Sidney Lok
Navigating Singapore by MRT, the island’s Mass Rapid Transit system, you’ll notice signs sporting an illustration of a giraffe (affectionately named “Giffy”) with the words “Dementia Go-To Point.” Walking through the estate of Khatib Central, you will see buildings painted in primary colors and matching directional signs with large lettering. Biking through the city, you may be stopped by barricades prompting you to dismount and walk your bike through high traffic areas. These individual elements are all a part of a coordinated, nationwide effort to help senior Singaporeans, especially those living with dementia, age in place comfortably.
Dementia-Friendly Singapore (DFSG) is a national initiative spearheaded by the Ministry of Health and supported by the Agency for Integrated Care. Under this initiative, AIC works with community partners on the ground to support persons living with dementia and their caregivers. Announced by Singapore’s Ministry of Health in 2016, the DFSG initiative was created to help meet the needs of and raise awareness for Singapore’s rapidly aging population, a growing number of whom live with dementia. The condition is a progressively degenerative condition that commonly impairs memory, language, problem-solving, and cognitive abilities severe enough to affect daily life. Around one in ten Singaporeans over the age of sixty and one in two Singaporeans over the age of eighty-five have dementia. Through individual and community outreach, DFSG aims to educate and inform the general population about dementia and create spaces where people with dementia (PWD) and their care partners feel safe and included.
An overarching theme of the Dementia-Friendly Singapore initiative is a social movement that cultivates a compassionate nation community and centers the needs and voices of one of its most vulnerable populations. This social movement in turn transforms whole communities, physically and relationally.
Taking a whole community approach
The DFSG initiative is centered on the idea of creating Dementia-Friendly communities (DFCs), defined as a community “whereby people know about dementia and mental wellness [and] persons living with dementia and their families feel included, involved, and supported in the community.” These DFCs, now totaling sixteen active sites, incorporate design elements such as those of Khatib Central to facilitate navigation and to protect persons living with dementia who are susceptible to disorientation. DFCs are co-designed by healthcare partners, design consultants, and community members. Directly involving people with dementia has been crucial to the success of this initiative.
One colorful example is the wayfinding project in Kebun Baru, which was led by people living with dementia. Anjang Rosli, one of the project volunteers who has early-onset dementia, describes being “happy and excited” to participate after he had gotten lost in his neighborhood because of how similar all of the ground floors, lifts, and landings are in Housing Development Board buildings (Singapore’s public housing, which over 80% of the population calls home). Whimsical illustrations of iconic local items, such as a traditional pastry called ang ku kueh or the nostalgic white rabbit candy, not only serve as manifestations of cultural pride but also work as markers to identify different housing blocks and to stimulate parts of the brain that deal with memory and cognition. These illustrations have at maximum three colors and only adorn key points in the neighborhood identified by PWD, who not only have trouble with memory but can be sensitive and overwhelmed by loads of information.
Beyond design, the DFC framework also heavily focuses on community education and awareness through partnerships with community-based organizations as well as training for neighborhood staff and retailers. Each DFC has a designated service provider that leads community outreach and manages the provision of care programs and services. In and around the DFCs are Go-To Points for neighborhood residents to escort wandering people with dementia to get assistance from trained staff members. Go-To Points also serve as resource centers for the general public and for caregivers to get educational material or to get connected to services.
Preparedness to assist PWD in need was lacking before the initiative began. These programs and resources equip the community. Bryan Tan, a FairPrice supermarket manager, said he was unsure of how to approach or help PWD he encountered in his store. After his store became a Go-To Point and he underwent dementia awareness training, which “taught [him] what to look out for, what to do and what to say when we encounter someone in our store who might be living with dementia, [he was] then able to spot the symptoms and signs of dementia and use the right approach and care.”
Creating a coordinated effort across public agencies and private partners
Dementia-Friendly Singapore’s work is not isolated within Dementia-Friendly Communities. Go-To Points can be found in all train stations on the Northeast and Downtown lines. SBS Transit, the company that operates Singapore’s mass rapid transit system, has also worked with Dementia Singapore on an initiative called “Find Your Way.” In collaboration with artists and self-advocates living with dementia, SBS Transit introduced large directional floor stickers at train stations to help seniors get to station exits safely. Similar to the Kerun Baru Wayfinding Project, these stickers depict nostalgic items like tiffin carriers, lanterns, and bamboo baskets.
