'No one has visited me in years': The quiet lives of seniors with no next of kin in nursing, welfare homes
There is a growing group of seniors without next of kin who are spending their final years in nursing or welfare homes, but that is not necessarily a bad thing. Here is a look into how they are supported in finding solace, community and comfort in their twilight years.
The reasons why people with no next of kin end up in long-term residential care can vary, as do their levels of grief, loneliness and acceptance of their circumstances. (Photo: CNA/Nuria Ling)
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At 83 years old, Mr Lee Ah Meng has come to accept that a nursing home in Yishun will be where he will spend the rest of his life.
When he was younger, he lived in a one-room rental flat in Geylang Bahru with a friend, after going through a divorce and having lost touch with his siblings.
Then, as his health deteriorated in 2022, Mr Lee was discharged from a hospital and admitted into a nursing home run by social service agency Sree Narayana Mission.
“I am over 80 years old now. No one has visited me (in years). There’s no one in my family to come see me.
"They don’t know that I came (to a nursing home) and I don’t know my sister or brother's address,” Mr Lee said. He has not spoken to his younger sister and older brother in more than 30 years.
Mr Lee is among a group of elders in Singapore who arrive at nursing or welfare homes not by choice, but out of necessity, often after they can no longer care for themselves.
Some of these elders, like him, have been estranged from their family and friends for years. Others have no children or have outlived the few family members they had.
When her husband died, Madam Chan Sow Lin, who does not have children, found herself truly alone for the first time in decades.
At the time, she had been a regular at a day-care centre, and staff members soon noticed that she was becoming increasingly forgetful and dependent on others for care.
Concerned about her safety and well-being after she returned home, the day-care centre referred her to full-time care in a nursing home.
The now 83-year-old widow has resided in the Sree Narayana Mission nursing home facility since 2024 – a place she told CNA TODAY she never imagined herself being.
Her case manager and social worker at the facility, Ms Mary Joseph Lourdes, said that many seniors such as Mdm Chan initially struggle to adjust to life at a residential care centre.
“Most of these residents will be in denial (at first), like, ‘How come I ended up being in a nursing home?’” Ms Lourdes said.
This is particularly true for those with no next of kin, many of whom have gotten accustomed to living alone until age and illness catch up with them.
A search of police news releases by CNA TODAY found that for people who had died in nursing homes and welfare homes in 2024, there were at least 14 reported cases of appeals for their next of kin.
In 2023, the Ministry of Health said that about 83,000 seniors will live alone by 2030.
National programmes such as Age Well SG support seniors “ageing-in-place” – encouraging them to grow old in their homes and communities – but what happens to those who cannot lean on anyone because they do not have family or friends?
With the support of grants, donations and volunteers, nursing homes provide long-term medical care for seniors with chronic illnesses or disabilities who need daily assistance.
Then there are the welfare homes overseen by the Ministry of Social and Family Development (MSF), which cater to destitute individuals who are generally more mobile and independent but lack the means or family support to live on their own.
As of February this year, around 1,500 people reside in these homes, with 60 per cent of these aged 60 and above, MSF told CNA TODAY.
The reasons why these people with no next of kin end up in long-term residential care can vary, as do their levels of grief, loneliness and acceptance of their circumstances.
Yet, for many seniors who first entered these eldercare facilities fearing isolation and abandonment, there is a sense of belonging and companionship still to be found in their twilight years.
Speaking to CNA TODAY, they told of how, despite initial apprehension about easing into life at these facilities, they eventually grew to appreciate the companionship of staff members, volunteers, as well as fellow residents who also understand the fear of growing old alone.
Residential homes, too, go beyond just providing care and strive to create a lively atmosphere with activities that encourage social interaction and outings that keep residents connected to their past.
“It can’t be helped that I’m staying in a nursing home – I can’t walk,” Mr Lee said in Mandarin.
“But I’ve come here and it’s good. There’s someone to take care of me. I can play mahjong, go outside and I have friends here.”
RESIDENTIAL CARE IS THE ONLY OPTION FOR SOME
Mr Zack (not his real name), 70, who is single, has been a resident at MWS Christalite Methodist Home operated by Methodist Welfare Services since 2020. Due to the sensitive circumstances of their admission and stay, the welfare home cannot disclose residents' identities.
