to uphold its potential for social contribution. The values and set its policies apart 50+ generation has a dual identity To ensure that services are tailored to sites and 50+ Centers. The Foundation from existing ones, the Foundation as ‘prosumers’ (consumers who also the needs of citizens, the Foundation focuses primarily on research and embraces an ‘Empowerment produce at the same time). seeks to build a 50+ framework in which programmes that deal with site-specific Movement’ philosophy. An roles are distributed and assigned agendas and users. Empowerment Movement is The Foundation’s platform has among the Foundation, 50+ Campus a campaign based on self- three aims. First, it provides shared empowerment: it enables individuals services such as a database on job to ‘solve one’s own problems’. opportunities, a shared office, an General Directions of the Foundation Empowered individuals work information centre, and community voluntarily together to find solutions support. Second, it serves as a network Share, match and to improve their lives, protect their hub for over-50s to connect with each Focus on site/user- connect people, oriented research rights, and engage with the local other and with other generations, institutions, organisations, and improved policy administrators, and community. One of the key objectives sectors and locations, in order to actionability resources of the Seoul 50+ Foundation is to help create networks, share information the 50+ generation to create their and draw benefits from a matching own community and find solutions system. Third, the platform will offer Enable policy services to problems, thereby kindling their a venue for a variety of initiatives. This and daily campaigns that own empowerment movement. The includes opportunities to test pilot transform the lives of the Benchmark innovations, over-50s as well as raise over-50s are policy beneficiaries, projects as well as provide physical from both home and public awareness and abroad, and localise them and a generally educated, asset- venues for activities. understanding of that rich generation with tremendous generation
3 Aims of the Foundation’s Platform
Provides shared Serves as a Offer a venue for services e.g. a network hub various initiatives. database on job for over-50s to This includes opportunities, a connect with opportunities to shared office, an each other and test pilot projects information centre, and with other generations, as well as provide physical community support sectors and locations, in venues for activities. order to create networks, share information and draw benefits from a matching system. The Foundation embraces an ‘Empowerment Movement’ philosophy in which individuals are enabled to ‘solve one’s own problems’. 118 ACTIVE AGEING ACTIVE AGEING 119
Educational Programmes objectives. Students select one Second Semester Courses at the Seoul 50+ Western according to their personal interests, Campus (2016) Under the auspices of the Foundation, preferences and circumstances. This the 50+ Campus develops and offers has been influenced in part by the courses customised to the needs of the academic system of the Rikkyo Second 50+ generation so that they may explore Stage College in Japan. and prepare for new modes of life. Key principles guide the planning and The ‘Department of Life Redesign’ running of these courses. These include: focuses on changing perceptions forming partnerships with relevant on life and old age and designing a organisations, steering clear of non- new life. The ‘Department of Career Department of Department of Career Department of Life Redesign Exploration Everyday Skills interactive teacher-to-student lectures Exploration’ offers education that and rote learning, matching education redefines the meaning of work and encourages participants to explore Change perceptions Redefine the meaning of work and • Sejong Art Center with work/activity, and facilitating and of life and old age and explore new career paths. Art & Culture encouraging citizen involvement. new career pathways. Lastly, the design a new life. School: Musical, ‘Department of Everyday Skills’ • 50+ Encore Career (Introduction Bongsan traditional • Seoul 50+Life to career exploration) mask dance, The 50+ Campus offers three helps students to acquire the daily School (Introductory haegeum playing departmental faculties, each with skills necessary to live a happy, course to the • 4050 New Career Workshop Campus) • House of My Life different educational content and independent life. • 50+ Business Start-up • Seoul 50+Time • Slow Fashion • ABCs of Starting and Workshop (Special guest Running a Non-profit lecture) • Cooking Class for • 50+ Vision through Social Middle-aged Men • The 7PM Salon Enterprises and Cooperatives (For those with • People+ current jobs) • International Development Photography Class and Social Economy • Volunteer Guide (Introductory/overseas visits) • Body & Mind Yoga • 50+ Life Design • Introduction: Farming Special Courses Counseling Center Renaissance and 50+ “ • 50+ Book Club City to Farm” • Life Photography • 50+ Odyssey: Visiting Farms Workshop • 50+ Travel Planning School • Chef Young’s Saturday Brunch • 50+ Guide to Starting Class an Urban B&B • 50+ Programs • 50+ City Commentator Training • Planned and • 50+ Creative Professionals managed by 50+ Training organisations and individuals • 50+ IT Maintenance Class • 50+ Professional Instructor Training
The 50+ Campus develops and offers courses customised to the needs of the 50+ generation. 120 ACTIVE AGEING ACTIVE AGEING 121
The Department of Life Redesign of the 50+ Campus, Seoul 50+ Life is best exemplified by the courses School is characterised by the following offered by Seoul 50+ Life School. As an process: introductory programme representative
Seoul 50+ Life School Process The courses arrange for students to meet with communities or people who have made small but meaningful changes.
First, the Dean and teaching staff—who are the same age as the students—lead the way. As mentors, they stimulate and establish rapport with students and help them along each step of the way, from learning preparation to Students are encouraged to volunteer for follow-up. Theirs is a relationship unlike any other. community groups and take up self-empowerment activities. The first class organised six communities— Leaders Forum, Ludens Tango, Value Bank, 50+ Play (movies and theatre), Jamshin (exploration of traditional cultural heritage), and 50+ Busking. They continue to engage in activities after graduation.
Students then submit a ‘letter of commitment’: a summary of what to add or subtract from their life, for selection. Students are selected based on the originality and value of their idea (‘lecture-shoppers’ are discouraged), diversity in age, gender and career background, and potential as fellow partners (open- mindedness and commitment to community). All formalities and ceremonial protocols are removed from graduation day. Instead, graduates make their graduation special by renewing their commitment to their way forward.
The core of these educational courses is not lectures but workshops that engage students both physically and mentally. The courses employ movies and plays to share Sixty classmates go on a two-day trip to celebrate and discuss the growing pains associated with adulthood their new beginning. as well as ways for different people—another ‘me’—to live together. 122 ACTIVE AGEING ACTIVE AGEING 123
Survey on the First Class of Graduates As the name indicates, the Department design a life they want (work, finance, of Career Exploration supports students social contribution, social relationships, as they explore the world of new family, leisure, and health). The second occupations. The training courses are activity is to identify the needs of “The School is for both designed to help students, both directly those being counselled and match the mind and the body.” and indirectly, to experience different them with the SMG’s or the Korean types of jobs and build their own vision central government’s policies and for their second career. programmes to make access easier. Today, the central government, local “The greatest assets are The Department of Everyday Skills governments and district governments my 60 new friends.” broadens the scope of existing cultural offer their own policies for the middle- and liberal arts education to ensure aged and elderly, but the over-50s that members of the 50+ generation are often unaware of the policies and acquire and develop all the ‘skills’ programmes from which they could necessary to lead a happy life. In this benefit. “The School is the starting context, ‘skills’ collectively refer to point of change.” knowledge, technical competence, For over-50s who visit the 50+ Campus “I want my general knowledge and insight. The for the first time, the 50+ Counseling husband to be my Department offers general culture and Centers serve as a reliable guide. At alumnus.” liberal arts classes as well as courses the Counseling Centers, consultants “An opportunity to transform my philosophy on ‘money’.” in skills that enable the over-50s to and moderators, of the same age as take care of basic needs on their own, the Campus users, examine individual as well as to prepare themselves, both needs to help design and build learning physically and mentally, for a second and activity plans. Campus users can begin with extensive counselling and “Experience at the beginning. THURSDAY School made me 1 6 design their roadmap forward step 2 7 3 8 “Busy Thursdays realize that citizens 4 9 Counselling Programmes by step, according to their interests 5 10 were mine of Seoul are truly and competencies. The 50+ Campus and mine only privileged.” at the School The 50+ Counseling Center is a programmes are built on the platform where everyone one-stop destination for counselling provided by the 50+ Counseling Center, “I was able to probe deep within experienced me and focus on myself.” customised to individuals, providing organically bringing together crucial growing pains.” information on education, jobs, finance, components such as counselling, leisure, and life design. The Centers education, job, and voluntary activities. “Through play a vital role, not only because communication “All 60 classmates were and appreciation, I alike and yet completely they provide counselling services, 50+ consultants are particularly learned things that I different. It was as but also because their services lay the indispensable in making policies never had in 50 years exhilarating as dating.” groundwork for the SMG’s 50+ policies, practical and effective. They are on of my life.” programmes and plans. the frontline of implementing 50+ “It was a time to policies, counselling students in hone the sword The 50+ Counseling Centers are their efforts to design their life, and “Time to contemplate over my that had grown engaged in two main counselling conducting a variety of studies and passive attitude toward life so far blunt over the activities, the first of which is to provide site surveys. How the students perform and my dynamic attitude toward last 50 years” life from now and forward.” professional consultation in seven areas and what they achieve will demonstrate that enable the 50+ generation to the potential of empowerment 124 ACTIVE AGEING ACTIVE AGEING 125
movements run by and for the 50+ resource persons that can help resolve Supporting Other 50+ From May to September 2016, 956 generation. Many empowered over- a wide array of social issues. It is useful, Organisations people in 98 communities benefitted 50s take part in Counseling Center when working with over-50s, to train and from support under this programme. activities, experimenting with this new support them to develop their own job The 50+ Organisation Support Program Community Plus facilitates activities counselling model shaped and enabled models, instead of falling back on the identifies and supports organisations after the completion of the 50+ Campus by collective intelligence. approaches typically adopted by public that are led and operated by the over- courses. Over-50s who complete their job programmes, such as one-on-one 50s themselves. Support is provided in courses get to organise a small group, Jobs Programmes job matching or job placement. three categories: establishment, initial plan their own projects and gain set-up, and growth. In 2016, a total of 27 experience on implementation. While the SMG has new 50+ policies Boram Job Program is an excellent organisations—nine in each category— in place, no magic bullet can resolve embodiment of the Foundation’s 50+ had their activities subsidised. Conclusion the issue of jobs once and for all. It job programme strategies. ‘Boram’ Five months after the start of the will also take much more than just means “purposeful, rewarding, or programme, half of the subsidised While the primary focus only a few the commitment of Seoul citizens. meaningful” in Korean. Although organisations had completed the years ago was on jobs, the 50+ In fact, the central government’s job the financial compensation is small, process for establishing a legal entity, generation in recent years has become employment programmes are of candidates are matched with jobs that or were about do so in the near future. increasingly interested in a wide considerably larger scope than those offer work and the opportunity to give For organisations that had been range of areas. A number of concerns of the SMG. With respect to jobs, it is back to society. When they complete subsidised for the initial set-up period relevant to the over-50s have emerged, vital that current policies are linked and a number of hours of education, they of two years or less, the programme including questions about who they coordinated with current jobs, even as are immediately encouraged to gain helped to broaden membership. Those want to spend their old age with, efforts continue to innovate solutions practical experience in their newly organisations subsidised for growth where they can live, what they can do based on what previous policies have chosen field. In 2016, the Seoul 50+ (with two or more years of activity), have to support themselves, what work they missed. Western Campus selected 472 over- expanded their network and projects. can do and so on. Different solutions 50s and assigned them to ten different have been developed by the over- In terms of employment, it is particularly fields via the Seoul Rewarding Jobs Community Plus is one of the 50s themselves: from experiments in important to accurately capture the programme. They are now actively programmes implemented by the shared living to learning communities features of jobs that the over-50s want engaged in various fields of work. 50+ Campus to provide support to or new businesses led by over-50s. and require. The Survey on the Needs the 50+ generation. Community Plus Such activities have evolved and of the 50+ Generation for the Second Research Activities assists over-50s in developing and progressed as the 50+ generation Stage of Life, conducted by the SMG in implementing educational, in-field, or continues to grapple with these issues. 2015, revealed two key findings. First, The Seoul 50+ Foundation’s research is social contribution projects to share over-50s increasingly want to fulfil their characterised by being field-oriented their knowledge, talent and experience. These inspiring developments life purpose by doing what they have and practically focused, without much This programme does not adhere to a demonstrate how empowerment always wanted to do, rather than what emphasis on theory or meta-discourse. fixed theme or format. Any community movements have taken the 50+ they have to do. Second, they want a Examples of their research include of three or more people aged 50 and generation beyond personal concerns life in which work, relationships and finding jobs suitable for the over- above is eligible to apply. A community for life after retirement, towards leisure are interconnected. They want 50s, and developing 50+ content. In receives up to KRW 500,000 as subsidy an entirely new stage of personal to work in a job they like, connect with addition, the Foundation is keen on for project implementation; it is also development in pursuit of social value as people as they do so, and earn a certain collective intelligence: it collaborates provided with access to a meeting well as a culture in which the elderly are level of income. with organisations that have practical space, conference rooms and other seen as creators and contributors. To experience in specific areas, as well as facilities. There are also opportunities for keep up with such divergent needs and The 50+ generation should be seen not with academic scholars, researchers communities to present extraordinary evolving aspirations, the SMG and its as an employment liability but valuable and over-50s eager to take part. cases and promote their projects. 50+ policies must also seek to change. 126 ACTIVE AGEING ACTIVE AGEING 127
