Demand for Community Care Apartments and Assisted Living Developments, and Review of Affordability and Eligibility Rules of These Options

Mr Yip Hon Weng asked the Coordinating Minister for Social Policies and Minister for Health given falling demand for Community Care Apartments (CCAs) (a) whether the effects of fees, location and eligibility were assessed; (b) why subsidies require an Activity of Daily Living limitation although the CCA scheme targets prevention; and (c) how lower-income, pre-frail or isolated seniors will be protected from being priced out of CCAs.

Dr Wan Rizal asked the Coordinating Minister for Social Policies and Minister for Health regarding the private assisted-living pilot at Parry Avenue (a) what affordability assumptions and expected monthly price range were considered when the site was awarded; (b) what income or asset segment of Singapore’s senior population the development is intended to serve; and (c) whether affordability benchmarks or price commitments will form part of the assessment of future private assisted-living proposals.

Mr Liang Eng Hwa asked the Coordinating Minister for Social Policies and Minister for Health (a) on the reasons for the lower-than-expected subscription demand for the recent launches of the community care apartments; and (b) how the overall affordability can be further improved, including the price of the basic service package.

Sir, may I have your permission to address Question Nos 3 to 5 on the Order Paper together, please?

Go ahead.

Our approach is to provide a range of housing and care options for seniors – different services, different price points, subsidised and commercial products.

We will have a million seniors aged 65 and above by 2030. The most sustainable solution is for seniors to age in place, which is also their preference. Hence, we are bringing aged care services closer to where seniors live by expanding our Active Ageing Centre (AAC) network and offering Enhanced Home Personal Care (HPC+). We are also stepping up such services under the Age Well Neighbourhood initiative at locations with a higher density of seniors.

At the same time, we will continue to provide other options, such as Stay-in Shared Caregiving Services, Community Care Apartments (CCAs), as well as privately-provided assisted living options such as the facility at Parry Avenue. For the latter, operators determine the pricing and services based on commercial considerations, but they serve a niche segment of the population.

As for CCAs, the Government provides eligible seniors with housing grants and offers market discounts, to keep them affordable for seniors.

Notwithstanding, with more options to age well in the community, demand for CCAs has moderated. With the roll-out of subsidised services such as AACs and HPC+, we extended the same level of subsidies to CCA residents. That is a key reason why we have lowered the CCA Basic Service Package fees. In particular, subsidies for care services by CCA staff are similar to existing subsidised aged care services, hence similar eligibility criteria apply, including requiring Activities for Daily Living (ADL) support, to ensure subsidies are targeted at those with care needs.

Mr Yip.

hank you, Mr Speaker. I thank the Senior Minister of State for his response. I find it odd that demand for CCAs fell, even though the demand for senior housing is increasing, given that we have a very senior society. I have two supplementary questions.

Beyond affordability, what factors did the Government find most decisive for CCA take-up, such as location, mandatory services, eligibility rules or reluctance to relocate? Will it share the evidence so that future CCAs reflect how seniors actually want to age?

My second supplementary question: whether the Government will consider allowing MediSave or the Central Provident Fund (CPF) to be used for paying for CCA service fees to enhance the take-up of such housing services?

Sir, let me take the two supplementary questions by Mr Yip in turn.

On his first question around some of factors that affect the take-up of the CCAs, well, CCAs are still considered a fairly new product in Singapore. About seven in 10 units across the past five Build-To-Order (BTO) projects were taken up by the end of each BTO selection. Most recently, for Fernvale Plains, it was about 50%.

There could be a number of reasons why seniors choose a particular project. I am sure attributes related to housing like location, proximity to amenities, price points, perhaps familiarity with the environment, all play a part. So, it is hard to attribute to any one factor.

Importantly, I think we should take a step back and look at CCAs as part of the broader gamut of assisted living facilities and long-term care support given to seniors. I mentioned earlier, many seniors actually do want to age in place, age in a community, age in familiar environments in their neighbourhoods. And we have been enhancing our support – HPC+, for example, and many initiatives under the Age Well Neighbourhood programme.

We will continue to review CCAs together with the Ministry of National Development on locations and the kind of launches in future, but it is something we take into consideration as part of the spectrum of options.

Most importantly is that options are available at different price points and supporting the different needs of different groups of seniors in our community.

On the second question around the use of MediSave, well, firstly, I would contextualise my answer by saying that we review the affordability of long-term care and assisted living support on a regular basis. That is why we recently enhanced the HPC+ and various other support initiatives for seniors and their caregivers. So, we do review it on a regular basis.

But for the use of MediSave, we have to consider carefully the policy objective of MediSave, which is really to make sure that there is adequate savings in the MediSave accounts for seniors as they grow older so that they can continue to afford basic medical support. So, to any use of MediSave for services – like what the Member mentioned, the Basic Services Package under CCA – has to be considered carefully. It is something we will continue to look at, as part of the whole affordability considerations.

Dr Wan Rizal.

Mr Speaker, I thank the Senior Minister of State for sharing about the Parry Avenue pilot project. It has generated some interest in the seniors, especially the middle-income seniors. I think if the eventual total monthly cost, including accommodation, the service, the care, is beyond the reach for most middle-income seniors, what public policy objective is the Parry Avenue project actually trying to achieve? I think that is one of the questions they have been talking about.

The second is, will the Government require the operator to publish the expected all-in monthly cost so that residents, before they are committed, they are invited to understand fully what is the components that are involved in this? And before releasing further sites in the future, will the Government consider affordability conditions or requirement for proportion of the units to be accessible to the middle-income residents, who are really much interested in this project?

Sir, the project at Parry Avenue, which the Member Dr Wan Rizal spoke about, is a pilot project. We have to look at the outcomes of that project before we decide how we want to proceed.