After a few stints of being imprisoned for drug and theft offences, Mr Zack sought shelter in public places because he did not want to burden his family.
Over the years, he lost contact with his surviving relatives and relied on his limited savings.
“Here, food and basic necessities are all prepared for me," he said in Malay. "Back then, I had to go around to find (food) myself.”
Mr Zack is one of many seniors living in Singapore’s 11 welfare homes, which are run by social service agencies to provide care for destitute persons.
MSF said that an individual may be admitted into a welfare home under the Destitute Persons Act for “social investigation”.
The ministry added: “The social investigation seeks to establish that the individual meets the definition of destitute persons under the Act, that is, an individual who has no visible means of subsistence or place of residence or is unable to give a satisfactory account of himself or herself.”
Because of these criteria, many ageing residents in these homes are those without caregivers or next of kin to support them, making long-term residential care their best or only option.
Associate Professor Helen Ko from the Singapore University of Social Sciences (SUSS) said that with the rise of dual-income-no-kids households and the "beanpole" family structure, where each generation has fewer children, the number of seniors in such circumstances is sure to rise.
Since a number of the elders are from lower-income families, or are frail and have limited social support, they are also more likely to be reliant on institutional care, Assoc Prof Ko added. She teaches in the university's master’s and doctorate programmes on gerontology, which is the study of old age and the changes it causes the body.
Speaking to CNA TODAY, 77-year-old Ah Tan, who has been staying at MWS Christalite Methodist Home for 17 years, recounted how he was found rough sleeping in the Tekka area in Little India after his brother, with whom he was sharing a flat, had died.
“My brother, my sister, my mother … they have all gone, so I’m alone,” Ah Tan, a double amputee, said in a choked voice.
Methodist Welfare Services said the common circumstances that have led the residents to stay in the welfare home include the lack of finances, long-term prison sentences or admission to the Institute of Mental Health (IMH), which eventually result in a loss of accommodation.
Many of them, such as Ah Tan, receive direct counselling and attend social activities during their stay, to manage the “complex psycho-emotional challenges” they face.
“For this group of individuals who are so rarely seen in public, it’s possible that many Singaporeans either do not know of their existence or have misperceptions about them,” its representative said.
Mr Richard Quah, chief executive officer of St John’s Home for Elderly Persons, said that about 8 per cent to 10 per cent of the residents there have no contact with their families.
“This may arise from various situations, including disagreements, communication breakdowns, life transitions or the differences related to caregiving responsibilities,” he added.
Nursing and welfare homes said that many of these elders lacking family support also come from lower-income backgrounds, previously living alone in one- or two-room rental flats, and they have significant health conditions.
Ms Tho Pei Leng, a senior medical social worker at social enterprise NTUC Health, said that some of these individuals have experienced past family conflicts, including physical abuse, absentee parenting, or issues related to gambling and money lending.
As for who foots the bill for these seniors with no next of kin, Ms Bridget Monica Das, head of psychosocial services at Ren Ci Hospital, said that some seniors may lack family connections but are able to pay their own bills.
For seniors without the financial ability, however, the nursing home taps government subsidies, money from charities and MediFund, a government endowment fund that helps needy Singaporeans who cannot pay their medical bills.
ADJUSTING TO LIFE IN A NURSING HOME
At MWS Christalite Methodist Home, residents' days begin at 6am with a shower and breakfast, before they receive medical treatment and take part in morning exercise.
“The rest of the day’s programme comprises different activities that are aimed at maintaining the residents’ overall well-being. These include adaptive sports, cognitive games, recreational games, and physio or occupational therapy sessions,” Methodist Welfare Services said.
The welfare home provides all residents with three main meals and two tea breaks. It also hosts recreational activities such as a monthly movie night.
Although the essentials are provided for them, for some residents with no familial connections to speak of, the fear of loneliness is a primary concern when adjusting to their new life.
Ms Lourdes said that around 30 residents at the nursing home run by Sree Narayana Mission have no contact with their next of kin. Presently, the 224-bedded facility is operating close to full capacity.
“One of the main things that the residents with no next of kin speak about is grief. Before they entered the nursing home, they may have had some connections, but no one visits them now, so that’s a great loss,” Ms Lourdes added.
These residents may receive visits now and then from volunteers, but the inevitable comparison with other residents with families exacerbates their sense of loneliness.
