Planning for the Golden Years - Home Care, Assisted Living or Nursing Home (Updated 2023)

According to a report on ageing in place in Singapore, as of 2021, over 97% of seniors grow old at home. Of the remaining, the majority reside in nursing homes (2.5% of total) and only a few opt for assisted living facilities (0.1%). The numbers suggest home care is an overwhelmingly popular choice among elderly Singaporeans. But is it popular because of the limited availability of nursing homes and assisted living establishments? If a senior needs 24/7 care, would home care still be a good option? 

In this article, we discuss elderly care needs, how each care option meets their needs and the financial implications. Understanding the pros and cons of each type of arrangement can help you make a decision that can benefit you and your loved one the most, rather than based on just availability. 

Elderly Care Needs in Singapore

Ageing is a natural yet complex process, bringing about changes in body functions, cognition and physical strength. With these changes comes the rising need for medical care in the later stage of life. A study of health care spending per capita in 9 high-income countries shows that seniors (aged 65 and above) spend 3 times or more on medical bills compared to younger adults (aged 20 to 64). This does not take into account indirect costs such as hiring a domestic helper for support at home. 

Elderly care needs are not just higher than younger adults, they may also be fluctuating and unpredictable. For instance, elderly people have a higher risk of falling. When a fall happens, they may require longer recovery time. Recovery again may be extended due to surgery related complications such as infection, bleeding, etc. Other fluctuations in an elderly’s health can lead to changes in medication, dietary needs and care levels. A chronic condition like hypertension might be well-managed for an extended period, but suddenly experiences a spike that requires immediate medical attention. 

Broadly speaking, a senior’s expenses for health care are made up of 3 categories of costs: routine health care costs, emergency medical costs, and other incidental or one-off costs. 

Elderly’s Routine Health Care Costs:

  • Medications: These ongoing costs can be significant, to manage one or more chronic conditions, control symptoms, and improve overall health.
  • Doctor Visits: People typically visit doctors more often as they get older, for follow-ups, routine checkups and screenings, or consultations on arising health issues. 
  • Long-Term Care: By 2050, it is projected that 1 in 6 elders in Singapore will need support with one or more activities of daily living (ADL’s, i.e., daily self-care activities) while 1 in 3 elders will need assistance with at least one instrumental activity of daily living (IADL, i.e., activities that allow an individual to live independently in the community). The need for such long-term assistance results in running costs to pay for the service of a nursing home, an assisted living facility, or for a caregiver or domestic helper at home.

Senior’s Emergency Medical Cost: 

  • Hospitalisation: A study estimates that Singaporeans aged 55 and above spend an average lifetime amount of SG$33,000 on expenses related to hospitalisation. This includes the costs of hospital stays, surgeries, procedures, and treatments for acute or chronic conditions, or injuries.
  • Post discharge care: Incidents such as a surgery or a stroke may require post-discharge rehabilitation or therapies to regain mobility and functions, or palliative care to manage pain and improve well-being. This translates into costs for home therapy or home palliative services, or for short-term stays at rehabilitation centres.

Other Costs:

  • Home Modifications: For all elders who stay at home, enhancements such as installing ramps, handrails, bathroom grab bars, anti-slip treatment to bathroom floors are necessary to make their homes safe and accessible. Some seniors also need specific safety measures, such as sensors or alert systems to keep a person with dementia from wandering and getting lost. This is often a one-time cost. However, maintenance and replacement costs may be incurred down the road. 
  • Dental, Optical Care: Apart from routine dental and vision checkups, seniors may need to spend on denture, dental implants, spectacles, etc.
  • Assistive Devices: These may include devices to support mobility such as wheelchairs, walkers, canes, mobility scooters, or to support hearing such as a hearing aid.
  • Medical Equipment at Home: Blood pressure monitors, blood sugar metres, oxygen tanks are examples of equipment and aids an elderly may need at home to support their daily health care. 

Home Care - Home is Where the Heart is

Home care refers to providing assistance and care to seniors within the comfort of their own homes. The range of care services may include support with activities of daily living (ADL’s), medication supervision and management, companionship, housekeeping, and certain medical services that can be conducted at home.

According to a Lien Foundation-NUS study, the vast majority of seniors in Singapore prefer to age in place and be cared for at home, rather than to grow old in institutions such as nursing homes. The benefits of home care are abound, with familiarity being the most apparent. Remaining at home in the golden years provides elders with a sense of independence, security and comfort. They can get to see their loved ones more often. They can also maintain the social connections that have been built over the years with their communities, neighbours, and friends, which is an important part of their overall well-being.

However, home care can be a challenge for elders who live alone, or need a high level of caregiving and medical care. Issues arise when they do not promptly get the medical attention required, or when family caregivers have too much on their plate. There may also be additional costs and the hassle of being transported frequently between the care places and home. Situations like this can pose a significant financial and logistic burden for the seniors and families who opt for home care. We detailed the 10 pros and cons of home care in another article here.

Nursing Home - When Is It a Good Option?

The same Lien Foundation-NUS study above reveals that while younger Singaporeans are open to staying in a nursing home themselves, they are not willing to send a family member to one. Almost one in three surveyed said they were strongly opposed to the idea. The stigma associated with nursing homes remains relatively strong in Singapore. This may have to do with the fact that nursing homes often have regulations to ensure the safety of their residents and maintain a general order. Such restrictions can make seniors feel like they lose their independence. 

Preferences aside, there are circumstances when nursing homes can be a good option for the elders. Nursing homes are designed to provide 24/7 care for individuals who need assistance with most of their activities of daily living or are mentally impaired. They have medical staff on duty around the clock to attend to complex medical needs of their residents and to handle emergencies. Thus, you may want to consider nursing homes when your elderly loved ones need 24/7 care which you have difficulty providing at home. 

