Ageing Policy to Support The Elderly Well-Being
in Late Life:
A Comparison of Indonesia, Malaysia and
Singapore
Introduction
Rapid population ageing has occurred in
almost all parts of the world, including in Indonesia. The decline of fertility rate and longer life
expectancy have caused changes in demographic features and have given rise to the
new emerging issues in society as the impact of diverse changes in relation to socio-economy
and political aspects. With the current absolute number of elderly at about
16.3 millions (based on national census 2004), this has placed Indonesia as the
seventh largest country in the world with the number of older people (BAPPENAS, 2005). Whereas according to the research done in 2007 by the UNFPA in
cooperation with the Government of Indonesia, the total number of population at
the age of 60 and above is projected to rise from 8 percent to 25 percent by
the year of 2050 (Abikusno, 2008). This means that by 2050, there will be about 73.6 million elder
Indonesian.
Whereas some argues that population ageing
bring positive changes and opportunities such as longer lives, healthier lives
and longer working periods, Bloom, Boersch-Supan et al. (2011) point out that it needs to be seriously responded as it may cause
fundamentally new challenges and risks. Furthermore, sustainable development
and overall stability within the nation may also be affected (Wu, 2012). Therefore
policies to support long-term support, formal and informal, may need to be
addressed well as when people getting older, they tend to become more
vulnerable due to the loss of physical functions and disabilities, and at the
same time becomes more dependent to others. This paper explores to compare the trending,
issues and ageing policy responses between the experience in Indonesia, Malaysia
and Singapore. The result is expected to benefit Indonesia to learn from the
experiences of the neighboring countries and improve its own policy to support
the wellbeing of Indonesian elder citizens. Malaysia is chosen because of its sharing
a common Malay heritage. While Singapore’s experience is highlighted as a
reference to the most advanced and developed country in the South East Asia
region.
The Proposed Research Methodology and Its Contribution
Because ageing policy and caring patterns are
diverse among countries, this study will apply the grounded theory approach
that will allow case studies from what are the best practices and challenges
towards policy implementation in both Singapore and Malaysia.
The specific research question underlying
this study would be as this below:
1.
What are the experiences of other
two neighbor countries in delivering ageing policy to support elder well being?
2.
How does the ageing policy in two
neighbor countries support the well being of the elders at their late life?
3.
What can Indonesia learn from
those experiences to improve its ageing policy?
Because this study would like to explore the perception
and building theory on the success and challenges towards policy implementation,
the method used would be a qualitative with comparative-based approach.
Technique used for data collection would be in-depth interview and focus group
discussion to the selected identified data sources from the two countries. The
selected informant would be chosen from those represent the policy makers,
implementing agencies of the policy, representation of elderly from different
social class and their families, and representation of carer, both formal and
informal. Document literatures from policy papers, agencies monitoring and
evaluation reports, and media clippings will also be utilized on this research.
In addition, to validate and ensure the credibility of this research,
triangulation technique to the collected data will also be used before presenting
final analysis and research finding.
Despite the number of population ageing
studies that have been undertaken, limited focus is still given to the current
impact of policy implementation towards the wellbeing of the elderly. This study will provide insight to what works
and what does not work in these specific issues, especially in correlation with
the Southeast Asian cultures. While it
sheds light on the experiences of the neighboring countries, the result of this
study is expected to give recommendations to design a feasible future ageing policy
and improve the current practice in Indonesia. Furthermore, it is also expected
that the result of the study could be used to promote social awareness and
achieve greater involvement from other stakeholders to participate in an
inclusive Indonesian society, which recognizes the role of elder citizens and
their carers.
The Strength and Weakness of the Proposed Research
Because the nature of this study is
explorative and comparative, some challenges and limitations may occur
especially during data collection and analysis stages. Furthermore as this
study involve diverse source of data from different countries, in general it
will need more time in both collecting and analysis the data. In addition,
accessing the data and its availability may also bring some challenges. For
example, prior to access some data such as policy document and agency’s
reports, an intergovernmental agreement and confidentiality may need to ensure
before kick-off the research. In contrast, some data may not easily available
due to different recording and data management system from each country. For
example, statistical data on older population that disaggregated by aged,
gender and income group may vary among countries. Whereas Singapore data
already more systematic, Malaysia and especially Indonesia are still struggling
in compiling this kind of national disaggregated data set under their system.
Arranging time availability for in-depth interview and focus group discussion
with number of informant from different inter-sectorial agencies in three
countries may also need flexibility from time to time.
Despite its weaknesses, this research will
also provide its usefulness and own strength. Because the study is using
qualitative approach where data collected through in-depth interviews and focus
group discussions, the depth and richness of information may be useful to describe
complex phenomena in regards to ageing population and its problematic issues.