The National Museum of Singapore has a dedicated cafe and activity space called “Reunion” for people living with dementia and their loved ones to gather, socialize, and experience the museum. Café Brera, adjacent to the activity space, is open to all visitors and employs a majority senior team, promoting economic justice and independence for older adults. Other collaborative projects include awareness training for bank employees in partnership with DBS/POSB, art programming at the National Gallery, and vocal workshop opportunities with Esplanade Theatres by the Bay. The initiative has built a network of Dementia-Friendly Partners and Community Care Partners who commit to ensuring awareness training for staff, leading outreach efforts, and implementing processes to support persons with dementia. DementiaHub, managed by Dementia Singapore and the Agency for Integrated Care, serves as a central point for information, resources, and news related to dementia.
Encouraging self-advocacy
DFSG centers people with dementia through design, collaboration, and empowerment, combating the misconception that persons living with dementia are not able to think or make decisions for themselves. At the center of many of the programs and projects are self-advocates who contributed to design development and implementation. Reflecting on his experience working on the wayfinding project, Rosli said: “The process was very empowering for me. It was really a team effort. Happy to also be able to work with other persons living with dementia. It felt good because I know that whatever is put in place will truly be helpful to people with dementia… It was fun, and a huge sense of achievement after completion.”
One way the DFSG movement empowers people with dementia and their care partners to become self-advocates is through Dementia Singapore’s Voices for Hope. Voices for Hope is a ten-week capacity building program that equips participants with skills, creates space for participants to share experiences, and builds confidence in participants to share their needs and views publicly. Voices for Hope has provided platforms for people such as Emily Ong, who now serves as a board member of the Dementia Alliance International and co-founded the dementia-friendly design-focused Environment & Dementia Special Interest Group. Of her experience as a self-advocate, Ong says “To me, having a dementia advocate involved in the planning and facilitation of a programme (i.e. Voices for Hope) is critical to achieving the programme/s goal of encouraging people living with and affected by dementia to step up. It is also about embracing an inclusive work culture within (Dementia Singapore) to ‘walk the talk’ of including persons living with dementia in the workforce.”
Voices for Hope has also created a community amongst its twelve cohorts, with many graduates going on to serve as co-facilitators. Participants are “given many opportunities to intermingle, to openly express [their] feelings, desires and hopes” and it helps PWD “feel important, needed, useful and accepted and [they] can have an enjoyable, happy and fruitful and successful future,” says Thomas Ong, a graduate of Voices for Hope’s fifth cohort.
While Singapore’s project is for a specific population in specific geography, its implications are far-reaching. New York has one of the highest rates of dementia in the country, with the Bronx reporting the highest rate of dementia in the United States. The need for policy and design change to accommodate this growing population in New York City is great, but there has yet to be large-scale action. NYC simply does not have comprehensive programs or interventions rooted in community action that Singapore does. The resources that are available to PWD in the city are isolated to individuals and their care partners.
Two Urban Review issues prior, Jade C. Williams pointed out the city’s reliance on “patchwork remedies and shoddy safeguards” to “meet the needs” of senior New Yorkers, one in seven of whom live in poverty. From housing to financial wellness, senior New Yorkers face a significant burden. The failure of the city to care for the most vulnerable New Yorkers does not end with seniors but extends to other populations as well. A recent New York Times investigation found nearly 100 random attacks by mentally ill homeless people were preceded by errors made by service providers. The investigation highlighted our systemic failure to care for New Yorkers struggling with the compounding effects of homelessness and mental illness, a failure that has resounding, violent impacts on the community. Again, the article points out the city’s disjointed network of care providers and underfunding of programs.
A crucial component missing from many of NYC’s existing programs is self-advocacy. Organizations like Alzheimer’s Association, NYC Chapter and NAMI-NYC strive to fill in those gaps by equipping people and working with communities, but NYC has a part to play in funding and implementing those programs to ensure there are no gaps in the first place.
Dementia Friendly Singapore serves as a roadmap for planners invested in equity and justice in cities. Beyond infrastructural enhancements and cultural programming lies an initiative that is grounded in larger values and priorities. By bringing whole communities along in its journey and creating a comprehensive initiative, Singapore makes space for its most vulnerable community members. Its investment centering vulnerable populations and models for participatory planning with people that have been labeled “hard-to-reach” point to the fundamental, radical social change that is key to the creation of inclusive urban futures.
Sidney Lok is a Master of Urban Planning candidate entering her final semester of study. During the day, she is a Program Assistant with the Housing and Homelessness team at Trinity Church Wall Street Philanthropies. A proud Brooklynite all her life, she lives in Bensonhurst with her husband and dog.