Note that nursing facilities mainly offer long-term elder care service. They are typically not meant for short-term 24/7 care, such as when a person goes through post-stroke and post-discharge recovery. Also, they prioritise those who have exhausted other care options including home care. You will need to check with the nursing homes if your elderly loved ones are eligible for admission. 

A detailed analysis of the advantages and disadvantages of nursing homes is published on our blog here.

Assisted Living - What are the Pros and Cons?

Assisted living is a relatively new elder care arrangement in Singapore. In general, it caters to seniors who are relatively healthy and independent. They need some assistance with their daily living (e.g., 1 or 2 ADL’s) but do not need the intensive care of a nursing home. The facilities provide accommodation (shared room or single room), meals, other daily support assistance as required by the residents and basic health care. 

Assisted living offers residents several advantages: 

  • Social Interactions: Assisted living facilities often have communal spaces and organise regular group activities to promote a sense of community living. Seniors who enjoy social activities will benefit from this.
  • 24/7 Assistance: Caregivers and staff are available 24/7 to provide support to residents. However, the level of support is lower than nursing facilities. On-site medical care is available but often limited. 
  • Peace of Mind: Families can feel assured that their loved ones are being cared for professionally. The seniors can also feel a relief that they are getting care without creating a burden on their families.

However, assisted living also comes with a few disadvantages: 

  • Cost: Assisted living in Singapore is considered to be on the pricey side. Monthly cost for basic accommodation and meals is reported to be SG$3,000 upwards, with private residences and single rooms cost more than public housing and shared rooms. 
  • Limited Privacy: Elders who value privacy and personal space may not feel comfortable at an assisted living facility.
  • Few Options to Choose From: There are only a few providers of assisted living in the market at the moment, which means limited supply.   

As assisted living facilities offer limited medical care, seniors may still need the service of nursing home facilities when they require long-term extensive care.

Need 24/7 Care - Which Option Works Best?

A senior’s need for 24/7 care may arise due to an injury, after suffering from a stroke, advanced dementia or going for cancer treatment. In most cases, available options for 24/7 care include hospitalisation, nursing home and home care. 

Staying in a hospital provides families with the assurance that their loved ones are in the competent hands of medical professionals. However, intensive care comes with high costs, and hospitalisation is meant to be short-term. When their condition stabilises, patients are often recommended to seek alternative care arrangements. 

Outside hospitals, nursing homes are best equipped to provide such extensive care to the elders in the long term. The drawback is that nursing facilities prioritise seniors who are not able to get care at home and do not have other care options. So this option might not be for everyone.

Home care is often the most accessible option for elders. To ensure timely and appropriate medical care when bringing their senior home from the hospital, families can consider enlisting transitional care service. Rehabilitation and therapies can be done at home or at rehabilitation centres. If the seniors are comfortable with being transported between home and a care centre daily, combining home care with the service of day care can be a good plan. It also relieves the need of engaging a professional caregiver or having a family member performing caregiving duties 24/7. If the elder prefers to recuperate at home as much as possible, there are services such as home palliative care, home rehabilitation, house call nurses and doctors to meet your needs. Family caregivers can also count on respite care service when you need to take a break, or need time off to care for other matters. Respite care can be for a few days to a few weeks as you need. 

Cost of Care - Which Is The Winner?

Home care involves higher initial costs such as home modifications, engagement of caregivers and training of domestic helpers to ensure care and safety of the elderly. In the long run, home care often turns out to cost less. This is because in Singapore where accommodation is a significant expense, staying at home means you can allay this component in the care cost. 

However, there can be situations where the senior does not have someone to care for them at home, or when they have complex medical needs that the home environment is not equipped for. Staying at home can lead to inadequate care, which can exacerbate the senior’s condition and increase their likelihood to be hospitalised and other medical costs. Nursing facilities might be a better option in such cases, from both financial and care quality perspective. 

Assisted living is considered relatively costly, due to the high rental cost in Singapore. However, it can suit elders who need limited assistance in daily living and medical care. It also provides opportunities to meet peers and socialise. 

Note that cost of care may involve indirect costs, such as non-salary costs for a live-in helper or caregiver, the loss of income if a family member has to give up work. Although finance is an important consideration, it needs to be balanced with other criteria such as the needs of the seniors as well as the family. We share references of detailed costs for each living option in a separate blog article. You can also explore available subsidies, financial assistance schemes and tap into your MediSave when budgeting for care of a elderly loved one. Learn more about the latest subsidies and support available here.

Ageing in Place with Ninkatec

Home is where the heart is and where most seniors want to grow old. Though it can be an enormous challenge at times to ensure appropriate medical care and daily support for the seniors while balancing other responsibilities in the family, know that you are not alone. From professional service providers to support groups, assistance is available to help you and your loved one age in place with a peace of mind. 

Ninkatec is a home care specialist with a focus on elderly care. We leverage clinical expertise and medical technology to make home care more accessible and affordable in Singapore. Our care plans cater to different care needs. From Hospital @Home to 24/7 Remote Monitoring, Doctor Home Visits to Nursing Care and Caregiving, our team of professionals are equipped to walk with you throughout your home care journey. Visit our Services page to find out about us. Call, chat or drop us a message through the form below for any enquiry on home care you may have.

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Ninkatec also operates in-clinic GP services under Charazoi Medical Clinic, and caregiver services under Comfort Keepers Singapore. Visit our sister websites to find out more.

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