community and society. To enable pairing students with seniors to Singapore: National Silver Academy (NSA) seniors to be cognitively and socially learn about topics such as public active, the Ministry of Health (MOH) speaking, social media and music. worked with the Ministry of Education Background wide range of subsidised courses for (MOE) to establish the NSA, to enable When it was first launched, the seniors aged 50 and above. seniors to pursue learning in diverse NSA offered over 10,000 learning The National Silver Academy (NSA) is areas according to their interests. places across 500 courses across 17 an initiative under Singapore’s Action NSA was set up in response to institutions. Since then, the NSA has Plan for Successful Ageing. Launched feedback from seniors that many The NSA offers three key types of grown from strength to strength and in May 2016, the Academy is not a would like to “learn for learning’s learning opportunities for seniors. now offers 20,000 learning places physical campus, but made up of a sake” and not necessarily for work or Course offerings include IT, media, across 1,000 courses and more than 35 network of over 30 post-secondary employability. Learning keeps their health and wellness, business and the institutions. Enhancements have since education institutions, community-based minds active, and allows them to stay arts: been made to the course offerings organisations and partners that offer a engaged with their family, friends, based on public feedback, to • Subsidised short courses include additional bite-size learning These subsidised short courses aim opportunities and modalities such as to equip seniors with life skills e-learning. such as home maintenance, financial planning for retirement and general knowledge on how to age well. There are also courses to aid skills upgrading at the 3 Learning Opportunities for workplace. Seniors
• “Exam-free” modules ITE, polytechnics and publicly- funded universities will open up selected modules to seniors, Subsidised short courses Class on Traditional Chinese Medicine (TCM). without the need for formal assessment, at a token fee. Seniors can attend these classes together with regular, younger students attending the same modules. “Exam-free” • Other learning opportunities modules The NSA will also offer the Intergenerational Learning Programme (ILP) and other ad- hoc learning opportunities such as talks and seminars organised by community-based organisations. Other learning opportunities The ILP aims to promote
Engaging seniors through active learning and pursuing interests. intergenerational bonding by 128 ACTIVE AGEING ACTIVE AGEING 129
The government provides heavy Conclusion subsidies for NSA courses to encourage course take up. On top NSA has helped seniors keep WELL-BEING AND of that, Singaporean seniors can use active with its accessible and varied their SkillsFuture Credits to defray out learning opportunities, each tailored WELLNESS of pocket costs for most courses post- to the diverse needs and interests government subsidies.73 of Singaporean seniors. As of 2018, 26,000 seniors have benefitted from 74 As part of its outreach efforts, The NSA’s course offerings and the reach Seoul: Gwanjin-gu Socio-Economic Cluster Council for Third Age organises NSA of the network continues to grow each roadshows in the community, and year. A study by Duke-NUS Medical operates a hotline to assist seniors with School’s Centre for Ageing Research Background signing up for learning opportunities. is being conducted to evaluate the impact of lifelong learning on seniors. In Seoul, seniors depend mainly on economy in the local community, state-provided vouchers to access resolve social issues and gather lessons private providers for their meals, learnt from success stories that could cleaning, laundry, and care services. be applied broadly. However, private sector services are often of low quality, do not engage As part of this programme, the SMG emotionally with the seniors, and are calls for citizen-involved initiatives therefore limited in satisfying needs. tailored to the specific needs of local Gu-districts. From these, SMG Gwangjin-gu’s Local Care Cluster is a selects preliminary and principal socio-economic cluster that integrates projects to support. The principal private sector senior care services projects are subsidised up to KRW within Seoul’s Gwangjin district. 500 million over three years. Gu Supported by a framework of social district governments apply for the enterprises and local community SSEZ grant under different themes, groups, it represents a pioneering based on their local needs. strategy to enable seniors to age actively and in place. In Gwangjin-gu, it was care services that were needed. Gwangjin-gu was Gwangjin-gu’s Local Care Cluster is selected in 2016 as a Special Care a project under Seoul Metropolitan Zone, with its project to establish an Government (SMG)’s Special Social integrative care service by forming Economic Zone (SSEZ) programme. a local cluster of social economy The SSEZ programme is an intensive resources. Gwangjin-gu is now in the local-specific programme to create third year of the SSEZ programme. a sustainable ecosystem of social 130 ACTIVE AGEING ACTIVE AGEING 131
Status of Special Social Economic Zone Projects in Seoul Gwangjin Social Economy Local Care Cluster Network (GSEN)
The Steering Group for Gwangjin- While the GSEN’s Local Care Cluster Principal projects Dobong- gu’s Special Care Zone is led sought to build a framework for an underway gu 2 primarily by the Gwangjin Social integrated life-cycle care service, it
Preliminary projects Eunpyeong- Gangbuk- Nowon-gu Economy Network (GSEN), a social began with aged care. Existing aged underway gu gu cooperative network consisting of care services provided in Seoul had a 1 social economy organisations and number of problems. 5 1 Seongbuk- Jungnang- local community groups located gu gu Jongno- in Gwangjin-gu. What began as a First, the rapid growth of Korea’s aged gu Dongdaemun- Seodaemun- gu network of 17 organisations in 2014 demographic, and changes in family gu Gangseo-gu Jung-gu soon grew considerably: by 2017, the structure, had resulted in higher 6 Seongdong- Gangdong- gu gu Mapo-gu Gwangjin- network had come to include some demand for elderly care services 3 gu 2 39 organisations, 690 staff, and 2,000 and lower service quality levels. In Yongsan-gu 4 Yeongdeungpo- cooperative members. 2017, the size of the care services Yangcheon- gu gu labour market was approximately 4 Dongjak-gu Songpa-gu Even before the GSEN started 643,346 people. However, only a Guro-gu Gangnam- gu operations, many of its member small percentage of this manpower Gwanak-gu Seocho-gu organisations were social enterprises was in public service; the rest were Geumcheon- gu that provided care services to the in private micro businesses—which 3 5 local community. The GSEN aimed made it difficult to manage the to bring together organisations quality of human resources pool and Local regeneration which were providing similar services. service levels. Young generation in the locality Local management enterprise This was to enhance solidarity and A social economy-based ecosystem established in Jangwi-dong collaboration, as well as to encourage Second, existing elderly care services designed for younger generations neighbourhood communities to were segmented according to the established in Gangbuk-gu Resource-cycling Resource-cycling network built become more active, thereby paving type of providers and not by actual the way for an ecosystem of social needs. In other words, institution- Leather industry Sewing industry economy in Gwangjin-gu. The GSEN bound services, homecare, hygiene A cooperative system of leather and A fashion industry ecosystem built wanted its members to devote their and cleaning services, nutritious meal fashion industry established using local industries time to attending to those in need provision, and services catering to and nurturing a happy community, emotional and mental needs were all Lifecycle care Neighborhoods & schools Projects of collaboration among rather than worrying about sales. A separately provided by different care A school-based social economy local social economy enterprises number of strategies were proposed providers. cluster established providing care services towards this end: one of them, the formation of a Local Care Cluster, was The GSEN decided that success Childcare Young generation in the locality A social economy model of childcare submitted to the SSEZ programme would be more likely if these social ‘Dongjak Young Adults Community’ developed for consideration. enterprises were to work together built to help young adults based on a socially responsible Culture and arts tourism elderly care business model for the Develop cultural/arts tourism Childcare public good. programmes and interactive culture and art services near Hongdae 132 ACTIVE AGEING ACTIVE AGEING 133
In fact, the GSEN was well-equipped offering education programmes to train GSEN Local Care Cluster’s Members and the to pursue such a business model. First, senior as employees and instructors. Aged Care Services They Provide many of its members were capable and experienced aged care service The GSEN also promoted collaboration providers. One of these is Gwangjin between its member organisations to Social cooperative Gj-Care Care (Gj-Care), the nation’s first social advance individual services while also cooperative to be designated and building a framework for integrative certified by the Ministry of Health care services. Members shared their and Welfare. Since 2008, Gj-Care has expertise and experience to improve Lifecycle social care provided lifestyle services, including: service levels and to develop new care service bathing, domestic help, activities services. The GSEN was also able to In’s Home Nutritional Well- and outings, conversation and combine various service channels to Care cleaning, care, easy- Union companionship. Another example ensure economies of scale, and to offer hygiene Social to-swallow economy is Well-Union, founded in 2011. one-stop services to meet a range of service food cluster Well-Union is a social enterprise needs. that develops and sells nutritious Traditional music aged-friendly food, offers nutrition Furthermore, with Gj-Care’s membership, Instructors, entertainment assessment for senior citizens, and the GSEN had access to individuals new social for healing & service provides nutrition consulting to small who would need new aged care emotional care welfare facilities. Others include In’s services. As of 2017, Gwangjin-gu’s Korea Music Care, a social enterprise specialising in public elderly care services were Senior Teaching Academy home cleaning, hygiene management offered to 1,477 persons; 13.1% of the cooperative for Children and pest control; the Korea Music services was provided through Gj-Care. (KMTAC) Teaching Academy for Children Numbering nearly 200, Gj-Care service (KMTAC), which uses traditional music recipients were potential customers for to offer emotional care and therapy the new services provided through the Expansion of Social Care in GSEN Local Care Cluster services; and senior cooperatives Local Care Cluster.
Market Share of Gj-Care Culture & Hygiene & Emotional Cleaning Bonding (Project 2) (Project 2) Domestic Activity Home Aged Category Help and for the Subtotal Care Care Nursing Disabled Social Economy Expansion Cluster Expansion Total Users 981 94 18 384 1,477 (Project 1)
Gj-Care Users 38 36 13 107 194
Healthy Food Care Percentage (%) 3.9 38.3 72.2 27.9 13.1 (Project 2) (Project 2) 134 ACTIVE AGEING ACTIVE AGEING 135
Since 2016, the Local Care Cluster has provided the following integrated senior services: Conclusion
Integrated Senior Services Provided since 2016 The Gwangjin-gu Local Care Cluster is have a broader, positive impact on significant in creating a local community intergenerational relations and the model of elderly lifestyle services social involvement of the elderly: two Service Category Number of Recipients, Description based on a social economy and local important elements stressed in the Hours, Cases community support. This model is World Health Organization (WHO)’s NURSING CARE quite unlike current ones provided by guidelines for age-friendly cities. • Caregiver visits the state or the market. How social persons, • Physical activity up to 36 Lifestyle 5 hours a month enterprises form a cluster to improve However, for the Gwangjin-gu Local Services 174 hours • Domestic help the quality of one-stop elderly care Care Cluster to be expanded as a • Lifestyle support services and meet the needs of the major element of a broader age- elderly is well worth benchmarking. friendly city strategy, some concerns NUTRITIONAL CARE will have to be addressed. • Texture-modified/patient A social economy grows and meals (17 kinds, 300g per progresses when members of the First, public support should be serving, 300kcal) local community are involved in its continued after the SSEZ project ends. persons, • 7 packs delivered weekly Nutritional 109 for 3 months production and use at a larger scale. In particular, financial support from the Services 2,079cases • Monthly visits by public sector must be secured in order nutritionist In its first year, Gwangjin-gu’s Special to keep public welfare affordable. • Nutrition assessment and consulting Care Zone programme targeted 600 senior citizens who used care Second, the Local Care Cluster is services; by its second year, GSEN being administered throughout the HYGIENE CARE had 2,500 staff and members. In the whole Gwangjin-gu with a population • 2–4 cleaning and hygiene third year, GSEN’s goal is to attract of 350,000. In future, the service managers Cleaning 79 persons, • Eco-friendly cleaning and more local residents and increase the should be subdivided at the smaller Services steam cleaning services membership to 10,000. Care services dong level to provide even better 212 cases • Dusting, cleaning, would then no longer be confined to customised community services. disinfection, polishing the elderly but can be expanded to meet the needs of the entire life-cycle, Third, connecting various care • Blanket / comforter including single-person households services from social enterprises is persons, Laundry 24 laundry service (collected and children who do not have access a meaningful task. The Local Care Services by car, laundered and 85 cases delivered home) to proper meals. This will enable the Cluster’s integration effort should be elderly to interact with people of other further expanded to link up with other age groups. It may even encourage services essential to elderly living, EMOTIONAL CARE them to join the other side of the care such as housing, health, and welfare. • Music (folk music, service desk. Such approaches may persons, traditional drum, ukulele, Emotional 33 etc.) and creative activities, Services times once a week for 3 months 174 (12 times)
TOTAL 250 persons 2,697 cases 136 ACTIVE AGEING ACTIVE AGEING 137
Under the Wellness Programme, health Singapore: Wellness In Communities services, health education, senior learning and volunteerism are delivered at the community level. Caring for seniors’ health and wellness Wellness Programme traditionally takes place at home or Main Initiatives in dedicated medical facilities. In Background Singapore, apart from medicalised care in clinics and hospitals, families A key channel through which active are largely expected to care for a ageing programmes are provided is senior’s well-being. However, there the People’s Association (PA). PA is a are emerging trends shifting the focus statutory board which promotes racial National University Hospital (NUH) Mobile of health and wellness towards the harmony, community bonding and Hearing Clinic. community. social cohesion in neighbourhoods. In addition to looking after the health The PA’s Senior Citizens Executive of individuals, the Wellness Programme Household structures are changing— Committees (SCECs) constitute the also keeps seniors socially and families are getting smaller and largest seniors’ network in Singapore. physically engaged through community more seniors are living alone. This Through this network, the PA plans and programmes and interest groups means seniors may have less access organises a wide array of activities and organised by CCs, various committees to familial support, thereby running courses to enrich the life experiences of and networks, and by seniors greater risks of social isolation senior citizens, such as sports and dance themselves. These programmes include Basic Health Screening conducted as part of the and poor health. However, family activities, lifelong learning courses and Wellnes Programme. activities that are easy to take up, such support can be complemented with more. as brisk walking, health qigong, line- community support and seniors can To secure better health outcomes dancing, strengthening exercises, be encouraged to lead healthier The most widespread senior wellness for seniors, vaccinations and handicraft and gardening. They may also lifestyles by ageing actively in their and health programme implemented by health screenings are conducted include niche activities like Rummy-O, communities. In line with Singapore’s PA at the community level is the Wellness at convenient neighbourhood ukulele and sports-stacking exercises. commitment to go beyond the hospital Programme. The Wellness Programme community facilities such as CCs and Being socially connected helps reduce to the community and to go beyond is far-reaching as it is conducted RCs premises. Those found to be at loneliness and boosts seniors’ mental healthcare to health, various health through PA’s extensive network of 1,800 risk of developing chronic illnesses and physical health. and wellness initiatives have been put grassroots organisations and over 100 and age-related functional decline in place at the neighbourhood level to Community Clubs. are then encouraged to adopt develop local clusters or ‘communities healthier lifestyles, and to participate of care’ for seniors to keep active and Started in 2008, the PA Wellness in follow up interventions by the healthy. Active ageing programmes Programme reaches out to Singaporeans Regional Health Systems (RHS) and are spread out in various active ageing and Permanent Residents, aged 50 the Health Promotion Board (HPB). nodes in the community such as years and above, to engage them in Mobile clinics also travel to different Community Clubs (CCs), Residents’ programmes and activities that keep neighbourhoods to provide screening Committees (RCs) and Neighbourhood them mentally, physically and socially and services for visual, nutritional, Committees (NCs).75 The Wellness active. These programmes encourage oral, aural and bone health. Programme and Wellness Kampung seniors to adopt healthier lifestyles. are two such community initiatives. Wellness Programme activities such as briskwalking keep seniors physically and socially active. 138 ACTIVE AGEING ACTIVE AGEING 139