In addition to this, the studies can portrait detail pictures on phenomena
where it situated and embedded in local contexts from the three countries, and it
may useful to further analyzing number of cases in depth. Furthermore, the
approach used will allow in providing description on people’s individual
experiences and give broader understanding about the context. As the study will
compare policies in three countries and their experiences, the approach enable
to conduct cross-case comparisons and analysis toward ageing population and
policies. The finding may also provides individual case information, such as
being ageing in Indonesia, experiences of elderly in Singapore, or just a
lesson learned from Malaysia in delivering their ageing policy.
What Other Research Says
Along with the rapid demographic changes and
ageing population fast becoming reality in Asia, increasing studies has
undertaken to understand better the phenomenon and as response to the new
emerging issues. Japan, Singapore, China, Hong-Kong, Thailand, and The Republic
of Korea are among countries in the sub-regions known as the forefront on this
issue (Abikusno, 2008; Nam, 2004). While Malaysia, and now follows by Indonesia, is currently catching
the other countries to face population ageing. The OECD (2011) report highlights that the current challenges need to be addressed
by most of those countries are on how to relate and combine caring support with
the friendly labor market for both elderly and their family carers, and on the
same time acknowledge carers wellbeing and recognize their financial
contribution.
For the effectiveness of ageing policy, Gautun
and Hagen (2007) recommend on the importance to design policy that directly target
and support the role of family carers. According to them, as primary caregiver,
families are continuously struggling to balance their caring role with their
participation on labor market, and it often gives rise to new problems such as
stress, health and financial difficulties to the family of care recipient. In
their qualitative approach study, they claim that informal caring duty has
caused lower labor participation and poor performance of the work force due to
irregular attendance and lack of concentration. Meanwhile, the longitudinal
studies done by Pavalko and Henderson (2006) found that initiating flexible working hours and family leave
embedded with employment policy will bring positive effect to help family in
balancing between work and caring role, and especially to improved women
participation on the labor force.
Hung Sing Nam (2004) in his qualitative research with in-depth interviews and focus
group discussion to a total of six cases with 18 respondents represent elderly
people, family carers, and formal carer institutions states that sharing
responsibilities between informal and formal caregivers are becoming commonly
found, especially in Asian countries. Due to smaller size of family household,
migration and globalization, Asian families expand their caring role by
recognizing the formal caring services, such as nursing home for elderly and
home-based caregivers. The study found that despite the elderly respondents
still preferred to have their family members to provide personal care, they
acknowledged on the quality care provision by the formal care institution such
as day-care center, nursing home, or just a home-based visit of nurses,
physiotherapists and other professionals. Whereas Asian cultures and norms are
still hold martial relationship and filial piety, the study further shed light
on the importance to acknowledge the combination roles of the elders as
self-carer, family carers and formal carers to provide best quality of care for
the wellbeing of elderly in their late life. Similarly, the 2011 OECD’s report
states that for countries can no longer remain silent to the demographic changes,
one way to continue the provision of greater needs of care for the future and to
minimize higher cost for public systems is by valuing the role of both formal
and informal caregivers.
Trend, Issues and Ageing Policy Responses in the Three Countries
In general the three countries share similar
Asian values of filial piety as part of its intergenerational contract to
support and provide care for the wellbeing of elderly in the late life (Chow, 2006). Families are still the primary source of care for the elderly,
from providing time, emotional to financial support. Despite economic growth is
currently shining in Asia and a trend where household size becomes smaller in
Asian families, still the majority of the current older people co-reside with
their family network. In the three countries, similarities found where the
daughter or daughter-in-law of the first son is mostly act as the primary caregiver
for the elderly in their family. In addition, sharply contrast to Malaysia and
Singapore; grandchildren in Indonesia are also play significant role in
providing care for the elderly. Whereas
to the urban families in the three countries, there is a similar trend on the
use of external domestic worker who live-in at their house to provide support care
for the elderly (Wu, 2012). In
both Malaysia and Singapore, domestic workers as secondary carer are mostly
hired from overseas. While in Indonesia, they are mostly sourced from the
villages within the country, or part of their extended family.
With regard to the policy, the three
countries have implemented a number of policies in response to population
ageing. In Singapore and Malaysia, most of their policies are directly targeted
to family carer and the recipient. Indonesia, in contrast, is still far left
behind in providing care support for the wellbeing of the older citizens and
the carer. It is only by 2008 when the Presidential Decree No. 93 enacted with
the establishment of the National Commission for Older Persons, a set of
programs and regulations addressing the issues of the aging population and the
wellbeing of elderly in Indonesia were discussed and developed. However those were
still mainly focused on the provision of basic services such as on health, access
to public nursing home and cash assistance as part of social welfare program,
and accessibility in public infrastructures especially in the cities where the aging
population are higher (Abikusno, 2008). Whereas in the two countries the policies coverage have expanded
to the equal rights in employment and provision of other social benefits to
acknowledge the role of informal caregiver (such as the family of the elderly)
and only in Singapore given to business sector who employ elderly. In addition,
compared to Indonesia, both countries have developed advanced and well-equipped
aged-friendly buildings and public facilities due to the implementation of its infrastructures
policies for the elderly.
