Choosing a care arrangement for elderly loved ones with long-term care requirements is often a difficult decision for families. A balance needs to be struck between health needs, personal living preferences and cost of care. On top of that, there are various care options out there, each with its own implications involving not just the seniors but also the households. How do we know which one will work out the best?
In this guide, we discuss the benefits and downsides of various elderly care arrangements to help you carefully weigh your options. We also lay out the landscape and explain the different services available, so you can make the optimal long-term decision based on what is most important for your ageing loved ones as well as the family.
Table of Contents
1. Types of Elderly Care Services
Broadly speaking, there are 5 main categories of care arrangement for seniors in Singapore.
- Home Care, or In-Home Care: Medical care is performed at the senior’s home. This is the preferred option for individuals who want to ‘age in place’.
- Nursing Home, or Nursing Facility: Equipped to provide medical care 24/7, this option works best for elderly people who need daily medical attention for the long term. All living and medical assistance are provided by the facility.
- Assisted Living, or Community Living: This type of care is typically for seniors who are relatively healthy and independent. Thus, the focus is to create a comfortable living environment and promoting community activities. Nursing and medical care is available and more limited than at nursing homes.
- Elderly Care Centres: Seniors come here to be cared for during the day and return to their home in the evening. Centre-based services provided at these facilities include social and recreational activities (Active Ageing Centre, Senior Activity Centre), rehabilitation and therapies, or specialised care such as dementia care, palliative care, hospice care.
- Short-Term Residential Care: Different from long-term stay-in services at nursing homes, short-term residential care facilities offer care for a set period of time, after which the seniors will return to their primary residence. An example is community hospitals where patients are admitted to continue their recovery after treatment for an acute situation, such as a stroke or a surgery.
2. Home Care Services for the Elderly in Singapore
Home care or in-home care refers to an arrangement where a person receives physical and medical assistance in the comfort of their home.
Day-to-day physical care may be provided by a family member, a professional caregiver, a domestic helper, or a combination of the above. Care tasks range from performing daily chores, helping the elderly with grooming, mobility, and other personal needs, administering medications, to keeping the senior’s company and providing a listening ear. Depending on the level of support needed, a professional caregiver may live in or come over for a set amount of hours.
Seniors opting for home care may have medical needs attended to by doctors and nurses visiting their home. However, home care does not eliminate the need to visit a clinic or hospital when necessary or in cases of emergency. If your elderly loved one receives in-home care, it is crucial to equip yourself with the knowledge of when to perform self-care at home, when to call a doctor, and when to head straight to a clinic or hospital. We wrote about 10 home care situations where you may need to immediately contact a doctor or a clinic on our blog. It is also highly beneficial to make your home is senior-safe to prevent tripping and falls, and find ways to help the elderly avoid isolation and a sedentary lifestyle. Check out our blog post on 8 ways to provide better home care for your senior beloved for ideas.
3. Home Care - Understanding the Pros and Cons
Advantages of Home Care
Being able to take care of an elderly loved one at home offers several important benefits:
- Familiar Living Environment: There is no place like home, home care provides the comfort, cosiness and familiarity that no other care locations can offer.
- Sense of Independence: Staying at home also provides a sense of independence and control over one’s daily routines, which is important for many seniors.
- Personalised Care: The elderly can get care tailored to their specific needs and preferences, from their loved ones or a professional caregiver with whom a personal relationship can be formed.
- Family Involvement: Family members can actively participate in caring for their loved ones. Being in the care and company of family members can be of emotional significance to the seniors. This could help to boost the overall well-being of the senior.
- Lower Cost in the Long Run: While there are costs associated with engaging a domestic helper or a professional caregiver and having a doctor or a nurse visiting your home occasionally, the total care cost often works out to be lower than other types of elder care arrangements in the long run.
Disadvantages of Home Care
Home care also has its limitations. Below are important aspects you need to take into account when considering in-home care:
- Care Disruption: Care can be disrupted when the primary caregiver is not available, for instance when the domestic helper goes on leave, or when the family caregiver has to prioritise other duties. It can also happen during ‘peak’ periods when hourly professional caregivers are in high demand.
- Limited Medical Support: The home environment is often not suitable for complex medical tasks unless the family has made arrangements to provide such care. The quality of medical care may be compromised for individuals who are further into the debilitating stages of a severe illness.