Wellness Time Kampung is to bring healthcare beyond hospital walls and into the Together with the Ministry of Health community. Wellness Kampung offers (MOH) and the Silver Generation a platform for residents to remain Office (SGO), PA is currently active and healthy through activities establishing Wellness Time at suitable and preventive health programmes, community facilities throughout allowing the frail elderly to age-in-place Singapore. Wellness Time is a suite with follow-up care services, and even of active ageing activities conducted give them opportunities to contribute on a weekly basis at selected back to their neighbourhoods. As the Wellness sites. These include health name suggests, Wellness Kampung screening and coaching, senior- facilitate a close-knit support network centric exercises and social living between residents—akin to how village activities. The Wellness sites thus communities functioned in the past— Wellness Kampung @ 765 Nee Soon Central. far have realised that getting the bolstering their overall wellness and traditional Senior Activity Centres programming and better administration majority of people who are sedentary encouraging healthier lifestyles. (SACs) were being run. Their findings of the centres. to be more active physically is an showed that residents appreciated uphill task. PA is making a concerted Process simple and actionable health education With funding from MOH for effort to work with multiple agencies that affects their everyday lives, such renovations, the three Wellness and grassroots organisations in Yishun Health (YH), a network of as how to eat well and sleep well. In Kampung were set up in Yishun town order to reach out to these seniors. medical institutions and health addition, they noticed that most SACs in March 2016.78 They are located in facilities under the National Healthcare lacked participation from male seniors, Nee Soon East, Nee Soon Central and At its inception, the Wellness Group (formerly Alexandra Health and that administration processes Chong Pang. Programme targeted to engaged with System), initiated the idea of Wellness discouraged people from joining 50% of the senior population aged 50 Kampung. YH oversees public in activities. These findings helped Features years and above in every constituency. healthcare provision for over 800,000 the team accommodate resident To date, it has engaged with about residents in the north of Singapore: preferences and circumvent known While each of the Wellness Kampung 500,000 seniors. PA continues to this includes Yishun town, where about challenges through physical design, is unique to suit the populace served, increase touchpoints around the 20,000 seniors reside.77 YH wanted to country so that seniors can age well encourage its residents, particularly within their communities. seniors, to adopt healthier lifestyles actively rather than be passive Wellness Kampung recipients of traditional formal health education. Background To ensure that the three Wellness The Wellness Kampung initiative is Kampungs would meet the particular a network of three wellness and care needs of the Northern residents, YH centres for residents in the North of proactively partnered local advisors Singapore. It was formed through a from Nee Soon GROs, and also partnership among Alexandra Health conducted preliminary ethnographic Systems,76 St Luke’s ElderCare and studies. The team spoke with Yishun Nee Soon grassroots organisations residents to understand what ‘health’ Wellness Kampungs were designed to look like extended ‘community living rooms’ with open concept (GROs). The purpose of Wellness means to them and observed how plans and minimal physical barriers. 140 ACTIVE AGEING ACTIVE AGEING 141
there are several common general extended ‘community living rooms’ features. with open concept plans and minimal physical barriers (such as walls, doors or Physical Design fencing). The openness of the physical space makes Wellness Kampungs easily In line with the purpose of bringing accessible and encourages residents to healthcare into community spaces, enter and walk through them. The open the three Wellness Kampungs are plan also eases management, allowing conveniently located at the void decks the entire centre to be overseen by a or ground floors of housing blocks single manager. so residents can easily access them. Furniture can be moved around to suit the needs Daily mass exercises. Adjacent to each Wellness Kampung In the case of Wellness Kampung @ of the residents. is an eldercare centre run by St Luke’s 115 Chong Pang, the open design Further positioning the centres as YH and a single centre manager as ElderCare, where seniors who are was further extended to its community welcoming community spaces, the facilitators. No membership fee is frail receive rehabilitation and day garden, which is in front of the centre. interior of every Wellness Kampung imposed on participants and anyone care services. The co-location of the The community garden is fenceless and is designed to look like a trendy café can join in activities regardless of their Wellness Kampung with the eldercare features an open allotment system so with blackboard menus. The space place of residence. This encourages centre allows these seniors to join in the that the gardening beds are integrated also features a corner library run by the participation and ownership, driving the centre’s activities and forge friendships with public areas in the precinct. The National Library Board (NLB). residents to take charge of their own 79 more easily. seamless flow from centre to garden health and wellness by incorporating further promotes wellness by allowing a Since successful physical design does healthy and active behaviours into their The overall design concept for visual connection between the centres’ not always come from a top-down daily living. Wellness Kampungs was for them to interiors and surrounding greenery in approach, the team encouraged be seen as community spaces, not the estate. This reinforces YH’s emphasis different forms of participatory design. Wellness Kampungs offer both health- clinical medicalised spaces. As such, on the benefits of greenery for healing. For instance, the interior setup of focused programmes as well as interest the centres were designed to look like the Wellness Kampungs had been group activities to promote active deliberately left ‘incomplete’, giving ageing. They host daily mass exercises, users the flexibility to move furniture stretching exercises and aerobics around to suit their needs. The sessions for seniors. Seniors also take successful physical design of Wellness the lead in educational and leisure Kampung @ 765 Nee Soon Central programmes, forming interest groups clinched the Singapore Good Design such as a singing group and quilt Mark (SG Mark) award in 2017.80 blanket making group, sharing their skills with one another. As part of their Management and Programming multigenerational engagement efforts, Wellness Kampungs invite students The community is the leader at Wellness from nearby schools to participate in Kampungs. Residents are encouraged intergenerational programmes such as to take the lead in the management digital workshops, in which they teach of each centre and its activities, with seniors how to use smartphones.
A resident tending to the community garden. 142 ACTIVE AGEING ACTIVE AGEING 143
A second challenge is encouraging participation from the younger Other Wellness Initiatives in Singapore generation. The centres are not exclusive to seniors but are meant to be National Seniors’ Health 7 sectors and targets 120,000 multi-generational spaces. However, Programme mature workers aged 40 and above. despite hosting intergenerational Initiatives include health screenings programmes, most youth are only able An initiative under the Action Plan at workplaces and designing to commit to activities once a year, for Successful Ageing, the National workplace-specific preventive health due to conflicting school schedules. Seniors’ Health Programme aims to programmes. For example, the encourage and empower seniors to “Check Car, Check Body” programme Finally, not all initiatives are welcomed take charge of their health through collaborates with local taxi operator by residents living in the housing Intergenerational programme. community-based activities, healthy companies to offer mature taxi blocks surrounding the centres. lifestyle campaigns and targeted drivers free health screenings while YH brings in healthcare professionals Some popular programmes such intervention for mature workers in their taxis are being serviced. This intentionally to support resident- as mass exercises are conducted in workplaces. programme has helped time-pressed led programmes, mindful not to neighbourhood common spaces due drivers prioritise their health and well- over-medicalise efforts or adopt a to high participation rates, but have The inaugural healthy lifestyle being.82 paternalistic approach. For instance, received resident complaints about campaign was launched by Health a community dietician visits regularly noise. Promotion Board (HPB) in September Healthy Ageing Promotion but does not dictate or ‘teach’ seniors 2015 with an exercise video for seniors Program for You (HAPPY)83 what to eat. Rather, the dietician Nevertheless, the Wellness Kampung titled ‘7 Easy Exercises to an Active is present for seniors to consult initiative provides accessible and Lifestyle’. Other campaigns include With ageing population, prevention during cooking programmes. YH attractive spaces for seniors of various the Falls Prevention Awareness of frailty and dementia will also engages community nurses as abilities to pursue hobbies, manage Campaign that aimed to educate become a public health priority. educators, coaches and counsellors so health and forge close-knit networks seniors and their caregivers on the Intervention programmes have residents can get regular health check- with minimal support. Their holistic five tips to reduce the risks of falls, shown that frailty may be reversible ups at the three centres. The centres, approach to health and wellness also and the Stroke Awareness Campaign or modifiable through lifestyle however, do not bring in clinical ensures that seniors can age both that worked to deepen public interventions. Healthy Ageing practice as they want to encourage actively and healthily in ways that understanding of the signs of stroke Promotion Program for You (HAPPY), sustainable self-management rather suit their preferences. The strong and advocate timely action when initiated by the National University than doctor-led health management. emphasis on self-organisation sets an stroke occurs.81 Healthcare System (NUHS), is example for how active ageing can be a programme encompassing Challenges promoted in a sustainable way. A new workplace health programme physical activity, brain activity and is also being implemented across empowerment of seniors conducted Although YH sought to engage more male seniors, users of the three Wellness Kampungs today are still predominantly female. To address this, the centres organise targeted programmes such as weekly appliance repair workshops to draw in male seniors and help them feel less out of place. 144 ACTIVE AGEING ACTIVE AGEING 145
within community centers and as teams provide services such as housing estates in Singapore. The health monitoring, coordinating aim of HAPPY is to improve cognition, medical care and connecting seniors CENTRES FOR reduce prevalence of frailty and to informal networks and formal improve overall mental well-being of services. Under the SECDC ‘Friend ACTIVE AGEING seniors in the community. Early results a Senior’ initiative, residents are show promising results in reversing engaged as volunteers to conduct frailty and improving memory. regular house visits for participants. Strong networks are also established Seoul: Senior Welfare Centers and Day Care There are now 30 sites across the with community partners to connect Centers island with more than 500 seniors seniors to services and long-term participating in HAPPY on a regular support. basis. Senior Welfare Centers Since launching in 2013, the Neighbours for Active Living84 Neighbours programme has grown Background significantly. It has been rolled out The Neighbours for Active Living in all 18 constituencies in eastern Seoul’s Senior Welfare Centers were Metropolitan Government (SMG) and or Neighbours programme was Singapore and over 15,000 home established, along with various other Local District Gu Governments (LDG).85 developed by Changi General visits have been conducted. The social welfare facilities, when Seoul’s Hospital (CGH) and Southeast Neighbours programme has local self-government system was Currently, Senior Welfare Centers cover Community Development Council benefitted more than 6,000 patients. introduced in 1995. Prior to 2000, one most of the city’s districts, but there is a (SECDC) to reduce hospital Between 2013 and 2017, 73% of Senior Welfare Center was built in each growing demand for additional Centers readmissions of high-risk senior patients with frequent readmissions of the 25 administrative Gu districts. due to the rapidly ageing population. residents through engagement and had a decrease in the number More were added as circumstances The local Gu district average was community support. Community of hospital readmissions. Their allowed. There are at present 76 such 10.4 persons per m2 of centre space. care teams, comprising of healthcare readmissions rate fell from 2.3 to Centers operating in Seoul. Initially, There are also issues: while some professionals from CGH, are 1.1 over 6 months. CGH is now these Centers were subsidised by the areas are oversaturated in terms of embedded within communities to exploring scaling up the programme central government. Today, however, service coverage, other areas remain reach out to and befriend vulnerable and activating communities in other most are run and funded by the Seoul underserved. seniors in their homes. Seniors’ regions. health and well-being are supported
Mapo Senior Welfare Center. 146 ACTIVE AGEING ACTIVE AGEING 147
Service Coverage of Senior Welfare Centers in Seoul Changes in Seoul’s Senior Welfare By 2011, an ordinance on senior welfare (Radius of 1 km) Center Policy was enacted in an effort to make the city more senior-friendly. This ordinance Prior to 2010, the SMG focused on also enabled support for lifelong growing the number of Senior Welfare learning and retraining programmes. In Senior Welfare Centers Centers. In 2010 however, the city 2012, the “Aging Friendly City Master Similar Institutions announced a plan to adopt a different Plan” was put forward to reinforce approach: the creation of “Happy Silver the role of Senior Welfare Centers in Towns” in different regions, as well as leisure and social engagement, while smaller Senior Welfare Centers better separating out other current homecare adapted to local conditions. services. In the following year, financial support that had been concentrated
149-1355 1355-2561 Number of Senior Citizens per 2561-3768 Administrative 3768-4974 Dong District 4974-6180
Number of Senior Welfare Centres in Each Gu
District No. of Facilities District No. of Facilities Jongno-gu 3 Seodaemun-gu 5 Jung-gu 2 Mapo-gu 4 Yangcheon-gu 3 Yongsan-gu 2 Gangseo-gu 5 Seongdong-gu 2 Guro-gu 2 Gwangjin-gu 1 Geumcheon-gu 2 Dongdaemun-gu 1 Yeongdeungpo-gu 2 Jungnang-gu 4 Dongjak-gu 2 Seongbuk-gu 5 Gwanak-gu 1 Gangbuk-gu 2 Seocho-gu 3 Dobong-gu 5 Gangnam-gu 6 Nowon-gu 2 Songpa-gu 3 Eunpyeong-gu 6 Gangdong-gu 3 Total 76 Calligraphy activities at Mapo Senior Welfare Center. 148 ACTIVE AGEING ACTIVE AGEING 149
Changes to Seoul’s Senior Welfare Center Policies
2010
2020 Aged Society Master Plan • Build infrastructure for senior 2011 welfare - Build 5 regional Happy Senior Towns Ordinance on senior welfare to make by 2014 Seoul more senior-friendly (revised - Build 125 local smaller Senior Welfare on December 11, 2014) Centers by 2020 • Lifelong learning and retraining programmes for the elderly • Build and support senior leisure welfare facilities (e.g. Senior Welfare Centers) 2012
