By Geralyn Magan
LTSS Center experts recently shared their housing plus services research with health officials in Singapore.
Imagine living in a country that guarantees affordable housing to every citizen. You’d be imagining Singapore, a city-state and island country of 5.6 million people located in Southeast Asia.
A former British colony, the Republic of Singapore was established in 1965 when the country gained its independence from Malaysia. The new government immediately set out to rebuild the country, in part, by establishing housing as a basic right.
“This small country has a planful nature that we could learn from,” says Robyn Stone, co-director of the LeadingAge LTSS Center @UMass Boston. “From its origins, it acknowledged the rights of citizens to certain things, like housing and health care. The mechanisms for how that happens are imperfect, but the infrastructure gives you an opportunity to do a lot of experimentation and transformation to improve systems.”
Improving is exactly what Singapore is seeking to do. That’s why the National University Health System (NUHS) asked Stone and Alisha Sanders, the LTSS Center’s director of housing and services policy research, to share their housing plus services research during a February trip to Singapore.
NUHS, which oversees all health care services in one of Singapore’s 3 health districts, is interested in using the country’s housing infrastructure as a platform for delivering health and supportive services to a rapidly aging population.
“We talked about using research to understand how these models actually work on the ground,” says Stone. “We may help them think through a little bit of that as they move forward.”
WHY HOUSING PLUS SERVICES COULD WORK IN SINGAPORE
Singapore is well positioned to adopt the housing plus services model because its housing infrastructure is already in place, says Stone. Most citizens—82% by some estimates—live in high-rise buildings called housing estates that were built by the Singapore government. Most buildings operate on an ownership model, with subsidies provided to help households with lower and modest incomes purchase their flat.
“You’ve got a lot of economies of scale and opportunities for all kinds of programming to help people stay in their apartments, engage in activities and health care management, and address social isolation,” she says.
NUHS’s interest in housing plus services models is connected to its efforts to redesign the country’s primary care system, which is fragmented and challenged by high rates of unmanaged chronic diseases like diabetes. Health officials hope that linking Singapore’s housing estates with polyclinics and primary care networks will help address those challenges.
“The current primary care system is not coordinated or integrated at all,” says Stone. “But they’ve got a housing infrastructure they can potentially use to create a really good regional primary care and early-intervention network.”
OFFERING STRATEGIES
Government health officials were very interested in learning about the components of the housing plus services model that the LTSS Center has been studying for a decade.
“They seemed really open and interested in learning from other systems,” says Sanders. “They were really interested in learning about the service coordinator role and the research around the service coordinator. Even though the health system is spearheading this effort, they realize the value of the social service-related role the coordinator can play.”
Stone and Sanders also went on site visits to several housing estates, including a new community that, unlike most of Singapore’s intergenerational housing estates, is designed to house only older adults. Health services, including a health center, are integrated into the building’s infrastructure. The building also contains extensive community space for social activities and gatherings, a grocery store, a senior day center, and a day care center for children.
“This is a unique building among all their stock, but I think that they’re thinking about whether they should design more of this,” says Sanders.
Stone says she will be looking with great interest at the progress NUHS makes over the next few years to incorporate its redesigned primary care system into its plentiful supply of affordable housing.
“I think there may be some things we can learn about their model, because they are very intentional and you can control for a lot of things there,” says Stone. “So, potentially, Singapore could become a laboratory. That doesn’t mean we’d be able to translate everything to the U.S., but I think we can learn a lot. But first they have to do it, and they’re not there yet.”