Everyone wants to live life on their own terms, but what happens when they lose mental and physical capacity? Can Singaporeans still be the captains of their own life journey in the event of dementia and severe disability?

The rising number of seniors in Singapore brings a higher likelihood of severe disability and need for long-term care. Ageing, accidents and critical illnesses like stroke and diabetes are common factors that can lead to severe disability. However, what many people may not realise is that neurological diseases like dementia are the fifth leading cause of disability in Singapore.

Dementia and the rising demand for long-term care in an ageing society can put significant burden on shrinking families. Thankfully, national initiatives like CareShield Life address this growing care gap by helping every Singaporean become more financially self-reliant in the face of uncertainties.

To understand people’s perceptions around financing long-term care for disability and dementia, Singlife conducted a long-term care study and released the results in 2024. Read on for interesting findings plus insights on how to continue having choices in life even if cognitive decline or disability sets in.

Common health and insurance terms explained

To better understand some of the study’s results, familiarise yourself with these abbreviations frequently used in long-term care discussions.

Singaporeans’ views and attitudes towards dementia and long-term care

The Singlife study surveyed 1,005 Singaporeans and Permanent Residents, aged 18 to 65, including 281 caregivers. Here are five findings that stood out…

#1: People’s top concern around dementia is being a burden to loved ones and loss of independence.

When participants in the study were asked about their concerns around dementia, “being a burden to loved ones” (67%) and “loss of independence” (64%) were the top two most commonly cited worries. “Cost of long-term care” came in at 59%.

Emotional and social concerns often supersede financial and practical concerns when it comes to dementia. What people may not realise is that financial adequacy can help to address those emotional and social concerns by providing access to services and tools that allow them to retain as much independence and control over their lives as possible.

What this means: It can be reassuring for individuals to know that if they’re diagnosed with dementia, they can maintain some level of freedom and their loved ones will experience minimum disruption. People place high value on preserving their quality of life, and a higher level of comfort and care can make a world of difference in how persons living with dementia cope, adapt and continue to have a meaningful existence. Knowing that a loved one’s quality of life is not compromised due to dementia could also relieve stress on the family, who may be anxious about his or her well-being.

Maintaining quality of life is important as there is no cure for dementia. It could involve things like:

• special diets

• extensive therapy beyond what is prescribed

• hiring professional caregivers with specific skills instead of being limited by the scope and duration of community-run care programmes or schemes, or relying on the goodwill of family and neighbours

• fall-proofing a home by installing non-slip flooring and grab bars

• remodelling a home to have a lift, ramp or auto doors so the individual has greater physical access at home

Having ample funds could provide access to these things, some of which are hard to come by and hence, more costly. It could also mean a spouse or loved one won’t have to work extra shifts just to make ends meet and cover the costs of living with dementia which, like living with other illnesses, is simply more expensive than living in general.

#2: Illness is seen as the most common cause of severe disability, and more older individuals recognise that dementia could lead to it too.

Majority of participants across all four age groups in the study think that “illness or medical condition” is the leading cause of severe disability. Meanwhile, the impact of dementia or cognitive decline on severe disability is recognised most by those aged 55 and above (28%) compared to under 20% for the other age groups. The study further shows that 68% are either “somewhat concerned” or “very concerned” about dementia, and this response is most prevalent among those who know someone with dementia and are aged 55 or older.
 

What this means: People are generally more likely to be worried about dementia and aware of its association with severe disability if they either know someone living with it or they are older. Dementia awareness is a good start; it’s also important for all age groups to take proactive steps to lower their risk of developing dementia. Start by paying more attention to brain and mental health – it's as important as looking after the heart, limbs and other body parts.

• Maintain a healthy lifestyle – eat balanced meals, exercise regularly, maintain a healthy weight, get adequate rest, and give up alcohol and smoking

• Try to keep stress levels in check

• Stay socially engaged to prevent isolation and depression

• Give the brain a regular workout with mind-stimulating hobbies like reading, doing puzzles and learning new things

• Fall-proof the home to prevent falls which can lead to head injuries 

• Go for regular health checks to detect illnesses like anxiety and depressive disorder early

#3: About 1 in 3 individuals think they will develop dementia.

When asked how likely they think they’ll develop dementia in the future, 32% of the study sample said “likely” or “very likely”. Again, this sentiment was higher among those who know someone with dementia. Conversely, 68% are either ambivalent or think that it’s unlikely to happen to them.