Aging Friendly City Master Plan Members can participate in classes like English classes at no or low cost. • Restructure/improve the roles of 2013 Senior Welfare Centers Reinforce support for LDG Senior - Supervise street-level welfare services on city-run Senior Welfare Centers was Welfare Centers and provide and encourage local community Role of Senior Welfare Centers activities extended to those run by the LDGs. balanced subsidies - Reinforce the Centers’ role in leisure In 2014, manpower was increased to According to the Welfare of the and social engagement handle employment and counselling. Aged Act, Senior Welfare Centers are - Provide community spaces to bring 2014 In 2015 and 2016, the 50+ Centers categorised as leisure facilities. They different generations and local were opened, to which baby boomer also provide counselling services to the Adjust the basic HR capacity at residents together and offer inter- generational programs programmes were transferred. In 2017, elderly for little or no fee. The Centers Senior Welfare Centers • Increase capacity of social welfare • Separate and operate homecare/care the Senior Welfare Centers began to offer services such as health promotion, workers (employment/counselling) by service centres provide one-stop employment services culture, and leisure. While they focus on one person from 23 to 24 persons to its users. In 2018, it was announced leisure, the Centers handle interventions that a new approach to the Senior in all matters concerning the elderly, Welfare Centers would be developed, such as poverty or long-term care, as 2015 2016 in response to soaring demand. The programmes are often launched or specifics of this new approach are added to their offerings when required Transfer baby boomer programmes currently being looked into. by the SMG or LDGs. to the new 50+ Centers 2017
Reinforce job counselling and employment functions and encourage social engagement • Provide one-stop employment services to senior citizens using the Senior Welfare Centers - Manage the entire cycle of hiring/ job seeking, counselling, job placement, and follow-up 150 ACTIVE AGEING ACTIVE AGEING 151
Seoul’s Senior Welfare Centers’ Functions
Elderly Family
Lifelong Learning Hobby / Leisure Employment Family IntegrationFamily Service
Local Community B
A
Healthy Living Local Resource Local Welfare Matching Senior Rights • Functional Recovery Development • Collaborations with Protection and • Care Service • Volunteer recruitment other Centers Promotion • Health Promotion and management • Joint local programmes • Meal Services Emotional Support Social Engagement • Sponsorships
Organisation Management
Senior Community Center Innovation Operations and Research and Programme Management Development Management Program Residential Support Income Support 152 ACTIVE AGEING ACTIVE AGEING 153
Eligible Users of Senior Welfare its membership to all citizens of Seoul Users of Senior Welfare Centers in Seoul Centers who are above 60. Members are free to participate in the Center’s programmes Municipal ordinance stipulates that at no or low cost. Low income seniors, Gender Age Eligible Benefit Residential local residents aged 60 or older have so called “eligible benefit recipients”, Recipients Address priority access to Senior Welfare can use the services for free. Centers. Most of these Centers are 5% 17% 9% open to those aged 60 or older in A survey was conducted on the use 27% principle, but for married couples, as of a Senior Welfare Center in 2013. It 41% 25% 59% long as one spouse is at least 60 years of was found that 59% of the users were 73% 91% age, both spouses are deemed eligible. women and 41% were men, and that 53% In most cases, the Centers limit their 53% were in their 70s, 25% in their 80s, membership to local residents, with and 17% in their 60s. Only 9% were one exception. The Center in Jongno, eligible benefit recipients whereas 73% Local Gu Male 60s 80s General being located in the city centre, opens were residents of local Gu districts. District Benefit Female 70s 90s Other Areas Recipient
Problems Senior Welfare Centers centres. These rules are not consistent, Face and the lack of specific requirements and rules have led to confusion in While Senior Welfare Centers are operation. a positive development in many Reading spaces for all provided at Senior Centers engage seniors to provide regards, some issues have nevertheless Second, the Centers do not have Welfare Centers. community support services such as being surfaced after years of operation. sufficient space. While the average traffic wardens for children. building area of a Senior Welfare First, the Welfare of the Aged Act, Center is slightly greater than that the Ministry of Health and Welfare of a general social welfare centre, the guidelines, and SMG protocols area per person is relatively low. This stipulate different sets of rules is because the Senior Welfare Centers regarding eligible users, hours of experience a high volume of daily operation, fees, facility requirements, users. and the manpower of senior welfare
Facilities such as ping pong tables are popular amongst members of Mapo Senior Welfare Center. 154 ACTIVE AGEING ACTIVE AGEING 155
Capacity of Social Welfare Centers in Seoul Third, it is difficult to expand Center the elderly. The SMG and the LDGs services to more senior citizens. have even encouraged the Centers Current Senior Welfare Centers are to engage with cases involving the Building Area Daily Users Area per limited in space and have exceeded elderly living in poverty or other day- Centre Type per Centre (A) per Centre (B) Person (A/B) their maximum capacity. Therefore, to-day senior issues. Such programmes they are not as keen to take on undertaken by the Centers are now General Social 2,668 m2 726 Persons 3.8 m2 new users. There are cases where being transferred to other institutions. Welfare Centers new members do not adapt well At times there has been talk of when they fail to bond with existing creating an entirely independent Disability 3,026 m2 909 Persons 3.3 m2 Welfare Centers members. This is one of the reasons organisation to perform these tasks. many Center programmes focus These developments have left the Senior Welfare 2 2 2,888 m 1,279 Persons 2.3 m solely on existing members. It is a Senior Welfare Centers deprived Centers challenging issue to address. of an important role. Given the rapidly ageing population, a viable Fourth, there is prejudice against alternative role for Senior Welfare Senior Welfare Centers. Many citizens Centers has yet to be identified. see them as places that attract the The Centers are preoccupied with Compared to similar facilities overseas, categories: number of daily users, elderly who need financial or other managing the growth in the aged Senior Welfare Centers in Seoul building area, and area per person. assistance. This perception has made population. A better solution may operate under poorer conditions, Accordingly, Senior Welfare Centers are it difficult to expand the scope of have to be developed to respond to underperforming than those in other crowded more often than not, resulting programmes. It is crucial that general the challenges of the future. cities around the world in all three in space shortages. awareness be improved to show that while there are many free programmes Finally, there are issues regarding for eligible benefit recipients, the accessibility and dilapidated facilities. Capacity of Similar Facilities Overseas Centers are essentially designed as While some Senior Welfare Centers senior leisure facilities that are open are located near metro stations to all senior citizens. or near main roads, most are in Institution Building Area Daily Users Area per residential areas or the outskirts. City per Centre per Centre Person Fifth, the Centers are experiencing an Restricted access by public transport ‘identity crisis’ due to external changes. has discouraged many potential City Senior Seoul, 2,888 m2 1,279 Persons 2.3 m2 To date, Senior Welfare Centers Center users. Although there are Korea Welfare Center have responded quickly to issues free shuttle bus services for better facing the elderly, leading to their access to Centers, the number and New York City Hall Senior 2 2 5,500 m 300 Persons 18.3 m rapid growth. Despite being a senior frequency of buses are insufficient City, USA Center leisure welfare facility in nature, the to accommodate current demand. Centers have played a leading role in Furthermore, most Senior Welfare Fujisawa, 2 2 Shonannagisaso 3,150 m 310 Persons 10.2 m addressing local elderly issues such as Centers are more than 20 years old, Japan employment or daytime care. These and no longer provide a pleasant roles are aligned with their original environment. Budget allocation is not objectives as stipulated by law, and an easy matter to resolve, and facility have provided significant benefits to improvement will take some time. 156 ACTIVE AGEING ACTIVE AGEING 157
Day Care Centers Centers, Senior Community Centers, Certification Indicators for Senior Day Care Centers churches, temples or other such Background facilities to be used as small-scale care facilities or daytime care facilities. Seoul’s Day Care Centers are part of a This contributed to a rapid increase Fundamental Elements range of homecare services provided in the number of Day Care Centers. to senior citizens with limited physical In 2005, the central government • Organisational vision • Ethics and mental capabilities, who cannot decided to transfer the authority over • Human resources • Standardised service rely on long-term care from their the day care programme to local • Facility and environment families. Seniors are admitted to governments, after which the SMG daytime or night-time facilities to began to implement the programme support their daily routines and citywide. Care was provided only improve their physical/mental in the daytime, but it was soon capabilities. One of the major roles expanded to night-time: both are Tailored Care of a Day Care Center is to ease the available to the present day. Since physical and emotional burden on 2009, the SMG has reviewed and families. For a variety of reasons, certified those facilities that have • Service plans and • Pick-up and drop-off many seniors are taken care of by added professional programmes to evaluation service family members even when they need existing services. • Nutritional service • Leisure and social institutional care. Such seniors are • Dementia improvement participation assistance admitted to care facilities for a limited Role strategies • Night-time service period of time to help the family return to their lives. Day Care Centers in Seoul serve senior citizens with dementia or other serious It was in the mid-1980s that senior illnesses by looking after them on the Peace of Mind welfare organisations started this premises, either day or night, for a caregiving service. When the Welfare specific period of time. This provides • Hygiene and health of the Aged Act was revised in 1989, some respite for family members. • Emergency care check system this service began to be recognised as part of the public institutional care A variety of programmes are programme. These and other changes provided to the elderly for little led to the day care services in Seoul or no fees. These range from today. As of 2018, there are 323 Day basic health management, such as Care Centers in Seoul. help with high blood pressure or Rights to Use diabetes, to meals and nutrition care Changes in Seoul’s Day Care as well as professional programmes • Service information Center Policy for rehabilitation. The Centers and guide • Protection of user rights encourage seniors who need care • Family assistance After a pilot programme was launched to stay healthy and continue living in 1992, Seoul’s Day Care Centers in their local communities, delaying experienced substantial growth. their admission to care facilities as From 2002 onwards, regulations much as possible. were relaxed to allow Senior Welfare 158 ACTIVE AGEING ACTIVE AGEING 159
Users Long-term Care Insurance receive up to 85% in subsidies from the National Singapore: Senior Activity Centres (SACs) and An elderly person eligible under the Health Insurance Service, but the Active Ageing Hubs (AAHs) Senior Long-term Care Insurance Centers are left with only KRW 3 million scheme may apply for Center services. to take care of 15 seniors for 20 days a When circumstances allow, the Centers month. This places a lot of pressure on Complementing active ageing services This case study shares two centre-based may admit those with geriatric illnesses. the caretakers, who have to cope with and initiatives in the community are initiatives in Singapore that support a ratio of 1 caretaker to 5 seniors. The centre-based services, which play an active ageing—Senior Activity Centres Issues turnover rate of caretakers is quite high, important role in supporting seniors (SACs) and Active Ageing Hubs (AAHs). making it difficult to provide quality and families with seniors who have mild Day Care Centers face a number of service. to moderate care needs. These centre- SACs mainly focused on providing issues: based initiatives are important nodes resources for vulnerable and lower- Conclusion for seniors to continue being engaged income seniors while AAHs integrate First, there is the gap between family in the community, receive care support active ageing and care services, offering demands and Center services. For With the prospect of a super-aged and also support seniors with working both centre-based and home-based seniors suffering from dementia society looming in the near future, caregivers. care services. or geriatric illnesses, their families Senior Welfare Centers and Day Care often want facilities with beds like Centers cannot avoid the greater in hospitals or more advanced care challenges they are expected to face facilities. However, Day Care Centers in the years to come. The Centers also Aged Care Services in Singapore are often limited in space and cannot face the equally crucial responsibility provide beds to all users. Moreover, of being at the forefront in identifying Aged Care Services aim to enable seniors to age-in-place even as needs increase as operating hours are usually from and responding to elderly issues in 8 am to 10 pm, it is difficult for family the city. While the Centers will have to members who are working to drop off resolve their many issues, substantial and pick up the patients on time. investments are also needed to improve Preventive/ Centre-based Home Care Nursing Center spaces, expand facilities for Active Care Services Services Home Second, the budget and manpower easier access, and offer a wider variety Ageing Services Services/ For seniors For seniors of Day Care Centers are often of programmes. It will not be possible Senior with mild to with mild to For seniors inadequate. While they vary in size, to cater to every single demand from Activity moderate high care with high care SMG subsidies to Day Care Centers the growing senior population in senior Centres care needs, needs, with needs, with remains very small: between KRW facilities. Nevertheless, it is vital that with some some family little or no 11,000 and KRW 53,000 per person, per the Centers think beyond the old, rigid Keeping family support support (e.g. family support seniors (e.g. working frail caregiver, frameworks that continue to define month. It is true that seniors with Senior well and caregiver) or Foreign current programmes. identifying Domestic those with Workers) health needs earlier so that care can be provided 160 ACTIVE AGEING ACTIVE AGEING 161
Senior Activity Centres Community Development, Youth and Sport (now known as Ministry of Social Addressing the need for care and and Family Development) and Housing support services to be situated near to and Development Board (HDB) project where vulnerable elderly residents live, to improve the living conditions of Singapore established drop-in centres seniors living in HDB rental flats. known as Senior Activity Centres (SAC). Such centres provide a place in which The SAC is a drop-in centre that seniors can be kept mentally, socially provides information and referral, as well and physically active through social and as activities to support and engage the recreational activities. They also provide vulnerable and socially-isolated seniors a basic level of support, including living in HDB rental flats. emergency response, information or referral for care support. The primary target clientele of SACs is seniors, 60 years old and above, Background residing in HDB rental flats. The key objectives of the SACs are to: SACs were first established in 1995 to provide support services to low (a) Improve the quality of life of low- income seniors under a joint Ministry of income and vulnerable seniors Exercise programme at Evergreen Circle SAC. residing in HDB rental flats; (b) Detect and prevent social isolation the Alert Alarm System during their of low-income and vulnerable operational hours, and for responding seniors within the SAC’s service to the distress calls of seniors if they cluster; were to activate the emergency pull- cords fitted in their homes. (c) Enable seniors to remain cognitively and physically active in the Since April 2018, the SACs’ programmes community as long as possible by in public rental housing blocks are engaging them through social and funded by the Ministry of Health recreational activities. (MOH). As of 2018, there were 77 SACs supporting seniors residing in HDB Each SAC organises social recreational rental flats. activities and reaches out to all seniors residing in rental units at least once The success of SACs in public rental every year. Its representatives visit frail housing estates led the Ministry of and/or homebound seniors at least Social and Family (MSF) and HDB to once a week. Apart from these services, pilot SACs at HDB Studio Apartment the SACs also facilitate the formation (SA) developments in 2011. As of end of mutual help groups and offer 2018, there were 50 such SACs located information and referral services. Some at SA developments.
