SINGAPORE: Her one-room flat was a cluttered mess, and Madam Helen Fernandez herself never seemed to bathe, said her neighbours who always saw her in the same set of clothes.
When case workers first visited the unkempt and confused elderly widow, they had to rush her to hospital for very high blood pressure – which resulted because she hadn’t been taking her medication and had been missing doctors’ appointments.
Since her husband died 17 years ago, Mdm Fernandez had been living alone with no friends or family – and slowly falling prey to loneliness and dementia.
There were times when she’d even call up the police just to talk. It was how her case got referred to the Social Service Office, and then to case worker Ahmala Rajoo in 2015.
“She was receiving financial assistance, about S$500 a month,” said Ms Ahmala, a care executive with NTUC Health Cluster Support in Bukit Merah. “But she wasn’t managing it. She was always left with nothing, and she could never tell what happened to her money.”
But the neatly-groomed Mdm Fernandez you meet today almost doesn’t seem the same person. At 78, she is chatty, cheery and cheeky, and greets every visitor with a delighted “come in!”
“They want to put me in home, you know, old age home… I said, don’t want! Put me there for what? I won’t see anybody,” she said.
The walls of her newly-repainted, now-clean flat are plastered with photos and cards from friends. She has blossomed under the care of Ms Ahmala, meal delivery services, befrienders from volunteer group Helping Joy, NTUC Health Care@home services, and the Senior Activity Centre in her block.
“Her memory has worsened. But thankfully with the community support, she’s more active than before,” said Ms Ahmala.
“I don’t think she grasps that I am a social worker. To her, I’m probably like a friend that is helping her out.”
WATCH: The transformation of a lonely widow’s life (5:10)
THE DANGERS OF ISOLATION
Singapore’s elderly poor are not short of assistance schemes by the State to meet their material needs: From heavy medical subsidies and food vouchers, to long-term financial assistance, and even rental waivers for those on Public Assistance.
But the greater problem for many of them – especially those like Helen who are unable to work and homebound due to disability, failing health or mental illness – is social isolation.
Because of the stigma against mental illness especially, many of such elderly folks in Singapore are “forgotten by society” with people going out of the way to avoid them, said Mr Ng Koon Sing, head of COMNET Senior Services under AMKFSC Community Services.
This isolation from the outside world feeds depression and suicidal tendencies, aggravates mental conditions, and worsens their physical health.
In Singapore, elderly suicides have been creeping up, from 95 cases in 2010 to 126 cases in 2014. Said Ms Ahmala of her elderly clients:
Most of them will tell you that they’re just waiting to die. And they will tell you that there’s nothing else to look forward to.
And they can pass under the radar, until a neighbour, or a visit to hospital, or door-to-door outreach by social workers brings their plight to light.
Volunteers and community workers report finding some living in squalor, with cockroaches and bed-bugs, sleeping on the floor, and in poor physical or mental health because they have been neglecting their medication.
WATCH: The shocking condition of one elderly man’s flat, before volunteers gave it a makeover
But thankfully for these whom the rest of society has forgotten, there is a growing community network striving to ensure they find some measure of well-being and companionship in their final years.
It’s an extensive web made up of welfare groups, charities, hospitals, and operators (like NTUC Health) of Senior Cluster Networks initiated by the Ministry of Social and Family Development.
THE ONLY ONES AT HIS FUNERAL
Take Mr Jesmond Oh, a nurse who doesn’t spend his days in the hospital, but visiting the homes of his elderly wards.
One of them was an underweight, 60-year-old former security guard who was frequently falling down because his toes had been amputated due to his poorly-managed diabetes.
When Mr Oh’s care team at Tan Tock Seng Hospital’s (TTSH) Department of Continuing and Community Care took up his case and began visiting him at home to monitor his condition, Mr Oh said: “Initially, he didn’t listen to us. He kept taking his medicine his own way.”
His house was a mess. When we cleared his mattress, we found three cockroaches, scissors, medication all over the place, insulin injections on the bed as well. He’d just lie down on these.
The man was also depressed. At one stage, he told them: “If I jump down, all of you don’t need to come already.” Alarmed, the doctors had him brought in for psychiatric evaluation. Mr Oh recalled: “He was traumatised and decided, ‘I will not play this type of joke anymore.’ After that, he was very good and compliant with us.”
That rocky start evolved into a close friendship over six months.
One of the first things the team did was to arrange for meal deliveries, so that he would get the proper nutrition. His neighbours had been packing meals for him – but it was “all this unhealthy food that made his (diabetic) condition even worse,” said Mr Oh. “And he’d had to pay them ‘tips’. It was quite upsetting that they were making use of him.”
The team also called in a housekeeping service, arranged for escorts to his medical appointments, got someone to help him daily with his wound dressings, and a community social worker who visited him daily.
One evening after work, Mr Oh’s phone rang. It was the police. They told him that the man had been found dead at home; he’d fallen and hit his head. “They called me because my number was one of the last few that he’d dialed on his mobile phone,” said the nurse.
The man had never spoken of any next of kin, so his body stayed in the mortuary for 21 days while notices were posted in the newspapers.
Apparently, no one responded. So the few of us – the medical team, social worker and myself – were the only ones at his funeral wake.