"During the Chinese New Year period, some (of these) residents do observe that family members take other residents home for day leave,” Ms Lourdes noted. The nursing team ensures that residents have access to counselling if needed and has activities to help residents not feel left out during festive seasons, she said.
It may seem like being in residential care isolates a person from society, but nursing homes and welfare homes emphasised that there are many activities available to keep residents engaged, and efforts are made to reconnect residents with their past routines, relationships and former neighbourhoods.
Likewise, NTUC Health, which operates six nursing homes, estimated that 10 per cent to 15 per cent of its residents – around 160 people – have no family or are completely estranged from their next of kin.
These residents are typically referred by the Agency for Integrated Care (AIC), which manages subsidised nursing home placements under the Ministry of Health.
In response to CNA TODAY’s queries, the agency said its priority is to ensure that seniors receive the care and support they need to age well. It works with healthcare institutions, social service agencies and community partners to meet this goal.
As for how this group of seniors lacking family connections is supported, AIC added that seniors may be referred to the agency by hospitals, polyclinics, welfare homes, social service agencies or through the Silver Generation Ambassadors.
These ambassadors are volunteers with AIC who make house visits, befriend seniors and connect them with active-ageing programmes.
“We assess each senior’s case thoroughly in order to identify suitable care options. Factors such as the senior’s medical, social and financial needs are taken into consideration,” AIC said.
Ms Lourdes said that the Sree Narayana Mission home aims to recreate a “neighbourhood-like” atmosphere by hosting communal gatherings such as a pasar malam (Malay term for night market).
The nursing home also taps its residents’ SkillsFuture accounts to help them attend programmes such as gardening courses.
Over at Jamiyah Nursing Home, its head and director of nursing Abdul Hadi Kamarolzama said that residents go on outings to the nearby Ayer Rajah Food Centre and supermarket.
“At the end of the day, we all want to feel closer to our families. The whole process of ageing itself is really lonely, that’s why at our nursing home, we want to create the environment where they feel welcome, that we’re all a part of a family,” he added.
FINDING RESIDENTS' NEXT OF KIN
Where feasible, residential care facilities try to help its residents reconnect with any surviving next of kin.
Mr Michael Foo, director of Thye Hua Kwan Nursing Home, said that wherever feasible and at the residents' expressed desire, the home tries to reach out to estranged family members to ask about their potential interest in visiting the residents.
However, he noted that initial efforts to contact next of kin are typically done by the referring source such as restructured hospitals.
Senior medical social worker Tho Pei Leng said that the nursing homes under NTUC Health have on occasion been successful in locating distant or estranged relatives, who were able to visit the resident before they die.
In one such case, a nurse aide helped to communicate with a visitor to ask about potential family members, leading to a reunion between a resident and his son.
Another facility, Banyan Home @ Pelangi Village in Buangkok, said that it tries its best to contact family members if information is available.
The welfare home for the destitute can accommodate up to 189 male residents, most of whom have been diagnosed with psychiatric illnesses. About 70 per cent of their residents, all of whom were admitted through referrals by the Ministry of Social and Family Development, have no contact with their family.
The welfare home said: “We have even tried to, as part of our routine outing activities, take them to the neigbourhood of their listed addresses, hoping perhaps that they might bump into some old neighbours or friends.”
However, the chances of reconnecting with family members are often slim, due to many of their residents' prolonged hospitalisation in the Institute of Mental Health before admission to the home.
Ms Bridget Monica Das, Ren Ci Hospital's head of psychosocial services, said that the home’s medical social workers carry out contract-tracing efforts by reviewing personal records and reaching out to family members in situations where residents may be estranged from their next of kin.
For those who re-establish contact, the nursing home invites the next of kin to attend family bonding activities, such as reminiscence outings to a resident's old haunts. There is also a family portrait programme, where volunteers and staff members help residents to dress up before capturing a family portrait on-site.
Families are also guided through sessions to recall meaningful memories.
However, Ms Das noted that some residents may be content as is, even if they do not have contact with next of kin.
She said: “Residents who have no family or social connections may still be independent, of sound mind and happy with their current state. They are in a nursing home for care needs."
Despite the reliance on residential care to support Singapore’s ageing population, some nursing home and welfare home said that there remains a gap in understanding what ageing in these settings truly means.