Seniors participating in health programmes conducted at Evergreen Circle SAC. SACs are also responsible for manning 162 ACTIVE AGEING ACTIVE AGEING 163
access to a gym designed for seniors, and activities such as line-dancing and IT classes. The centre has 40 day care places for elderly residents and also serves 100 house-bound residents, providing them with home-based medical care.
Similarly, the NTUC Health Active Ageing Hub in Kampung Admiralty offers a diverse range of services for active and ambulant seniors, as well as care services. For instance, it offers senior day care services, which includes dementia care, respite care and other services such as transport Kwong Wai Shiu Care @ McNair. and escort services. It also provides day rehabilitation, which focuses on active Active Ageing Hubs residents in the wider neighbourhood rehabilitation therapy, maintenance and strengthen intergenerational exercises and a specialised gym In anticipation of increasing healthcare bonding. programme for seniors. needs, MOH unveiled Active Ageing Hubs (AAHs) in 2017. These are one- MOH has planned for AAHs to be built More importantly, this AAH has stop hubs in the community, often in at least 10 future HDB developments. developed community and healthy within new and existing housing As of end 2018, 5 Active Ageing Hubs Gym designed for seniors in Kwong Wai Shiu Care living activities such healthy cooking have started operations, of which developments, integrating both @ McNair. demonstrations, fall-risk and wellness active ageing programmes as well the first two (i.e. Kwong Wai Shiu screening, as well as advanced care and as care services such as day care, Community Care Centre at McNair retirement planning programmes. It day rehabilitation and assisted living Road and NTUC Health Active Ageing also cultivates volunteer opportunities, services. Hub at Kampung Admiralty) are the where younger and more active seniors most developed. can help older and frail seniors. These With a wide-range of services, AAHs aim volunteers might become a ‘makan to facilitate the seamless transition of The Kwong Wai Shiu Community kaki’, a buddy with whom seniors can care for seniors in the community—from Care Centre offers rehabilitative care cook and eat together, or be trained the active to the frail. This is important as well as social programmes for to assist as a Dementia Friend, caring as seniors’ needs change and evolve residents in the area, complementing for seniors with dementia. Co-located as they grow older. Moreover, these services offered by the Kwong Wai Shiu beside a childcare centre, this AAH also hubs also serve as venues for social and Hospital in the neighbourhood. Since supports intergenerational programmes learning activities for all ages, enabling the Centre’s opening in November Deepavali celebrations at Kwong Wai Shiu Care to encourage greater bonding between @ McNair. AAHs to be vibrant places which can 2017, more than 500 elderly residents seniors and young children. foster a sense of community amongst have signed up as members, enjoying 164 ACTIVE AGEING ACTIVE AGEING 165
Intergenerational reading and art and crafts programmes at NTUC Health Active Ageing Hub.
As a newly piloted initiative, the efficacy active ageing services, to also be key of AAHs remains to be seen. However, resources as senior volunteers. It also as a one-stop hub, AAHs can facilitate encourages the greater activation of the integrated provision of both social and public spaces to promote Health check-ups and screenings conducted at NTUC Health Active Ageing Hub. active ageing and care services. This active ageing, since AAH programmes should encourage both younger or extend beyond the physical space of more ambulant seniors, who can enjoy the hub into the community.
Intergenerational reading and art and crafts Seniors prepare soup together at NTUC Health programmes at NTUC Health Active Ageing Hub. Active Ageing Hub. 166 ACTIVE AGEING ACTIVE AGEING 167
LOCAL INITIATIVES
Seoul: Open Kitchen
Aiming to build a care service The Open Kitchen has three platform in collaboration with local functions: restaurant, service partners, the Steering Group for platform and education centre. the Gwangjin-gu Special Care Zone studied the needs of the elderly First, it is a restaurant offering and their families in 2015 before balanced meals under the leadership Patrons dining at Open Kitchen. launching its initiatives. They found and management of nutrition that meals were the main concern: specialists. The restaurant sells nutritious meals The Open Kitchen also serves as households comprising one or at lunchtime. Senior citizens pay an integrated care service platform two senior citizens found it very Co-located at the ground floor of the KRW 4,000 (others pay KRW 7,000) for Local Care Cluster members. challenging to eat properly and on building where Gj-Care and Well- for a meal of rice, soup, and seven or The service platform sells a wide time. Union are based, the Open Kitchen more side dishes. Senior citizens are variety of age-friendly food products is 130 m2 in area, and consists of not the only ones who use the facility. produced by Well-Union. It also As a result, member organisations of a dining area of 70 seats, a buffet- Gwangjin-gu Special Care Zone staff offers information to help people the Gwanjin-gu Special Care Zone style serving area, an open kitchen, members, employees and people access nutritional consultation and decided to start the Open Kitchen an age-friendly food stand and an from nearby businesses, schools and other care services. to provide healthy meals and related outdoor patio. a church also visit as well. The Open local care services for seniors. Kitchen thus serves as an avenue for Finally, the Open Kitchen is also an people of different generations to education centre offering training on interact socially. age-friendly cuisine to professionals and elderly care health consultants who are in the Local Care Cluster service. This helps create jobs for the elderly.
The Open Kitchen was promoted to other Gwangjin Social Economy Network (GSEN) member organisations, local welfare councils, an adjacent primary school, businesses, the church and the local
Example of a nutritious meal served at Open community. It attracted a sizable Open Kitchen in Gwanjin-gu Special Care Zone. Kitchen. 168 ACTIVE AGEING ACTIVE AGEING 169
number of users from the outset. As Meals play a vital role in bringing Singapore: Goodlife! Makan86 of 2017, it has 600 elderly members, senior citizens together with their 70 of whom use the facility every day. peers and with other generations, The Open Kitchen is accessed by helping to build a close-knit local Social support for seniors living alone alone such as meal deliveries, more than 300 people daily. Many community. Providing affordable comes mainly from the community: Montfort Care—together with of its aged users are from single healthy meals to older adults organised meal deliveries, home help the Ministry of Health (MOH), the or two-person households. They who do not have ready access to and befriending services. However, Agency for Integrated Care (AIC) are highly satisfied with the tasty, welfare care services is a form of these support services often deliver and the Tote Board Community nutritious meals that are also easy preventive care: an intervention right to the elderly’s doorstep, Health Fund—decided to change to chew. Seniors have also remarked before further social costs occur. leading to concerns that stay- the approach towards social support that they enjoy going to the kitchen Outside mealtimes, the space is alone seniors become even more for stay-alone seniors. Instead of as the lively ambience, made so by also open to local residents to be cocooned in their flats. While there treating stay-alone seniors as passive the presence of younger people, used for meetings, cultural activities are dedicated eldercare centres such recipients of help, they decided to is not like other welfare facilities for and other such events. The Open as Senior Activity Centres (SACs), the facilitate a social environment where the elderly. Kitchen thus becomes a community- efficacy of these centres depends on there is self-help. They sought to owned space. how frequently the individual senior empower stay-alone seniors to do uses them. Moreover, the extensive their part in contributing to the help and support given to the elderly community. can have an opposite effect: being recipients of help can make the The Goodlife! Makan community elderly feel they are not in control of kitchen was thus born out of this their lives, which in turn may worsen desire to empower stay-alone seniors depressive symptoms and feelings of and draw them out of their homes. loneliness. This community kitchen is designed to be for seniors, by seniors. Seniors One neighbourhood in Singapore living alone in the rental blocks and decided to do things differently. in the surrounding neighbourhood Hoping to go beyond traditional come together daily to prepare, forms of support for elderly living cook and share their meals together.
All are welcome to dine at the Open Kitchen.