What this means: While a good percentage of individuals recognise the possibility of dementia and close to half (45%) know someone living with dementia, almost two-thirds of the sampled population may perceive it as something quite distant. There could be many reasons for this – for example, they may not know much about dementia and its risk factors or they may associate dementia only with certain demographic groups. The truth is that dementia can happen even in one’s 30s and 40s¹. More than 100 individuals from as young as 40 years old are diagnosed with young-onset dementia in Singapore every year² – something which would catch this 68% of the population off guard as it’s quite likely they would not have prepared for it.

#4: Only 3 in 10 are confident their family would know how to make a health insurance claim in the event of severe disability, illness or death.

While six in 10 people say their family members are aware of their insurance plans, only half of this group are confident that their loved ones would know how to make a claim in the event of severe disability, illness or death. This can put family members through unnecessary financial and emotional strain at an already challenging time. It might also cause delays in accessing crucial help and treatment for their loved one.

What this means: It is not enough to just be insured. An insurance policy – especially a health policy – can only provide the financial relief it promises if there’s a successful claim on it. This can be challenging if an individual loses physical and mental capacity, so before anything can happen, family members need to know that the insurance policies exist and how to make a claim. Alternatively, they should know how to reach their loved one’s financial adviser should they need help with a claim. A successful claim can provide much-needed funds for treatment, caregiving, day to-day expenses or even funeral arrangements in a timely manner. And when family members are free of this financial stress, they can focus on spending quality time with their loved one.

Aside from ensuring family members know how to claim your policy benefits, it’s advisable to make a Lasting Power of Attorney (LPA). The Singlife study found that only one in five people have made an LPA, which is the legal appointment of someone to make decisions or act on your behalf for personal welfare and/or property and affairs matters should you lose mental capacity. Without an LPA, decisions on a loved one’s care and medical treatment could be delayed or there might be family disputes over who should make these calls.

It's also good make a will, Advance Medical Directive and Advance Care Plan (ACP) so your personal choices will be clearly and precisely communicated, and executed. With an ACP for instance, your loved ones will know exactly how to use payouts from your insurance policies so you get exactly the kind of care arrangement you want.

#5: Only 6 in 10 have made financial plans for long-term care and most do it later than they should.

Slightly over half (64%) of the study’s participants have made financial plans for long-term care. This is despite the fact that majority (nine in 10) agree that severe disability could cause financial and emotional woes. On average, people believe they should start financial planning for long-term care at the age of 37 – this is seven years later than the entry age (30) for CareShield Life and supplement plans, which are add-ons provided by private insurers for higher coverage.

What this means: In your early 30s, you may be thinking about growing your wealth, saving for early retirement and leaving a legacy, but it’s prudent to also make financial plans for long-term care – no matter your position in life. Severe disability can happen even in one’s prime and long-term care costs can span decades, easily wiping out funds meant for a spouse’s dream retirement or as a legacy gift for children and grandchildren. While you still have the mental capacity, make plans that’ll ensure the future you’ve envisioned comes to fruition. This includes getting adequate long-term care and dementia insurance that can cover your desired type of long-term care. Based on the Singlife study, 27% of individuals would prefer to have a qualified nurse visit them every day if they needed long-term care while 24% would prefer to stay at a nursing home. The cost of both these options can easily surpass S$2,952, which is the average monthly cost of long-term care according to the same study.

Conclusion

Living to a ripe old age is considered a blessing for many people. It can also bring challenges like disability and dementia. While there is growing awareness about dementia and severe disability, the general level of long-term care preparedness doesn't always reflect people’s desire to maintain control over their life and protect both their own and their loved ones’ lives from disruption. By taking a proactive stance towards dementia, individuals can protect their quality of life. Proper financial planning ensures their savings goals will not be compromised due to the high cost of prolonged specialised care. Having adequate long-term care insurance helps individuals afford the level of care they would want in the event of severe disability. Adding dementia insurance gives the assurance of financial support should they develop dementia – whether or not it leads to disability. Together, the two plans make for more holistic long-term care protection, reducing the need for other funding sources to cover the costs associated with dementia or severe disability.

^Notes

^{1. Source: Dementia Singapore, “Dementia in Singapore”, accessed on 19 April 2024.}

^{2. Source: Dementia Singapore, “What is young-onset dementia?”, accessed on 19 April 2024.}