Plan who will care for you and how that care will be paid for.
Most families decide how an older relative will be cared for in the middle of an emergency. Someone falls or ends up in hospital, and the people closest to them have to work out who stays over, whether to hire help and how to pay, all while tired and worried. Choices made that way are rushed and often argued over. Deciding some of it in advance takes far less effort.
Jasmine's family went through this last year. Her mother slipped in the bathroom. Nothing broke, but for six weeks her mother could not manage the stairs to the market or cook. Jasmine and her brother took turns staying over, juggled work, and argued about hiring a helper. By the time they agreed, their mother had recovered. Nothing had been decided in advance, and every choice was made tired and rushed.
Lesson 6.2, "Healthcare and long-term care costs after 65", priced care. You also need to know who would provide the care, how it would be paid for, and what you want decided before anyone needs it.
Care in Singapore usually comes from a mix of five sources: family, a live-in helper, home care services, day care centres and nursing homes.
Family is still the most common source. A spouse, adult child or sibling helps with meals, appointments and daily tasks. Family care costs little in cash but a lot in time, and it often costs the carer their own job and health. Many family carers in their fifties are still working.
A live-in helper can provide daily care at home. The costs include salary, levy, food, lodging, insurance and agency fees, and the helper also needs a room and some training. MOM's website explains the rules for helpers and the levy concessions for households that employ a helper to look after an elderly person.
Home care services send nurses, therapists or personal care workers to the home for set visits. They suit someone who needs some help each day but does not need a person there all the time.
Day care centres look after older people during the day with meals, activities and some therapy, so working family members can keep working. The centres usually arrange transport.
Nursing homes give round-the-clock care for people who cannot be safely looked after at home.
Most families combine these. One common mix is a helper plus day care twice a week. Another is family on weekends and home nursing on weekdays. Each arrangement costs a different amount and comes with different help.
Most government-subsidised care services are means-tested. The usual test looks at household monthly income per person, and in some cases at the value of the home. The Agency for Integrated Care (AIC) explains the current means tests, and its Care Services Recommender asks a few questions and suggests services based on a person's care needs. It does not estimate the subsidy for a given service, so check the subsidy for any service you are considering directly with AIC.
Subsidies are only one source of money. The others are: the person's own savings and income CareShield Life, or older ElderShield payouts MediSave, for some approved care costs help from family members caregiver support schemes for families caring for someone at home, which AIC lists along with who qualifies
Because subsidies depend on household income, two people with the same care need can pay very different amounts. If you have a large retirement portfolio and a paid-up flat, plan to pay most of your care cost yourself. Rules and amounts change, so check the schemes against your own situation with AIC and MOM before you rely on a figure.
Most families have this conversation in a hospital corridor, because it is uncomfortable to raise at any other time. Having it earlier is easier if you keep it practical and cover three questions.
The first question is what you would want if you could not look after yourself: to stay at home as long as possible, or to move somewhere with care on hand. The second is who you would hope could help, and whether they actually can, given their jobs, their homes and their own families. The third is how the care would be paid for.
Jasmine had this conversation with her daughter Megan, who is 29 and lives fifteen minutes away, and her son Ryan, who works long hours and travels a lot for work. She told them she would prefer to stay in her own flat with a helper and some home nursing, paid from her own savings. If home care became unsafe, her backup is a nursing home near Megan. She also told them she did not expect either of them to give up their jobs to care for her. The talk took forty minutes, and Megan said it was the most useful thing her mother had done for her in years.
Her partner Leong came up as well. They have been together six years, but they are not married and do not live together. He would want to help, but if Jasmine lost mental capacity, being her partner would not by itself let him make decisions for her. The same is true of family members. That authority comes from a Lasting Power of Attorney, which Jasmine can use to name him or anyone else she trusts, or, if she has not made one, from a deputy appointed by the court. The Office of the Public Guardian under MSF explains how both work. Lesson 7.4, "Who decides for you: the LPA, AMD and care wishes", covers how to do that. Module 7 covers written wishes in full, including the LPA and the documents recording what treatment you would want near the end of life.
For many people in their forties and fifties, the first care bill is a parent's and comes before their own. So a care plan has two parts: your own care later, and a parent's care possibly sooner.
Jasmine's mother is 82. If she needed full-time care, Jasmine and her brother would share the cost, and Jasmine's share could easily exceed the S$4,800 allowance already in her plan. If a parent's needs could change your spending in the next few years, add them to your drawdown map as a scenario, the same way module 5 tested markets.
When you have checked the subsidies and helper rules and listed what else could pay for care, the plan comes down to three decisions. For now, think through the arrangement you would want, the one you'd fall back on, and the person you most need to talk to about both.
Write down the care arrangement you would like, a backup in case it falls through, and the person you need to talk to about it.
Junxiong-WFG Organisation is an authorised representative of AIA Financial Advisers Private Limited (Reg. No. 201715016G).