Goodlife! Makan in Marine Parade neighbourhood. 170 ACTIVE AGEING ACTIVE AGEING 171
the walkways, Goodlife! Makan is its seniors. For example, a chef seamlessly connected to the wider who stays in the neighbourhood community. This setting not only helps recently walked past Goodlife! create an inviting communal space, Makan and willingly volunteered but also addresses the psychological his time to conduct baking lessons well-being of stay-alone seniors and for the seniors. Some stallholders reduces social stigma. from the adjacent hawker centre have also voluntarily supplied The community kitchen has redefined fresh produce free-of-charge to what it means to help the elderly. the kitchen. This helps improve Having such a community kitchen the sustainability of the social Seniors take charge of the different stages in meal preparation. draws the elderly who live alone out space, which need not be solely Goodlife! Makan is located in the 10:00 am in the morning and decide of their homes, and also enables dependent on government or Marine Parade neighbourhood. among themselves what the meal them to interact and build organisational funding and There were concerns that there was of the day will be, who will shop at friendships. For some, it is also manpower. a growing population of stay-alone the nearby market, and who will be a chance to learn new skills and seniors in Marine Parade and that in charge of the different stages of rediscover a sense of purpose and Goodlife! Makan is inspiring other some seniors might be at risk of preparing the meal. About 40 to potential. communities and neighbourhoods social isolation, given their limited 50 seniors will gather at the kitchen in Singapore, such as Tampines interaction with fellow seniors and every morning and only two or three What might have been another and Hong Kah North, to start their residents within the neighbourhood. staff members are present to help. typical gated elderly centre, where own ground-up initiatives that are This keeps the kitchen informal and seniors would passively receive similarly open and empowering Montfort Care, a voluntary welfare gives seniors a greater sense of their meals, has been redesigned spaces for the elderly. The organisation, has been providing ownership. to be a vibrant, active space for community kitchen has provided community-based support with conversation, learning and a good starting point to re-think a network of programmes to the There are provisions for seniors of companionship. how our community spaces can be Marine Parade community for 15 different backgrounds and profiles. truly multigenerational, engaging years. Through its programmes, For instance, there are designated Goodlife! Makan not only empowers residents of different age groups. Montfort Care reaches out to seniors cooking stations for Muslims and stay-alone seniors to take ownership As CEO of Montfort Care Mr Samuel living alone to ensure they are non-Muslims so that they can prepare in preparing their meals, but also Ng puts it, the initiative is a step provided with necessary assistance. meals together. The community transforms the way in which the towards being “part of a community For instance, they bring healthcare kitchen also sees other residents community lives and interacts with that is refining ageing and living.” closer to home for seniors diagnosed mingling and interacting with the with chronic illnesses. Montfort Care seniors. saw an opportunity to empower stay- alone seniors, and to build a place The design of the community kitchen where seniors can come together enhances its accessibility. The and help themselves. borderless compound shifts away from conventional designs for elderly The 360 m2 kitchen is located at the centres, which are usually fenced up void deck of a public housing rental and gated. With its bright, colourful block. Seniors stream in at around interior and doors opening up to The kitchen brings together seniors of different backgrounds and profiles. 172 LESSONS FROM SEOUL AND SINGAPORE 173
6. BUILDING AGE- FRIENDLY CITIES: LESSONS FROM SEOUL AND SINGAPORE
In recent years, both Seoul and principles are vital in building an age- Singapore have responded to friendly city: a concerted approach demographic shifts towards a rapidly which involves a range of partners and ageing population through a range of stakeholders, and the involvement of targeted policies and initiatives. They the seniors themselves in determining have sought to ensure that seniors how they will age well. can age in a familiar environment within their communities, with Concerted multi-stakeholder convenient access to health and approach social services near to where they live. Both cities are also supporting Ageing is a complex issue that cuts seniors in their active ageing, through across all sectors and domains, be lifelong learning programmes as well it housing, social services, transport as health and wellness activities, to or education. No one institution can keep their minds and bodies fit. cope with all ageing issues in their entirety. It is important to ensure that the different agencies within Common Principles the government are aligned and working together, across sectors, to The experiences of both Seoul and address the challenges of an ageing Singapore suggest that two key population. 174 LESSONS FROM SEOUL AND SINGAPORE LESSONS FROM SEOUL AND SINGAPORE 175
Singapore has taken a Whole-of- Planning with seniors, for seniors The purpose of adopting a multi- Beyond better integration, Singapore Government approach to ageing. It has stakeholder approach and actively is going further to explore Assisted developed a number of inter-ministerial While population ageing is a global working with seniors is to realise the Living. This is a model of living committees over the years, with phenomenon, ageing is also a personal vision of an age-friendly city guided by that integrates home and care. For representation from all ministries and experience and varies with each person. the principles of ageing-in-place and example, within one block or even agencies, to look comprehensively at As such, it is important in the planning active ageing. Through this joint study, on the same floor of a public housing the challenges of an ageing population. of an age-friendly city to engage with CLC and SI researchers have identified block, there may be individual Such committees have allowed the seniors, to understand their needs key lessons from these two approaches apartment units together with shared cross-cutting issues to be tackled as they age and their aspirations for to support effective ageing in our cities. communal facilities for dining, social holistically, with better coordination ageing well. This ensures that policies activities and a range of eldercare in addressing different ageing-related and initiatives can directly address the services. It was announced in 2018 that aspects of public policy, from health to needs of seniors, and that seniors are Key Lessons Housing & Development Board (HDB) infrastructure planning. empowered to share and be part of will be working with the Ministry of the decision-making process. Physical infrastructure and social Health (MOH) to pilot assisted living Alongside this coordinated strategy, services should be integrated in public housing in Singapore.87 Singapore also encourages a multi- The development of Singapore’s Action stakeholder approach to ageing, Plan for Successful Ageing involved The experiences of Seoul and ensuring that the family, the community multiple public consultations with Singapore show that it is especially and seniors themselves are actively seniors through different channels to important to integrate physical involved in ensuring the well-being of better understand how they wish to infrastructure for the elderly with Singapore’s elders. For example, while age. Seniors were able to highlight their senior-friendly housing and relevant the Government provides policies and needs and interests, such as the desire services, such as eldercare and programmes for seniors, the community to continue working and volunteering, healthcare. Infrastructure and services plays key roles such as providing the need for more caregiver support, should be planned from the point of befriender services and peer support. and the wish to see a more senior- view of senior citizens’ convenience friendly urban environment. These and needs. This is the most important The Seoul Metropolitan Government insights informed policies and initiatives element to consider in developing (SMG) has also made an effort to directed towards improving key areas senior-friendly living facilities. adopt a multi-stakeholder approach under the Action Plan. in dealing with ageing issues. To Singapore’s Kampung Admiralty overcome a tendency towards a silo After the finalisation of Seoul’s 2020 exemplifies this through the integration mentality in public administration, Aged Society Master Plan—the city’s of housing, healthcare, recreational the Seoul Comprehensive Seniors first master plan to become an age- and commercial facilities in one single Plan was designed to be led by a friendly city—a Senior Monitoring Team development. This ensures that seniors multi-agency task force formed within was formed from senior citizens living can access medical and social services the SMG. City agencies and outside in different districts in Seoul. The team’s where they live, enabling them to experts have participated to pursue mission was to review the progress continue to stay on in these homes the aims proposed by World Health of the master plan’s implementation, even as their needs change. Kampung Organization’s (WHO) Global Network and to propose policy alternatives Admiralty is a single development; of Age-friendly Cities and Communities for the future. Policy ideas and new Singapore also recognises the need (GNAFCC), which specifies key values suggestions from this monitoring effort to make such integration of physical such as active ageing, ageing-in-place, have been incorporated in the second planning and social services more Located opposite the Seoul Medical Center, Shinnae Medical Housing ensures that seniors can and generational integration. master plan, the Seoul Comprehensive widespread throughout the city. access medical and social services where they live. Seniors Plan. 176 LESSONS FROM SEOUL AND SINGAPORE LESSONS FROM SEOUL AND SINGAPORE 177
Similarly, Borin Housing and Shinnae the Cognitively Impaired for outdoor neighbourhood, and the assistance strong resistance in both Seoul and Medical Housing (SMH) in Seoul are space and Singapore’s research study needed to get to each venue or to Singapore towards moving into senior examples of integrating housing and on Age-Friendly Neighbourhoods. conduct each activity. Knowing a housing and facilities significantly social services. An in-house manager Both projects are however still in senior’s life space is important, as away from home (e.g. suburbs), even addresses the elderly’s needs for their inception; more could be done amenities and facilities can then be when health or other circumstances welfare and healthcare. Through a to disseminate this approach more sited according to the areas they obliged the elderly citizens to move variety of programmes in these housing widely. The outdoor spaces of high- frequent. out from their homes. establishments, senior citizens are rise apartments could serve as a good encouraged to lead an independent test-bed for further innovations of In this light, it is important to scale It is important to give the elderly an life and initiate ‘self-help’ activities. this nature, since apartments are the ageing-related policies and initiatives option to continue staying within their Such activities are closely aligned with most common type of housing in both to seniors’ actual way of life. This existing neighbourhoods. For this and supported by the physical design Seoul and Singapore. encourages localised initiatives that reason, public housing units designed of the housing facilities. Emulating the seniors can have access to near for the elderly should ideally be current best practices, a model Scale ageing-related policies and to where they live. It may also be distributed throughout the city, so should be developed for desirable initiatives to seniors’ actual way necessary to review the administrative that senior citizens can form their own senior housing, to document and of life unit of municipal planning and local bonds and later stay within their demonstrate how to integrate governance. For instance, dong, own communities. Again, Kampung physical planning and social service For seniors to age-in-place successfully, the smallest administrative unit in Admiralty in Singapore and Shinnae provision right from the early stage of they need to be able to easily reach Seoul, is used as a geographic basis Medical Housing and Borin Housing architectural design. the amenities and facilities they need. to provide social services to senior in Seoul point to some best practices Mobility and the accessibility of the citizens. However, according to a which could be more widely applied in Physical planning and social services living environment are therefore study conducted at the Seoul Institute other parts of each city. can also be more closely integrated important considerations. Mobility (SI) using GPS analysis, the sphere of in the outdoor environment. There can be understood in terms of ‘life senior activities tends to be smaller Greater accessibility to eldercare and is an increasing need to reflect the space’: the pattern of movements than the size of a dong.89 Further healthcare and a range of residential needs of the aged with cognitive and activities reflecting where and research, perhaps involving big data options, such as assisted living for impairment in built environments. how a senior lives.88 Life space can analysis, is needed to investigate elderly who could be too frail to live Such needs drive initiatives such as be measured in terms of how far the the actual behaviours of senior even in senior housing, should be Seoul’s Environmental Design for senior travels within or out of his or her citizens, in terms of walking, leisure, made more widely available in local consumption, and social networks. communities. The aim is to meet the varying housing needs of the elderly at Rethink housing and community different stages of health within local communities. As we grow older, we form emotional attachments with our familiar An age-friendly city is about surroundings and community. Senior having both appropriate physical citizens who can live independently infrastructure and effective social want to continue living in their own networks in the community to support homes. That said, some seniors may seniors as they continue to reside require specific amenities in senior- within the neighbourhood. For friendly housing. instance, Singapore’s Active Ageing Hubs (AAHs) are physical hubs with
Initiatives have to consider seniors’ life space. The research team has observed programmes and services to support 178 LESSONS FROM SEOUL AND SINGAPORE LESSONS FROM SEOUL AND SINGAPORE 179