- Requirements for Home Modifications: It is estimated that 1 in 3 elderly aged 65 and above experiences at least one fall within a year. Elderly individuals can face various mobility challenges and safety hazards in their own home if it is not well retrofitted for their safety and convenience. We wrote about fall risks among seniors and how to make your home senior-friendly in a past article.
- Additional Space for a Live-In Carer: If you engage a live-in caregiver or helper, you will need to share your space with someone outside your family. This can be a challenge for a compact home.
- Social Isolation: Seniors staying at home may miss out on social interactions that are available in a communal setting.
- Potential of Caregiver Burnout: Long-term continuous care may put family caregivers at risk of chronic stress, fatigue and even burnout. If you are a caregiver and are feeling the stress, make sure you get care and help for yourself. Here are 6 strategies to prevent caregiver stress & burnout that can be helpful for you.
4. Nursing Home - Who Is It For?
A nursing facility, commonly referred to as a nursing home, is an establishment that serves as a home for the elderly with complex care needs to live in long-term.
With licensed nurses and doctors as their primary caretakers, elderly residents receive complete medical supervision around the clock. Generally, seniors in nursing facilities have medical conditions that require support with most of their activities of daily living (ADL’s) and/or constant medical care due to a severe illness, disability, advanced dementia or other types of cognitive impairment.
Although nursing facilities are usually for long-term stay, some also provide short-term respite care service, for instance when the family caregiver needs a break.
Nursing Home vs. Other Long-Term Elder Care Facilities
The defining characteristics of a nursing home is the availability of skilled nurses to provide 24/7 medical care to the residents. This is not usually the case with other eldercare services. Below are the differences each of them has in comparison with nursing homes.
Nursing Home vs. Care Home
A nursing home may sometimes be referred to as a ‘care home’, but strictly speaking, they are not the same. A ‘care home’, or ‘residential care home’ often only provides residential care service, while a nursing home usually has medical professionals on duty to provide medical supervision and deal with emergencies.
Nursing Home vs. Old Folks Home
An ‘old folks home’, also known as a ‘retirement home’, ‘old age home’, or a ‘senior home’, caters to elderly individuals who are relatively healthy, self-sufficient, and want to live with their peers. Thus, the focus is on maintaining freedom for residents and fostering a sense of community through organised communal and social activities. Daily support and medical care are available but usually limited, which is in contrast with the level of care provided at a nursing home.
Nursing Home vs. Assisted Living
Assisted Living, or Community Living for the Aged, is a relatively new form of eldercare service in Singapore. It aims to meet the needs of the ‘missing middle’ - seniors who have difficulty with fewer than 3 activities of daily living (ADL’s). They are not able to live independently but are well enough to be in the community. They do not get sufficient family assistance due to various reasons, but do not require the extensive care provided by nursing homes.
Assisted living facilities, with trained caregivers on roster duty, offer seniors meals and other professional assistance services, as well as the company of their peers. Residents pay a monthly rental fee and a subscription fee based on the level of assistance they need. There are a few privately run options to choose from. Most recently, public housing projects called community care apartments were launched based on this concept.
5. Nursing Home - Understanding the Pros and Cons
Advantages of Living in a Nursing Home
A nursing facility often comes into consideration when the care needs of the elderly exceeds what the family can provide on their own. Specifically, nursing homes provide the following benefits:
- 24/7 Professional Medical Supervision: With medical professionals on duty around the clock, residents at nursing homes can access medical care as and when they need it.
- Specialised Services: Nursing facilities have a clear edge in administering more extensive care for various medical conditions, due to the expertise of their medical staff and availability of medical-grade equipment.
- Structured Environment: Routine activities and on-site amenities often encourage residents to stay physically and cognitively active.
- Opportunities to Socialise: Living with others makes people more sociable, which helps to prevent isolation and depression.
- Peace of Mind: Families with limited medical knowledge can find relief knowing their loved one is receiving professional care.
Disadvantages of Living in a Nursing Home
Opting for a nursing facility also requires you to meet certain criteria and make trade-offs, including:
- Loss of Independence: Following schedules and regulations set by the facility may make the residents feel they are losing control over their routine and life. With other stigmas associated with nursing homes, some seniors and families may find it emotionally taxing to adjust to nursing home life, despite the benefits it offers.
- Separation from Family and Friends: Nursing home residents typically see less of their family and close friends, which might or might not be made up for by interacting with staff and peers at the facility.
- High Cost: Nursing homes tend to be costly due to the high level of medical care provided.
- Admission Requirements: Admission priority goes to seniors with complex nursing care needs or a severe disability who are unable to be cared for at home.
