Assisted living, HDB style

In Singapore, discussions about retiring in HDB flats with care support have been taking place for over 20 years.

In 1997, I wrote an article that mentioned "sheltered housing" as a retirement option and interviewed a housewife on her dream retirement option.

This is what she said: "In an HDB estate, with shops, market, clinic nearby, so we don't have to travel too much. And small enough to keep spick and span by myself. Lots of people, with healthy minds, living together. Not like an old folks' home, with so many restrictions."

Fast forward to 2022 and her dream may be finally coming true.

The Housing Board has launched a new model of Community Care Apartments (CCAs). These offer HDB flats on shorter leases, that come with a basic care package of services that can be scaled up (such as adding meals and feeding) when needed, for additional fees. The pilot project of about 160 units in Bukit Batok is due to be completed by 2024.

Providing the CCAs is not just a matter of building brick and mortar flats. The project integrates housing with caregiving, and hence represents a groundbreaking policy innovation by Singapore standards.

But they are hard to scale up - because building new flats takes a very long time.

Instead, as participants at the roundtable suggested, using existing HDB and private homes, and turning them into assisted living apartments, is more scaleable.

This is precisely what a few private sector operators are doing.

One is the St Bernadette Lifestyle Village group, which has three assisted living homes, in Adam Road, Bukit Timah and Sembawang. Residents live in single or twin-bedded rooms in the houses. They are free to go about their day independently or to take part in programmes with trained staff. Fees in the newest Sembawang facility are $4,000 to $5,000 a month.

Then there is a new start-up, called Red Crowns, that is offering co-living for seniors in HDB flats or private condominiums.

Under the co-living concept, companies buy or lease properties and retrofit them to provide individual living suites in a complex that houses shared amenities such as kitchen, laundry, working spaces or dining areas. They are popular with young working adults. Co-living for seniors would offer similar housing options, but with eldercare services.

Founder of Red Crowns Senior Living, Mr Joshua Goh, 42, is an architect by training and entrepreneur with experience operating backpacker hotels and co-living projects for millennials.

His first "client" for a co-living home for seniors was his father, who suffered a few falls and was getting frailer. Not finding any care options suitable, he decided to help his father find fellow elderly flatmates to share caregiving costs with. Today, his father lives with two others in a three-bedroom HDB flat and they hire two caregivers who cook, clean and help them with daily activities. He realised this care model could work in Singapore.

A year on, without much publicity, Red Crowns has about 130 residents in 25 apartments. On the website, it advertises not only for elderly residents to stay in its homes, but also for "property partners" who want to lease out their vacant properties to be turned into such seniors' group homes.

A twin-bedded room in an HDB flat for independent living costs $2,200 per resident and includes caregiving and supervision, daily meals and housekeeping and laundry. A private room with attached bathroom in a condo costs $4,500.

Red Crowns is the "concierge manager" who handles the property maintenance, and manages the caregiving staff, who are foreign domestic workers.

Mr Goh is confident of the demand and thinks it is scaleable, both within Singapore, and beyond. He is running Red Crowns as a social enterprise, and a personal passion project. The morning I met him, he visited three homes in the Bishan/Ang Mo Kio area to talk to the residents and mediate in some lifestyle differences. His wife Lynette Ng, 42, who owns Sweatbox Yoga studio, developed yoga exercises suitable for seniors, for the residents.

Eventually, says Mr Goh, he plans to build a platform called RetireGenie, that lets seniors advertise for and find their own roommates, and match them with caregivers. "It will be like an Airbnb for seniors," he explains. But for now, expanding the pool of assisted living flats and residents is his main goal.

While the potential to expand assisted living in Singapore is immense, there are regulatory gaps that need to be addressed.

For example, people who get home care or stay in nursing homes get long-term care subsidies. Do those living in assisted living facilities get these too?

How should assisted living facilities be licensed? Are assisted living premises commercial or residential? What should be the ratio of care staff to residents? The minimum standards of care?

There are many details to iron out. Meanwhile, operators like St Bernadette and Red Crowns are not waiting for policy clarity, but testing new care models.

Having taken 27 years to meet demand for assisted living in an HDB estate, the state should make up for lost time and come up with rules to encourage the private sector to test new models in a safe and sustainable manner. At the very least, it must not stand in the way of those pushing the frontiers of possibility in aged care.


Originally posted on Straits Times (Premium): Can HDB flats be turned into assisted living units?