'Die can, sick cannot’: Singaporeans' approaches to long-term care

Our strategy

We visited a wide range of families with different compositions, including those currently managing long-term care situations, to ask questions like:

• How and why do people plan for ageing and the risk of disability?
• What is life like providing or receiving long-term care?
• Where do preparations for long-term care feature in people’s life plans?

Key insights:

1. Most people don’t want to, or can’t, think about it

Ageing and the concept of needing help aren’t at the front of most people’s minds - it’s hard to picture how it may affect them and their families.

Even just the thought of long-term care can be paralysing, especially when considered relative to today’s plans and responsibilities. We met Li Ping, a young mother of two. She feels she has no bandwidth to start planning for long-term care. Her time is already taken up by raising two infant boys, thinking about their education, planning to re-start her career, and selling and moving houses.

Families like Li Ping’s recognise that healthcare costs are rising. Anxious about the implications, they prefer not to think about it and joke, somewhat morbidly, that ‘in Singapore, die can. Sick cannot.’ 

1. Plans for ageing are a taboo subject

Having a conversation with loved ones about end-of-life scenarios – before a crisis hits – ensures the caregiver and care recipient are on the same page when it comes to care preferences.

Unfortunately, it’s not usually that simple. This conversation is one of a fragile nature, and often leaves family members on all sides concerned about independence and undiscussed family dynamics. If children raise the issue, they worry that parents will assume the conversation is a precursor to being sent to a nursing home. Parents, on the other hand, will insist that they ‘don’t want to be a burden’.

1. Managing family expectations is a big part of the challenge

In families, there are ‘invisible expectations’ around long-term care. Questions about who’ll finance it, who’ll deliver it, and ultimately whose responsibility it is can arise. This is also a time where conflicts – and rivalries - can come to the fore.

After her mother had a stroke, Mdm Chee’s three brothers expected her to manage all the care. Her brothers argued that she’d benefited from having her mother around to help raise her children.

However she was already too busy at work to care for her mother and didn’t trust that domestic workers had the right training to help. The only option left was to send her mother to a nursing home – which went against her wishes to stay at home.

As Mdm Chee spoke tearfully about the issue, it was clear she continues to feel profound guilt over this decision. She also said that even though she has a loving relationship with her own children, she wouldn’t blame them for sending her to a nursing home.

The opportunity: A human-centred approach to long-term care

The Government recognises that getting citizens to prepare for long-term care is something of an uphill battle. Thinking about this sort of issue requires people to challenge the human tendency to put off planning for something that is both uncertain and seemingly far away.

Our research insights offer some clarity into the mindsets of different types of citizens – from the well-prepared to the blissfully ignorant – and how to best support and communicate with them by taking a life-stage approach. This would involve helping people better understand the full costs of long-term care and how they can meet them at each life stage, from early in their professional life to when they approach retirement.