In Indonesia, most policies and programs for
elderly are still targeted and mean-tested. The current on-going social
protection and welfare programs are given to the poor, neglected and disabled
elders. For example is on the provision of institutional nursing home services
for the poor and neglected elderly. Despite being limited, a number of nursing
homes have been built and managed by the government in cooperation with private
and community-based organizations. In this provision, similarity found with Malaysia
where nursing and shelter homes are provided for those consider poor and do not
have family or kin to take care of them. Whereas in Singapore the similar
services are provided without differentiate the social class. Only provided in
Indonesia, unconditional cash assistance with total amount of USD 34 per-person
per-month is given to the targeted elderly. Whereas in regards to health
services policy, aged-friendly health services can now be accessed especially
in the health centers across Java islands, where aging population is
concentrated. The new law on national social security system, which will be
implemented in 2014, is expected to provide better social protection in related
to pension and universal health for all Indonesian. Interestingly to note that
whenever this policy implemented, Indonesia seems that it will catch up with
its two neighboring countries by initiating universality provision for its
citizen. To ensure fair access and support functional mobility for the elderly,
the Ministry of Public-Works is responsible in improving access and services to
aged-friendly infrastructure. Public facilities such as buildings, roads,
parks, transportation, and recreational areas are currently on progress in
Indonesia to support elderly participation within community.
In Singapore and Malaysia, ageing policy has
been long included on their national agenda. Singapore started in 1980, whereas
Malaysia in the mid 1990s. Singapore has established a coordinated national
response namely Singapore Inter-Ministerial Committee on the Ageing Population and
they responsible for the social integration of senior citizen, their healthcare
provision, financial security, access to employment and employability, housing
and land-use policies for elderly, and managing conflict and cohesion in
Singapore ageing society (Goh, 2006). Malaysia established its National Elderly Council, which is responsible
for almost similar areas as in Singapore, excluding financial security and
conflict management. Compared to Indonesia, both countries have acknowledged the
contributions of their senior citizens in the workforce by initiating the aged-employment
policy, which extend the retirement age from previously 55 to 64 years for
those who work on formal sectors (government and private institutions),
compared to 55 years in Indonesia. The aged-policy also allows part-time work,
flexi-time and work-at-home options. This policy is expected to help not only
the aged-worker, but also to the carer to remain in the labor force while providing
care needs and services for their elder family. In addition to this, tax
incentives for business sector in Singapore are provided whenever they employ
elder citizens. Elder friendly housing, transport and land-used policy are also
enacted in Singapore since 1990, and by late 1990 in Malaysia (Awang, 1992; Goh, 2006; Sim, 2010).
The policy in both countries obligates all new building, including apartments
and residences to be equipped with a barrier-free provision for elderly.
Whereas public transportation facilities such Mass Rapid Transit (MRT) and
subway stations have been reconstructed since 1990 with provision of low floor,
step free and wheelchair access to ensure accessibility of the elderly. To
encourage family support to the elder member in the family, Singapore
introduced several pro-families policies such as Family Housing Grant Scheme,
which give grant and priority for family with married children to buy a new
apartment or house to live together or near-by with their elder parents (Wu, 2012). Whereas
tax incentives policy are applied in both Singapore and Malaysia for children
whom are looking after their aged parents (Goh, 2006; Wu, 2012).
Conclusion
This paper aims to focus on examining the
experience of ageing policy from Southeast Asian perspective. A cross-country
comparison of Indonesia, Malaysia and Singapore will be carried out with the
use of qualitative research approach. In contrast to Western concept, Asian
families provide caring for their elder family based on the values and
practices of filial piety and intergenerational support. However due to demographic
changes and to anticipate the on-going increase of elder population, Southeast
Asia countries have started its policy to minimize the negative impact of ageing
population. A more developed country like Singapore has pioneered in targeting
their policy to support the elder as self-carer, recognize family as primary
carer and in supporting enabling environment to ensure the wellbeing of the
aged people. Malaysia has continuously improved in some parts, and follows by Indonesia
that just start implementing its ageing policy. All are aim to anticipate
demographic changes on the near future and to ensure stability and sustainable
development within the nations.
Melbourne, Spring 2013
Lia Marpaung-Abidin