For instance, there is the stereotype that residential care facilities are places where old people are abandoned until their demise.
Dr Muhammad Farihin Mohd Azhari, assistant director of nursing at Jamiyah Nursing Home, said that ending up in a nursing home can be “embarrassing” for some people, because of the expectation that one’s family should provide for them in their old age.
Past practices in nursing homes where residents were often left in highly restrictive environments with little engagement and mostly remained on bed rest have also contributed to a negative image of the care that nursing homes can provide, he added.
However, this stigma is slowly shifting as the standard of care and programme offerings at homes are being enhanced, he noted.
As mindsets shift, Mr Hadi the director of nursing from Jamiyah Nursing Home said that more people may come to recognise that entering a nursing home is not just because one's family "does not want (them)", but that trained professionals in a residential setting may be able to offer a higher standard of care for those who need it.
“(A nursing home) is just a different roof. But their lives still go on. The friendships and sense of family still goes on,” he added.
ENSURING DIGNITY IN FINAL DAYS
In the absence of a next of kin, residential care facilities often have to manage the affairs of residents in their final days, though honouring their wishes can be challenging.
Ms Das from Ren Ci Hospital said: "Sometimes, residents were already unable to express their wishes by the time they are admitted, due to diminished mental capacity, so we would have to make the decisions on their behalf."
Nursing and welfare homes said that they are reliant on government subsidies and donations to balance the books and support residents who have limited financial means during their stay.
Thus, they work with funeral directors and charities to arrange for pro bono services after death.
Direct Funeral Services, for example, provides a quarterly sea burial ceremony serving around 20 to 30 unclaimed deceased persons.
Its managing director Jenny Tay said: “We felt a strong moral responsibility to give (these individuals) a final moment of honour, no matter their life’s story.”
Mr Jeffrey Lee, sales and marketing manager at Singapore Casket, said that the company provides pro bono funeral services for about one resident without next of kin every month, and up to five cases monthly at peak demand.
Ashes are stored for three to six months in case a relative comes forward. He recalled one case where a family member, alerted by a government letter, found out about their estranged relative’s death and collected the ashes.
However, in this field of work, rising demand for long-term care raises concerns about the reliance on donations and volunteers to support this group of seniors with no next of kin.
Non-profit organisation Cheng Hong Welfare Service Society, which provides pro bono funeral services for low-income seniors, has seen requests surge from about 12 cases a year in 2012 to 270 last year.
“Many people don’t understand that this is very taxing,” its chairman Kenny Sim said, adding that the society's volunteers handle everything from claiming the body to arranging cremation. Funeral arrangements can cost up to around S$3,000 a person, all of which is donor-funded.
On whether more data is needed to support this group, experts noted that publicly available statistics on seniors who die alone, whether at home or in a facility, are limited.
Ultimately, the fact remains that nursing homes today are ever expanding. Mr Nicholas Netto, senior lecturer of social work at SUSS, said that the capacity of beds for nursing homes has increased from 9,400 in 2011 to about 16,300 as of end-2020.
Beyond the numbers, what is more important are the qualitative details, that seniors in nursing homes have positive lived experiences, one expert said.
Dr Andy Ho, who is professor of psychology and medicine from the Nanyang Technological University (NTU), said: “Right now, the public perception and our innate attitude to dying alone is that it’s a horrible thing.
"It can be (a horrible thing), but people also can choose and like that autonomy. Even if I don’t have many family members, it doesn’t mean that I don’t have a strong support system."
That is why with nursing homes as a core pillar of eldercare, there is a lot of work being done to ensure that these spaces offer a dignified home away from home, rather than just meeting the goal of providing enough bed capacity.
The point is that even if residents do not have any biological family, the ties they forge at these community homes make up for it.
At Ren Ci Hospital and Sree Narayana Mission's nursing home, for example, residents and staff members often mourn a resident’s death through in-house memorial services or dedicated remembrance corners.
Mr Quah from St John’s Home for Elderly Persons highlighted the case of Mr Loh PK, who became close to staff members and volunteers during his stay, with one volunteer becoming his goddaughter.
When he died in December last year, his cremation was facilitated by a pro bono funeral service.
“Staff members and volunteers who had known him well attended the ceremony. The ceremony was brief but meaningful,” Mr Quah said.
Additional reporting by Taufiq Zalizan.