Ageing as an opportunity Academy (NSA), for example, offers a platform where seniors can continue to Some senior citizens in Seoul have learn. It provides access to a network expressed that they feel overwhelmed of over 30 post-secondary education when nearing retirement age. institutions and community-based Not having prepared for life after organisations with which seniors can retirement, many seniors feel that they sign up for a wide range of subsidised are left without adequate financial courses and learning programmes. The resources for their later years. CLC and Seoul 50+ Foundation and 50+ Center SI researchers have also observed that is also looking to enable seniors with this trend is more common among men, greater opportunities to explore second Seoul’s Open Kitchen is open to the wider community. compared to women, as women tend careers and rediscover their life goals seniors as they age-in-place and to to help seniors age actively in-place to participate more actively in social through education, interest groups promote active ageing. These Hubs through their ongoing programmes activities and community initiatives. and careers. What remains crucial is also serve as focal points to foster and reach on the ground. to rethink the role of older persons in a sense of community amongst However, it is heartening that the society, seeing that they can continue residents in the wider neighbourhood Similarly in Seoul, the Reaching-Out conversation on ageing is shifting to to having meaningful roles throughout and to strengthen intergenerational Community Service Center (ROCSC) one that focuses on the opportunities their lives, as they age. bonding. Seoul’s Open Kitchen is is effective only because it taps into of ageing. Singapore’s National Silver a similar example. Made available a network of existing social services. not only to senior citizens but also Previously, social services provided by the wider community, it provides a Senior Welfare Centers, dong offices, gathering place during mealtimes in and community health centres were order to foster a sense of community scattered around the city. The ROCSC living. The Open Kitchen gives seniors brought all services providing welfare, opportunities to develop a sense of healthcare, cultural activities, and fellowship with community members assistance for daily activities under and strengthen their social networks. a single umbrella. This increased accessibility for the elderly significantly. Partnering with existing providers is more effective than developing Networking is a useful way to harness new social services resources from the private sector. Seoul’s Socio-Economic Cluster at A salient lesson is the effectiveness Gwangjin-gu represents a bottom- of involving multiple stakeholders: up social policy model. Originally partnering with existing providers introduced by a group of non- and tapping on existing communities governmental organisations, the Seoul rather than developing new services or government now aims to spread the creating new networks. In Singapore, Gwangjin model throughout the city. the Community Networks for Seniors Singapore’s Goodlife! Makan, while on
(CNS) initiative draws on the resources a smaller scale, is also a good example Researchers have observed that women tend to participate more actively in social activities and and energies of existing community of non-governmental efforts to take community initiatives. partners, enhancing instead of care of the needs of the elderly. displacing or centralising their efforts 180 LESSONS FROM SEOUL AND SINGAPORE LESSONS FROM SEOUL AND SINGAPORE 181
Conclusion
A rapidly ageing population is an also adopt a range of definitions of an Seoul and Singapore have offered Seoul and Singapore should continue unprecedented urban challenge for elderly, depending on the aim of their some good examples of this. Seoul’s to encourage and nurture seniors to cities around the world; Seoul and programmes. 50+ Foundation, for example, is a key become active contributors and assets Singapore are no exceptions. However, initiative in empowering seniors to take in their communities. With greater Seoul’s and Singapore’s experiences It would be simplistic to think that a charge of the second half of their lives— community and senior ownership of show that a rapidly ageing population certain age is the only marker of being to continue learning and pursuing new senior-friendly initiatives, the discourse is also full of opportunities—supporting elderly. Seoul conducted interviews activities and challenges. Wellness on ageing can grow beyond welfare seniors to age-in-place, empowering with seniors who indicated that they initiatives in Singapore also empower or healthcare concerns. This may well communities to play a part, facilitating consider themselves to have crossed seniors to take charge of their own encourage more innovative policies that lifelong learning and active ageing, and the elderly threshold at age 70 or health, so that they become community can address the varied and complex seeding local ground-up initiatives. above. This suggests that 65 years stewards themselves, managing senior- needs and aspirations of tomorrow’s need not be a rigid age boundary after related programmes and spaces and urban seniors. In concluding this study, CLC and SI which a person is considered senior: helping others to age well. picked out two considerations for cities it is a milestone that differs by society that are facing or will face population and individual. Many who are above ageing. 65 years of age continue to want to be active and socially engaged. There Reconsider how we view seniors is thus a need to be aware of and account for the complexities of ageing The seniors of tomorrow will be as well as the considerable physical and vastly different from those of today. cognitive capabilities one can continue Widespread improvements in healthy to possess despite one’s numerical age. life expectancy are expected, alongside new health challenges such Taking this into account, there needs as an increase in the prevalence of to be a mindset shift: from regarding dementia. As discussed earlier, the ageing as a negative process, to seeing profile of seniors is changing, with it as a natural process in which seniors higher education and income levels can stay active and continue to make and evolving lifestyle patterns. An age- distinct and positive contributions to friendly city not only needs to consider their communities, with the benefit of physical and social infrastructure, but their life experience and wisdom. also how seniors are defined, regarded and treated in society. Empower our seniors and foster a greater sense of ownership While most policies and programmes tend to use the age of 65 to demarcate If we need to change how we regard the turning point at which one seniors, we must also continue to becomes ‘elderly’, such a definitive empower seniors to be active agents of age marker continues to be debated their own lives and futures. and questioned. Policies and initiatives 182 LESSONS FROM SEOUL AND SINGAPORE LESSONS FROM SEOUL AND SINGAPORE 183
Towards an Age-Friendly City: Lessons from Seoul and Singapore
Planning for seniors, Physical infrastructure and with seniors Concerted social services should be multi-stakeholder integrated approach
Reconsider Empower our how we seniors and foster a view seniors greater sense of ownership
Partnering with existing providers
ma ma th is more effective th Rethink than developing housing and new social community services
Scale ageing- related policies and initiatives to seniors’ actual Ageing way of life as an C C opportunity 184 ENDNOTES ENDNOTES 185
GLOSSARY
AAH Active Ageing Hub NAFA Nayang Academy of Fine Arts AAS Alert Alarm System NC Neighbourhood Committee AIC Agency for Integrated Care, Singapore NCSS National Council for Social Services BCA Building & Construction Authority, Singapore NLB National Library Board, Singapore BTO Build-To-Order NParks National Parks Board, Singapore C3A Council for Third Age, Singapore NSA National Silver Academy CBP Community Befriending Programme NUH National University Hospital, Singapore CC Community Club NUHS National University Health System CGH Changi General Hospital PA People’s Association, Singapore CLC Centre for Liveable Cities, Singapore RA Retirement Account CNS Community Networks for Seniors RC Residents’ Committee CPF LIFE Central Provident Fund Lifelong Income For the Elderly RHS Regional Health System CPF Central Provident Fund ROCSC Reaching Out Community Service Center EASE Enhancement for Active Seniors SA Studio Apartment EHA Eastern Health Alliance SAC Senior Activity Centre FDW Foreign domestic worker SAPS Studio Apartment Priority Scheme GNAFCC Global Network of Age-friendly Cities and Communities SCEC Senior Citizens Executive Committee GRO Grassroots organisations SG Mark Singapore Good Design Mark GSEN Gwangjin Social Economy Network SG Silver Generation HAPPY Healthy Ageing Promotion Program for You SGO Silver Generation Office HDB Housing & Development Board, Singapore SH Corp Seoul Housing and Communities Corporation HPB Health Promotion Board, Singapore SHB Silver Housing Bonus ILP Intergenerational Learning Programme SI Seoul Institute ITE Institute of Technical Education SMG Seoul Metropolitan Government KMTAC Korea Music Teaching Academy for Children SMH Shinnae Medical Housing LBS Lease Buyback Scheme SPS Seniors Priority Scheme LDG Local District Gu Government SSEZ Special Social Economic Zone LKYCIC Lee Kuan Yew Centre for Innovative Cities SSO Social Service Office LTA Land Transport Authority, Singapore SUTD Singapore University of Technology and Design MCA Ministerial Committee on Ageing, Singapore TCM Traditional Chinese medicine MCYS Ministry of Community Development, Youth and Sports, Singapore URA Urban Redevelopment Authority, Singapore MND Ministry of National Development, Singapore VWO Voluntary welfare organisation MOE Ministry of Education, Singapore WCS World Cities Summit MOH Ministry of Health, Singapore WHO World Health Organization MRT Mass Rapid Transit YH Yishun Health MSF Ministry of Social and Family 186 ENDNOTES ENDNOTES 187
Ministry of Health, Action Plan for Successful Ageing, 9. ENDNOTES 15 Seoul defines the working age range as 15–64 years old while Singapore defines the 1 United Nations Department of Economic and Social Affairs, “World Urbanization working age range as 20–64 years old. Prospects: The 2018 Revision”, 2018, accessed 01 September 2018. https://population. 16 Seoul’s data was gathered from Statistics Korea, “Special Population Projections”; un.org/wup/Publications/Files/WUP2018-KeyFacts.pdf. Singapore’s data was gathered from PMO NPTD, Population in Brief 2017 and Toh, 2 Chris Phillipson, “Urbanisation and Ageing: Towards a New Environmental Gerontology’’, “Singapore ageing”. Ageing and Society, 24 (2004). 963-72. 17 Seoul’s data was gathered from Statistics Korea, “Special Population Projections”; 3 Anne Karpf, “Our cities must undergo a revolution for older people”, The Guardian, 15 Singapore’s data was gathered from Ministry of Communications and Information, March 2017, accessed 28 August, 2018. https://www.theguardian.com/ “Factually: How does the shrinking local workforce affect Singapore’s economy”, https:// commentisfree/2015/mar/15/age-friendly-cities-design-future. www.gov.sg/factually/content/how-does-the-shrinking-local-workforce-affect-singapores- economy. 4 Jayant Menon and Anna Melendez-Nakamura, “Aging in Asia: Trends, Impacts and Responses”, ASEAN Economic Bulletin 26, no.3 (2009). doi:10.1355/ae26-3e. 18 Seoul’s data from Statistics Korea, “Birth statistics for 2017”, 2018; Singapore’s data gathered from Department of Statistics, “Singapore Population”, https://www.singstat. 5 Seoul’s data was gathered from Ministry of the Interior and Safety and Statistics gov.sg/modules/infographics/population. Korea: Population Statistics Based on Resident Population (as of March 2018), http://kosis.kr/eng/statisticsList/statisticsListIndex.do?menuId=M_01_01&vwcd=MT_ 19 Data from Seoul Metropolitan Government (2015), The Seoul Survey. Baby boomers are ETITLE&parmTabId=M_01_01&statId=2008001&themaId=#SelectStatsBoxDiv; Singapore’s defined in Korea as those born between 1955 and 1963. data was gathered from Prime Minister’s Office Strategy Group, National Population and 20 Ministry of Community Development, Youth and Sports, “Baby-Boomers Survey”, Talent Division, Population in Brief 2017 (Singapore: Prime Minister’s Office Strategy 7 January 2009, accessed 10 August 2018, www.nas.gov.sg/archivesonline/data/ Group, Singapore Department of Statistics, Ministry of Home Affairs, Immigration pdfdoc/20090116004/baby_boomer_survet_7jan09.pdf. Checkpoints Authority, Ministry of Manpower, 2017), https://www.strategygroup.gov.sg/ docs/default-source/default-document-library/population-in-brief-2017.pdf and Elgin Toh, 21 OECD, Labor Force Statistics 2017, accessed 20 September 2018, https://data.oecd.org/ “Singapore ageing at a faster pace than a decade ago”, The Straits Times, 28 September emp/labour-force-participation-rate.htm. 2017, accessed on 01 September 2018, https://www.straitstimes.com/singapore/spore- 22 Data from Statistics Korea, “Aged Population Statistics”. 2015. ageing-at-faster-pace-than-a-decade-ago. 23 Elizabeth Linton, Bina Gubhaju and Angelique Chan, “Home Alone: Older Adults in 6 Lee Sang-Hyop, Andrew Mason and Donghyun Park, “Why does Population Aging Matter Singapore”, Research Brief Series 4 (2018), accessed 15 September 2018, https://www. So Much for Asia? Population Aging, Economic Security and Economic Growth in Asia”, duke-nus.edu.sg/care/wp-content/uploads/Home-Alone-Older-Adults-in-Singapore.pdf. ERIA Discussion Paper Series, ERA-DP-2011-04, (2011), accessed 15 November 2018, https://core.ac.uk/download/pdf/9306302.pdf. 24 Theresa Tan, “More Singaporeans living alone; trend seen rising”, The Straits Times, 2 March 2014, accessed on 10 September 2018. 7 Seoul’s data was gathered from Seoul Statistics (2017), Projections by Seoul Gu District (2015 - 2035): Population Composition by Age Group; Singapore’s data extracted 25 Linton, “Home Alone”. from Ministry of Health, I feel young in my Singapore! Action Plan for Successful Ageing 26 (Singapore: Ministry of Health, 2016), 8. Angelique Chan et al., “Loneliness and All-cause Mortality in Community-dwelling Elderly Singaporeans”, Demographic Research, 32, 1 (2015): 1361-82. 8 Seoul’s data was gathered from Statistics Korea, “Special Population Projections”, 2005. 27 Linton, “Home Alone”; Chan et al., “Loneliness and All-cause Mortality”. 9 Tan Teck Boon, “A super-aged Singapore: Policy Implications for a Smart Nation.”, 28 TODAY, 28 September 2017, accessed on 01 September 2018. Statistics Korea, “Aged Population Statistics”. 29 Seoul Senior Population Survey, Seoul Welfare Foundation, 2015. 10 Sarah O’Connor, “World will have 13 ‘super-aged’ nations by 2020”, Financial Times, 7 August 2014, https://www.ft.com/content/f356f8a0-1d8c-11e4-8f0c-00144feabdc0. 30 Ministry of Health, “Speech by Mr Gan Kim Yong, Minister for Health, Committee of Supply Debate 2018: Building a Sustainable Healthcare System for the Future”, 7 March 11 United Nations Department of Economic and Social Affairs Population Division, “World Population Ageing 2015”, 2015, 3, accessed 02 September 2018. 2018, accessed 20 November 2018, https://www.gov.sg/microsites/budget2018/ press-room/news/content/speech-by-mr-gan-kim-yong-minister-for-health-committee-of- 12 World Health Organization, Global Age-friendly Cities: A Guide. (Geneva: World Health supply-2018. Organization), 1. 31 Mythily Subramaniam et al., “Prevalence of dementia in people aged 60 years and above: 13 Ibid. results from the WiSE Study”, Journal of Alzheimer’s Disease, 45, 4 (2015): 1127-38.