- Waiting Time: There is usually a waitlist. In Singapore, the waiting time is reported to be 1 month on average, but this can vary among facilities.
- Specific Restrictions: For instance, individuals with pet companions might not find nursing facilities ideal since most of them do not permit pets on their premises.
6. Cost Comparison - Home Care vs Nursing Home vs Assisted Living
Now that you have a good picture of the pros and cons of home care and nursing homes, let’s move on to the next important consideration - Cost of Care.
How Much Does Home Care Cost in Singapore?
On average, home care and caregiver agencies charge an hourly rate from S$25 upwards, depending on the level of care required for the elderly person.
If you engage a live-in caregiver or domestic helper with caregiving skills, you can expect a monthly salary from S$600 upwards. Requested salary can be above S$1,000/month if more intensive caregiving experience and skills are required. Additionally, there is a one-time agency cost (usually in the range of $1,000 - $3,000) and a monthly Foreign Domestic Worker levy.
Families may also incur costs for house-call nurse or doctor visits. A home visit by a professional nurse for nursing procedures can cost from S$60 upwards during office hours, while a home visit by a GP doctor for consultation can cost S$200 or more.
Home care often works out to be less costly eventually compared to other care arrangements, as you are staying at home and do not incur cost for accommodation. It is important to note that the medical needs of the elderly individual primarily contribute to the discrepancies in overall expenses, regardless of where they stay. To save cost in the long run, consider maintaining relationships with a primary doctor, a regular nurse and a stable caregiver and preventive measures such as regular health screenings and taking the recommended vaccinations for seniors.
How Much Do Nursing Homes Cost in Singapore?
Nursing homes in Singapore are estimated to cost a basic monthly fee of S$2,000 - S$3,600, before government subsidy. High-end private facilities may charge up to S$7,000 - S$8,000/month. This monthly charge covers in-boarding expenses and basic medical care. Additional payments will need to be made for emergency services, special needs, and therapy appointments.
As noted above, nursing facilities are meant for long-term care of people requiring assistance with most of the ADL’s who do not have family support and other care options. In Singapore, a typical nursing home stay can be 5 years or longer. This means that the costs may add up to a sizeable sum. It is a good idea to check with the nursing home staff before enrolling for possible subsidies to lessen the financial pressure if you are eligible.
How Much is Assisted Living in Singapore?
Assisted living facilities typically charge a monthly room rate which covers accommodation, meals, basic personal and nursing care, and community activities. Rates differ by room type (shared or private room), public or private housing, location and services provided. Monthly costs have been estimated to range from S$2,500 for a 2-bed shared room to $5,000 or more for a private room.
Community care apartments by HDB cost much less than private facilities. However, the payment schedule differs and supply is limited at the moment. There is usually an upfront cost to be paid in full for a 15-year lease period, higher for longer lease. Basic service package is compulsory and can be paid upfront or monthly. Other living and medical support services are available on a pay-as-you-go basis.
Though the cash burden is high at the start, community care apartments seem to be the most affordable in the market at the moment.
7. Factors To Consider When Choosing Between Home Care Or A Nursing Home
Deciding whether to have an elderly loved one receive in-home care or move to a nursing facility is challenging for the ageing individuals and their relatives. Financial matters aside, considering these specific factors may help you and your family with the decision making process:
- The severity of the elderly loved one’s health – Assessing the existing and future medical needs of the senior is crucial in determining whether they need the extensive medical support that a nursing facility provides. For instance, a person suffering from a stroke may need 24/7 care in the short to medium term, but can be expected to recover after rehabilitation. In this case, short-term care facilities such as a community hospital could meet their care needs. However, the condition of someone with late-stage dementia requiring full-time supervision today is likely to worsen in the future, and a nursing home could be a better place to get care.
- Family’s capacity to provide care – A nursing facility is a viable option for people whose families are unable to provide adequate support. This may happen for a variety of reasons, such as a small family or the inability to find a domestic helper after repeated tries. However, if you anticipate the lack of support at home can be addressed at some point, you can consider interim or alternative options, such as getting respite care for a few weeks or months, or combining day care with home care.
- Elderly loved one’s preference and concern – Ageing is naturally accompanied by requiring more assistance. However, this can be quite difficult for seniors to process. Involving your elderly loved one in this discussion is a compassionate way to address their concerns and relieve them of the distress they may be feeling. You may find out their unspoken preference (e.g., when an ageing parent wants to go for nursing facility for the company of peers and 24/7 care, but they don’t want to upset their children who want to keep them at home).