BRINGING THEM A REASON TO CARE ABOUT LIFE
Sadness and loss is a part of the job, but what keeps Mr Oh going is the hope that “towards the end, I’ve actually touched them and helped them to achieve a better quality of life at home”.
Like Madam Ong Ah Hiong, 89, a widow who has survived the deaths of her husband, all three children and her siblings.
She had gone to TTSH’s A&E department with very high blood pressure in January this year. The doctors there assessed that she was at high risk of falling, and since she was living alone and had a history of depression, referred her to Mr Oh’s community care team.
Every visit, he banters with her while going through the basic health checks, where necessary calling up the doctor for a consultation.
Said Mdm Ong: “My heart tells me he cares for me. You can’t imagine how happy I am with all of you visiting me.”
WATCH: A special friendship (4:31)
If not for such services and home visits, many of the elderly poor would tend to neglect their health, to the point where they keep being hospitalised.
Ms Jess Ho, principal social worker for NTUC Health Cluster Support at Bukit Merah, said: “Some seniors refuse to take their medication, especially when there are more than five types. They find it so disheartening, sometimes they give up altogether. They feel that life is short, ‘I don't want to go through this in my final years, taking all this medicine’.”
And then there’s the cost of transport just to keep a doctors’ appointment, or of getting the proper nutrition. Said Mr Oh:
The elderly poor are prioritising their basic needs over their health. They will say that they can’t even afford three meals a day.
“The worst case I met, he’s surviving on S$2 chicken rice a day and S$1 mineral water. The rest of the day he will just eat biscuits.”
This is why the TTSH team works with the Social Service Offices to get their patients any assistance they might need, including something as basic as a running water and electricity supply.
NTUC Health’s cluster networks too work closely with hospitals, the various agencies and community groups, to “co-manage” their senior patients’ well-being holistically. From 2013 to 2016, they have reached out to more than 4,800 seniors in the Taman Jurong and Bukit Merah regions alone.
Ms Ho said: “Some need to be motivated, they need meaning because they’re all alone. We need to get them to know it’s worthwhile taking care of themselves.”
POVERTY ISN’T JUST THE LACK OF MONEY
Indeed, it is common to think of poverty as referring to material or financial resources. But researchers say that the lack of social contact can be just as impoverishing.
Assistant Professor Ng Kok Hoe of the Lee Kuan Yew School of Public Policy referred to a study done across four continents, where focus groups of the elderly were asked what they needed in life. Social participation was cited every time.
“It means not feeling like you are left out as a member of society,” said Dr Ng. “A decent standard of living means that I want to be a part of society, having access to friends. It doesn’t mean I stay home all day and eat to meet my bare nutritional needs.”
Just ask hawker’s assistant Mr Ong Hock Soon, who has lost touch with his children for years. His fault, he says, as he had a bad temper and he gambled.
The 69-year-old admits that in the emptiness of his flat sometimes, it all becomes too much.
When I go home at night, yes, I will feel lonely. I will cry.
“Then in the morning I wake up, go to work, and I’ll be happier. I’m most happy going downstairs (to the Senior Activity Centre) because I’ve got many friends,” he said.
“My greatest regret is my children. I want to say sorry to them. Dad was wrong last time. I hope you will forgive me.”
WATCH: Mr Ong’s biggest regret (6:08)
Elderly isolation happens for various reasons – apart from family estrangement, it happens when spouses die and the children are no longer around.
But there’s also the stress of caring for a sick spouse. “I’m cooped up with my spouse for over 20 years, I don’t have any life to myself, no resources and nowhere to turn,” is one common scenario that Tsao Foundation senior social worker Wong Yock Leng describes. Such spouses often end up prone to depression.
EVERYONE CAN LEND A HAND
Alleviating the loneliness and stress is what volunteer group Happy People Helping People Foundation is all about. Apart from organising food vouchers and ration packs for their clients, who are elderly cardboard collectors, the group also holds get-togethers and outings to places like the zoo.
It might sound tacky, said volunteer Ms Nurasyikin Amir, but the outings are “what they look forward to the most. When we are distributing rations, they will ask us when is the next outing?”.
When we first met them, they were very quiet and reserved. Now, they make friends more, and they look out for each other, which I think is very important.
Perhaps more importantly, what the vulnerable elderly need are for others – and not just the community groups – to keep an eye out for them.
NTUC Health’s Ms Ahmala, for instance, is kept busy handling 28 active cases concurrently, which can run the gamut from hoarders to the suicidal to the terminally ill. So it helps when neighbours step up to report someone they think might need help – and some actually help to shoulder the burden of caring for their fellow residents.
Said Ms Jess Ho: “They do visits and they are like our eyes and ears. Today (this neighbour) is not doing well, he is not eating, then they would call my case worker to drop by.”
As Ms Nurasykin put it, the hope is that more will replicate the Happy People model in their own neighbourhoods. “If everyone just helps their neighbour … like what our tagline says, not everyone can do everything, but everyone can do something.”
This is part of a CNA Insider series exploring the issues of elderly poverty in Vietnam, South Korea, Singapore and Myanmar. Watch and read the entire series here.