14 Seoul’s data was gathered from Statistics Korea (2016) http://kosis.kr/statHtml/statHtml. 32 Prime Minister’s Office Strategy Group, National Population and Talent Division, do?orgId=101&tblId=DT_1B8000F&language=en; Singapore’s data was gathered from “Occasional Paper: Projection of Foreign Manpower Demand for Healthcare Sector, 188 ENDNOTES ENDNOTES 189
Construction Workers, and Foreign Domestic Workers”, 7 November 2012, accessed 20 49 Buyers who are wheelchair bound may choose to have a lower kitchen countertop. November 2018, https://www.strategygroup.gov.sg/default-source/default-document- 50 Take-up rate is based on the 2-room Flexi flats set aside for elderly in Build-To-Order (BTO) library/occasional-paper-projection-of-foreign-manpower-demand-healthcare- projects where the selection has already been completed up to April 2018. It includes construction-foreign-domestic-workers.pdf. elderly who booked a 2-room Flexi flat, either on long lease or short lease. 33 Bina Gubhaju et al., “Deteriorating health but still working very long hours – A profile of 51 The Central Provident Fund (CPF) is Singapore’s social security system that enables Singapore’s older family caregivers”, Research Brief Series 3 (2017), accessed on 05 working Singapore Citizens and Permanent Residents to set aside funds for retirement. August 2018, https://www.duke-nus.edu.sg/care/wp-content/uploads/A-Profile-of-Older- Through its various accounts, it also addresses healthcare, home ownership, family Caregivers-in-Singapore.pdf. protection and asset enhancement. The CPF Retirement Account (RA) is automatically 34 Ministry of Health, Problems of the Aged: Report of the Committee on the Problems of the created when a Singapore Citizen or Permenant Resident turns 55. The CPF Lifelong Aged (Singapore: Ministry of Health, 1984). Income For The Elderly (LIFE) Scheme is a life annuity scheme that provides Singapore Citizens and Permanent Residents with a monthly pay-out for as long as they live. 35 Ministry of Health, “Speech by Mr Gan Kim Yong”. 52 The development of Kampung Admiralty was led by the Housing & Development Board 36 Because of the Korean War, Seoul’s definition of its baby boomers (i.e. those born between (HDB), in partnership with Yishun Health (YH), National Environment Agency (NEA), 1955 and 1963) is different from that of the rest of the world, where it is defined as those National Parks Board (NParks), Land Transport Authority (LTA), Early Childhood born in the 1940s to 1960s. Development Agency (ECDA) and Ministry of Health (MOH). 37 Content provided by New Taipei City Government. Additional content for this box story 53 This refers to an initiative in which pharmacies with good accessibility provide was retrieved from: Chia Jie Lin, “How New Taipei is turning back the tide on ageing”, various services such as medication, counselling, suicide prevention and comprehensive GovInsider, 5 November 2018, accessed on 12 November 2018, https://www.govinsider. management of medication history in order to promote the health of citizens. 215 asia/smart-gov/new-taipei-sharing-economy-for-elderly-eric-chu/. pharmacies of 15 local districts are designated as “safe pharmacies” as of 2017. 38 Paul Irving, “Asia’s ageing population: A golden opportunity for business”, The Straits 54 Continuous management rate is calculated as follows: Continuous management rate = Times, 12 September 2017, accessed on 01 September 2018, https://www.straitstimes. (Intensive management group + Regular management group) / Total number of persons com/opinion/asias-ageing-population-a-golden-opportunity-for-business. registered. 39 George Liao, “MOI: Taiwan officially becomes an aged society with people over 65 years 55 Health and medical resources include community health centres, welfare institutions, old breaking the 14% mark”, Taiwan News, 10 April 2018, accessed on 28 August 2018, medical institutions, dementia support centres, mental health promotion centres and https://www.taiwannews.com.tw/en/news/3402395. others. 40 All the statistics are from Jeong Eun-ha and Hwang Hye-shin, Senior Population Survey 56 Linking rate is calculated as follows: Linking rate = Number of cases linked / Total number 2016, Seoul Welfare Foundation, 2016. of elders registered. 41 Liam Foster and Alan Walker, “Active and Successful Aging: A European Policy 57 The decrease in the visiting rate and registration rate in the 2nd year compared to the 1st Perspective”, Gerontologist, 55, 1 (2015): 83-90; Alan Walker, “Commentary: The year was because 80 Dongs saw a significant drop in home visits aside from new Emergence and Application of Active Aging in Europe”, Journal of Aging & Social Policy, registrations and continuous management. This decrease does not necessarily mean there 21, 1 (2008): 75-93. were issues with the progress of the project. 42 Seoul Metropolitan Government, “SMG introduces ‘Dure House for Seniors Living Alone in 58 Kim Bo Yeong, “What does the Reaching Out Community Service Center project look Geumcheon-gu”, Press Release, 22 September 2015. for?”, Monthly Welfare Trends, People’s Solidarity for Participatory Democracy, 2017. 43 Tan Hsueh Yun, “HDB to sell studio flats for the elderly”, The Straits Times, 6 November 59 Jang Sook Rang, “Operation and Tasks of the Reaching Out Community Service Center 1997. Project: A Conception for Better Preventive Home-Visiting Health”, Paper presented at 44 Khaw Boon Wan, “Who Buys Studio Apartments?”, 07 May 2014, accessed 19 September 2017 Fall Conference of the Korean Association of Preventive Medicine, Seoul, South 2018, https://mndsingapore.wordpress.com/2014/05/. Korea, 2017.
45 Housing & Development Board, “Review of Studio Apartment Scheme and New Sites 60 Kim Bo Yeong, “What does the Reaching Out Community Service Center project look Identified for Selective En bloc Redevelopment Scheme”, Press Release, 13 January 2003. for?”.
46 Khaw Boon Wan, “Who Buys Studio Apartments?”. 61 References for this box story were taken from the following sources: Gwak In-suk, “Study on the Outdoor Space in Facilities for Senior Citizens with Dementia”, 47 A merger of the former Ageing-in-Place Priority Scheme (APPS) and the Married Child Journal of Korean Home Management Association, 21, no.3. 1-13; Son Chang-wu, The Priority Scheme (MCPS). Way Forward and Strategies for Seoul’s Dementia Program 2017 – 2026, Seoul 48 HDB suspended the supply of 2-room flats in the 1980s due to a lack of demand. In 2006, Metropolitan Government, 2017; Oh Chan-ok and Gwon O-jeong, “Before/After Dementia HDB resumed the supply of 2-room flats to cater to low-income families. Homecare Environment Design and Assessment of Its Effectiveness”, The Korean Housing 190 ENDNOTES ENDNOTES 191
Association, 2017; Jeon Seong-min and Gwon Sun-jeong, “Study on the Development and Its Care Services, February 2016; Seoul Social Economy Center, “SMG Special Social of Outdoor Space in Dementia Care Facilities”, Journal of Korea Institute of Healthcare Economic Zone”, accessed 19 September 2018, http://sehub.net/support-zone; 세모편지. Architecture, 13, no.1. 61-71; Jeong and Hwang, Senior Population Survey 2016. “‘식당’으로 일구는 지역돌봄 통합 모델’”, accessed 16 September 2018, https://sehub.blog. me/220845953537. 62 Activities inside the bounds of home include hours spent in sleep. Space near home includes streets in front of the home, pagodas and shaded areas for public use, homes of 75 Community Clubs (CCs) are community spaces located near transport nodes. Grassroots neighbours nearby, and routes used for daily walks. External activities include time spent organisations such as Residents’ Committees (RCs) and Neighbourhood Committees (NCs) on the move to reach a destination. also have their respective centres and spaces. Refer to Centre for Liveable Cities, Planning for Communities: Lessons from Seoul and Singapore (Singapore: Centre for Liveable 63 Ministry of Health and Welfare, Ministry of Health and Welfare Statistical Yearbook 2017 Cities, 2017), 44 – 45. (South Korea: Ministry of Health and Welfare, 2017), 360. 76 As part of the Ministry of Health’s healthcare system reorganisation efforts in 2018, 64 Son Chang-wu, The Way Forward and Strategies for Seoul’s Dementia Program 2017 – Alexandra Health Systems has since been merged with National Healthcare Group to form 2026 (South Korea: Seoul Metropolitan Government, 2017). the National Healthcare Group (NHG) cluster. Refer to Lianne Chia, “MOH to reorganise 65 Orientation refers to the ability to correctly recognize where one is. It generally concerns healthcare system into three integrated clusters”, Channel News Asia, 18 January 2018. the ability to distinguish between people, places, and time. Orientation requires 77 Janice Tai, “Yishun set to be first ‘dementia-friendly’ town”, The Straits Times, 21 January awareness, the ability to think and make decisions, memory, and attentiveness. Someone 2016. who is disoriented is generally unable to answer questions about identity, location and time, such as ‘Who are you?’, ‘Where are you?’ and ‘What date is today?’ 78 Nee Soon Town Council, “3 New Wellness Kampungs in Yishun”, The Nee Soon Link, 2017, http://nstc.org.sg/uploads/files/Issue%2014_LR.pdf. 66 There were 198 respondents in total, but only 53 took part in both the preliminary and follow-up surveys. 39 of these were 65 years or older. 79 Ibid.
67 The rates were calculated as follows: Increase (%) = (Follow-up survey – Preliminary survey) 80 Tay Suan Chiang, “Marks of good design”, The Business Times, 17 March 2017. / 4 (Top score – Lowest score) * 100. 81 Health Promotion Board, “New exercise campaign to encourage active living among 68 Irene H Yen et al., “Older people and social connectedness: How place and activities keep seniors, including those with reduced mobility”, https://www.hpb.gov.sg/article/new- people engaged”, Journal of Ageing Research (2012), http://dx.doi. exercise-campaign-to-encourage-active-living-among-seniors-including-those-with- org/10.1155/2012/139523. reduced-mobility.
69 Housing & Development Board, “Enhancement for Active Seniors (EASE)”, accessed 19 82 Ministry of Health, Action Plan for Successful Ageing, 34-7; Rei Kurohi, “Employers, September 2018, https://www.hdb.gov.sg/cs/infoweb/residential/living-in-an-hdb-flat/for- workplaces play important role in beating diabetes: Amy Khor”, The Straits Times, 26 our-seniors/ease. November 2018.
70 Building and Construction Authority, “Universal Design Guide”, accessed 20 September 83 Content provided by National University Health System. 2018, https://friendlybuildings.bca.gov.sg/resources/ud-universal-design-guide. 84 Content provided by Changi General Hospital; INSEAD. html?scroll=content. 85 Background on Senior Welfare Centers was obtained from: Jeong Eun-ha, “Proposal to 71 More information on Silver Zones can be found in the first CLC-SI publication. Centre for Improve the Operation of Senior Welfare Center”, 2015; Choi Seong-jae, Jang In-hyeob, Liveable Cities, Walkable and Bikeable Cities: Lessons from Seoul and Singapore “Welfare of the Elderly”, 2010. (Singapore: Centre for Liveable Cities, 2016), 79–82. 86 Centre for Liveable Cities, “Cooking Up A Community”, Urban Solutions, no. 10, January 72 National Parks Board, “Therapeutic Gardens”, accessed 16 September 2018, https:// 2017, 54–9. www.nparks.gov.sg/gardnes-parks-and-nature/therapeutic-gardens; Angelia Sia et al., “ The Effect of Therapeutic Horticulture on the Psychological Wellbeing of Elderly in 87 Ministry of National Development, “Budget 2018 Speech by Minister Lawrence Wong: Singapore: A Randomised Controlled Trial”, Journal of Therapeutic Horticulture 28, no.1 Building our Future City and Home Together”, 6 March 2018, accessed 20 November (2018): 1- 10. 2018, https://www.mnd.gov.sg/newsroom/parliament-matters/view/budget-2018-speech- by-minister-lawrence-wong-building-out-future-city-and-home-together. 73 Under the SkillsFuture movement, all Singaporeans aged 25 and above are given an opening credit of S$500 and periodic top-ups by the government to further improve their 88 Beth T. Stalvey et al., “The Life Space Questionnaire: A Measure of the Extent of Mobility skills. of Older Adults”, Journal of Applied Gerontology 18, no. 4 (1999): 460-78.
74 References for this case study were taken from the following sources: The Hankyoreh, 89 Ahn, Hyun-chan, 고령화시대에대응하는서울형지역사회전략연구 The Strategy for Age-friendly “Four Social Enterprises Work Together to Offer Korean Buffet at KRW 5,000”, 29 June Communities in Seoul (Seoul: The Seoul Institute, 2017). 2017; Park Yong-su, “Introduction to the Gwangjin Social Economy Network (GSEN) 192 193
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세모편지. “‘식당’으로 일구는 지역돌봄 통합 모델’”. Accessed September 16, 2018. https://sehub. 24, 26-27: Ministry of Health, Singapore blog.me/220845953537. 30, 32: Centre for Liveable Cities, Singapore 34-37: New Taipei City Government 38: People’s Association, Singapore 41: Unsplash, Shermin Ng 48: Flickr, Christopher Vu 52-53: Geumcheon-gu Government 54: Deborah Chan 55-56: Geumcheon-gu Government 59 (left): Housing & Development Board, Singapore 59 (right): WOHA 60: Housing & Development Board, Singapore 63: Seoul Love 66, 67 (top left): Seoul Institute 67 (top right, bottom): Deborah Chan 68, 69 (top): Seoul Institute 69 (bottom): Deborah Chan 71: Darren Soh 72-75: Housing & Development Board, Singapore 76: Darren Soh 77-78: Housing & Development Board, Singapore and NTUC Enterprise 198 199
80, 83-84, 92-93: Seoul Metropolitan Government 85: Seoul Metropolitan Government; Jang Sook Rang (2017) 95, 97-98: Ministry of Health, Singapore 113: Seoul 50+ Foundation 100-101: Deborah Chan 130: Seoul Social Economy Center 102: Cognitive Health Guidebook, Seoul Metropolitan Government 146: Seoul Metropolitan Government 103 , 104 (top): Deborah Chan 154: Jeong Eun-ha (2013) 104 (bottom): Cognitive Health Guidebook, Seoul Metropolitan Government 159: Ministry of Health, Singapore 106: Deborah Chan 108-109: Agnes Won 110: Geumcheon-gu Government 112 , 115-116, 118: Seoul 50+ Foundation 126: National Silver Academy, Singapore 137: People’s Association of Singapore 139-142: Yishun Health 145 , 147-148: Mapo Senior Welfare Center 152 (top): Mapo Senior Welfare Center 152 (bottom): Deborah Chan 160-161: Presbyterian Community Services 162-163: Kwong Wai Shiu Hospital 164-165: NTUC Health Co-Operative Ltd. 166-168: Welfare Union 169-171: Centre for Liveable Cities, Singapore 172: Geumcheon-gu Government 175-176: Deborah Chan 178: Welfare Union 179: Deborah Chan
Diagram Credits 6: Korean Statistical Information Service 7: Department of Statistics, Singapore 20, 22: Seoul Welfare Foundation 25, 27: Ministry of Health, Singapore 70: Seoul Metropolitan Government 82: Lee Tae Su et al. (2017) AGE-FRIENDLY
LessonsCITIES from Seoul and Singapore
Seoul and Singapore are experiencing a demographic shift as their populations age. Over the years, both cities have formulated plans, programmes and policies to support their seniors to live healthily, actively and purposefully as they navigate their daily lives within high-density urban environments. Both Seoul and Singapore share common aspirations to continue building age-friendly cities that support and empower their seniors.
Age-Friendly Cities: Lessons from Seoul and Singapore is the third joint research publication between the Centre for Liveable Cities and the Seoul Institute. This publication explores the current and future ageing landscape in Seoul and Singapore and their ongoing efforts to address these issues. Case studies are examined under the themes of ageing-in-place and active ageing to distil common lessons on how cities can be more inclusive for seniors.