- Current home location & accessibility – Choosing a nursing home means uprooting one’s life to an unfamiliar place. Family members would want to help their loved ones transition and settle in smoothly. Being able to visit the nursing home regularly facilitates that. It also helps to cast off the senior’s feeling of being separated from family or worse, of being ‘abandoned’.
8. Opting for Home Care: Consider Respite Care Service
Some families have a member taking on the full-time responsibility of caring for an elderly loved one, but many do not. More often, a family caregiver has to juggle work, caregiving, childcare, among other duties. Even with a domestic helper, the burden may still be substantial.
Day care centres for seniors can provide relief during the day when you are at work, or respite care when you need to take a break. Some care centres provide respite service over the weekend, and some nursing facilities provide respite care for up to few weeks. You can also get respite care from home care service providers. The seniors remain at home, but you are relieved from caregiving responsibilities during the respite break.
It is crucial to select one that provides the services your elderly loved one needs, be it dementia care, rehabilitation, therapies, or just social activities. The comfort of the seniors is important too. And so is location and accessibility if you opt for centre-based service, as the elders will need to be ferried between home and the centre daily. Make an informed decision by asking around, doing your research, and conducting site visits with your elderly loved one before signing up.
9. Opting for Home Care: Check if You are Eligible for Subsidies, Financial Assistance and Support Services
There are various subsidies and financial assistance schemes available supporting seniors to age in place in Singapore. Seniors and families can benefit from:
- $240 concession per month when hiring a foreign domestic worker to care for a senior (aged 67 and above)
- Up to 95% subsidy for the cost of making your HDB flat elder-friendly (seniors aged 65 and above, for approved items, up to a limit by flat type and by item)
- $200 subsidy per year when the caregiver of the senior takes one of the approved caregiver training courses
- Up to 90% subsidy for the cost of assistive mobility devices (seniors with disabilities)
Check out subsidies and financial support for caregivers in Singapore and what you are eligible for in our blog post.
You can also tap into your MediSave to finance the cost of nursing home, home care and other medical costs. Withdrawal limits depend on your balance, withdrawal history, among other factors. Planning your finances with MediSave usage in mind can help to reduce the cash pressure on your savings. If you need a guide on budgeting care cost for your senior loved one, check out our itemised list posted earlier.
A number of essential support services are available to seniors to help overcome the challenges of home care and lack of caregiving support at home, including:
- Meals on Wheels: Daily meal delivery service to homebound seniors who are unable to buy and prepare their own meals and do not have assistance to do so. Each meal costs approximately between $5 and $7 before subsidies.
- Medical Escort: transportation and accompaniment service between home and locations of medical appointments for seniors without support. Wheelchair friendly vehicles are available. Each round trip costs between $40 and $150 before subsidies.
- Befriending Service: Trained volunteers from befriending service can visit seniors who live alone to offer emotional and psychological support and keep a lookout for their general well-being.
- Counselling: Multiple organisations in Singapore offer free and paid counselling service, to both seniors and caregivers. You can check with the staff at the nearest Senior Activity Center and Active Ageing Center for recommendations.
- Caregiver Support Group: Caregiving can be stressful and overwhelming at times. Caregivers need care too. Connecting a support group is a great way to find a listening ear, get psychological relief and learn that you are not alone and help is available. Here are some support groups to explore.
To find out more about the above support services, check the latest available options on Support Go Where website.
10. Takeaway Message
Searching for a suitable care arrangement for an elderly loved one can be a long and arduous journey. To make a well-informed decision for the family, the first step is to find out the available options, the pros and cons of each, the financial implications in the short and long term, and how they relate to your personal circumstances. We hope to have provided you with some useful pointers in this article.
As a home care service provider, Ninkatec strives to provide affordable care to your doorstep by leveraging clinical expertise and technology, enabling Singaporeans to age in the same place they have grown old and build memories with. Visit our website to learn more about the comprehensive suite of elderly care and specialised care services we have, as well as the different home care plans available for different medical needs. Our medical staff and caregivers specialise in elderly care, dementia care, cancer care, stroke care, home palliative care, home hospice care, and more.
Should you need any clarification or consultation on how to provide the best care to your senior loved one right at your home, please feel free to chat with us, call us or drop us a message through the form below. Ninkatec team of experienced doctors, nurses and caregivers are just a click away from you.