Let me just go back to the basic point I made earlier in my reply – which is that the Government's approach is to provide a range of options at different price points. We cannot expect every assisted living model to serve every senior. What is important is that we want to have affordable options for most seniors. The Parry Avenue pilot project maybe more suitable for a niche segment of the community. But that is how the market works and we want to make sure we serve the needs of different groups of seniors.

So, the Government-supported options, such as CCAs and subsidised community care services, help to ensure affordable options are available to majority of our seniors, while private assisted-living option, like what the Member mentioned, provides additional choice for a very different segment. So, Parry Avenue does not replace our affordable options. It complements them. And a test of our overall policy objective is not whether every senior can afford every option, but whether seniors have access to appropriate options that they can afford.

On the Member's second supplementary question on whether the Government require the operator to publish the all-in cost before residents commit, I fully agree with the Member on the principle of transparency. Seniors and family members, the caregivers, should understand what they are committing to, including the relevant accommodation, care and service charge before making a decision. While the operator determines its services and pricing commercially, we expect them to be transparent and give clear information to the residents before they commit. And I understand that the operator has also committed that they will do so to provide this information and counsel the residents before they commit to any long-term commitments to the project.

On the Member's third point about future sites. Well, this is already a pilot. I will not prejudge the future of the other sites, but let us learn from the pilot and inform our overall strategy on assisted-living and support for seniors.

Mr Liang Eng Hwa.

Thank you, Sir. I want to express my support for the CCAs and notwithstanding the not so ideal take-up. So, I hope the Government will continue to build the CCAs. Two further questions for the Senior Minister of State.

Firstly, besides making the CCAs more affordable, can the Government also make it more appealing to the seniors by maybe adding on more lifestyle elements or the quality of care so that you can appeal to more to apply for the CCAs. My second supplementary question is whether in ageing town at Bukit Panjang, is the Ministry thinking of building a CCA there as well? I think there should be good demand because many of my seniors told me that they prefer to live in the same neighbourhood that they are familiar with, with their neighbours and friends around them.

Sir, I thank the Member for the two supplementary questions.

Allow me to address the second one first on Bukit Panjang, because I am sure it is very close to the Member's heart. The CCA is a new product and something with which we are testing the market to see whether seniors find it useful, and I must add that CCA is not the solution for every senior.

For many seniors, their preferred option is to remain in the existing home and their own community and neighbourhood that are familiar with, and we have initiatives to do so. For Bukit Panjang, for instance, where we know there is a higher density of seniors, it is one of the Age Well Neighbourhoods, and we are bringing initiatives, like enhanced AAC network, different active ageing healthcare and aged care services, closer to seniors in these neighbourhoods. The idea is for these neighbourhoods to lead the way because we want to test out many of these ideas. But the idea, the intent is to roll out and replicate some of these good working ideas to other parts of Singapore. So, rest assure for Mr Liang, that this is something we are working on in Bukit Panjang.

But going beyond Bukit Panjang, we want to bring those services to seniors into their neighbourhood. To the first question that Mr Liang has, affordability is only one consideration. I fully agree with him. An CCA must also be a place where seniors feel comfortable living and can remain active and importantly, socially connected with friends and neighbours. And they can get the support they need.

That is why the CCA model is not simply about providing a flat with basic care services. Social and active ageing programs will be provided through the AAC touch points near the CCAs, with most of the activities being free-of-charge and we will continue to learn from this experience. Going beyond the CCA, we want to bring these services to different neighbourhoods around Singapore to better serve our seniors because we have many of them and we want to care for them.

So, on both supplementary questions, I want to just assure Mr Liang that, that is something that we are very mindful of as we design the support network for our seniors in the future.

Ms He Ting Ru.

Thank you, Mr Speaker, for your indulgence. I just have a quick question for the Senior Minister of State on this topic. Maybe it is a little bit of a more niche area where, for example, a senior decides that they want to purchase a CCA, but but because these are BTOs, typically, they need to wait for a few years before the project gets built.

So, in those cases, firstly, is the Ministry aware and what sort of support is the Ministry giving to seniors who would like to purchase a CCA? They would actually like to go into living in a CCA now, rather than wait a few years. And what sort of support and how does the Ministry work with the Housing and Development Board, for example, in managing the timing and the lag between purchase, and also the CCA being ready for the senior to move in?

Sir, I thank Ms He for her supplementary question, which is, I think something on many seniors' minds.

Let me first say that CCAs are just one of the many options that seniors are considering, and I said earlier in my replies – the main reply and the different supplementary questions – by and large, many seniors prefer to age in their own home. They are familiar with it. They grew up there, their families grew up there. They know the neighbours. They are familiar with the local coffee shop, the local makan places, the neighbourhood. They want to age in place. So, that is the first preference that we know, when we speak to many seniors. In addition to that, there are others. That is why we are enhancing many of support at home and in the community, like the HPC+.

But if seniors choose to relocate, there are a number of options. CCAs are just one of the options for certain group of seniors that want to take up care services as part of CCAs, but many others options are available, including 2-room Flexi flats. There is also additional support from the Ministry of National Development and Housing and Development Board (HDB) in terms of Lease Buyback for seniors who want to live in their own home to sell back their lease. So, there are many options supporting our seniors, including CCAs and 2-room Flexis. And we are also constantly working with HDB to identify locations where these housing options can be provided to our seniors. Consideration will given to available land, demand and other attributes for housing. So, we work very closely with HDB on that, but CCAs are just one of the many options and I know HDB and the Ministry of National Development are working very hard to make sure there are more shorter waiting-time flats for buyers, including our seniors.