Perennial Holdings chairman and CEO Pua Seck Guan on Perennial Living, dignity and ageing in Singapore

Why has it been so difficult to reframe the stigma of assisted living in Singapore?

This is because people think it means abandonment. Children will feel they have no self-esteem if they send their parents to assisted living, and that is unfortunately the perception in Singapore today. The reason is simple. We do not have good upper middle-class assisted-living and nursing homes. People have not seen what is possible. Only when they see and say, “Wow, this is very good,” will the perception change. Until then, they assume staying at home is always better, even when it may not be.

You have said this development has to be better than their homes for families to even consider it. What does that mean in practice?

Eighty to 95 per cent of Singaporeans own their homes, and the quality of those homes is already good, so you must do better than their homes to persuade them to move. Not just nicer rooms. You need services that a home cannot offer. At home, you cannot have a Western doctor, a rehabilitation doctor and a TCM doctor working together, or proper rehabilitation facilities and people who know how to manage ageing day by day. If you cannot offer that, why would anyone leave their home?

Ageing at home is often presented as the ideal. In your experience, where does that model fall short?

If you try to look after a demented elderly person at home, you need two nurses. Each nurse costs eight to nine thousand dollars a month, and even then it does not work well. There is no interaction, no stimulation, and no environment designed for them. I have seen [their condition] deteriorate. When one elderly person has a problem, the whole family’s quality of life changes. Ageing at home sounds good, but it is not always [about] wellness. Sometimes, it is just [about] coping.

One distinctive aspect of Perennial Living is the integration of TCM alongside Western medicine. Why is this so important?

Because this is how people here actually manage their health, especially the elderly. In Asia, people do not see health in silos. They go to Western doctors, but they also believe in TCM. TCM is preventive. It is about balance and managing chronic conditions over time. Ignoring that would mean ignoring reality. The challenge today is access and quality. If you want to find a good TCM doctor in Singapore, it is mostly word of mouth, and there is no integration. Here, we quality-control and integrate TCM with Western medicine and rehabilitation, so the doctors talk to each other.

What challenges do elderly Singaporeans face today in managing their health across these systems?

Fragmentation. Too many places, too many appointments and too much responsibility placed on them. Many elderly live alone. Some cannot travel easily. Some do not understand how different treatments interact. They are told to monitor their health, but they are left to do it on their own. Here, we consolidate and guide. It is education. Once they understand it helps them feel better, they engage.

Perennial Holdings has extensive eldercare experience in China. What had to change when translating that model to Singapore?

The model itself is correct. Medical combined with eldercare, and Western medicine combined with TCM and rehabilitation. The challenge is land and labour. In China, I can build something three to five times larger. Here, every square foot costs money, so I must be very efficient. We adapt the model, create exclusivity and improve efficiency. Singapore is the most difficult place to do this, but if you can make it work here, you can make it work anywhere.

Much of the public discussion has focused on Perennial Living’s pricing. How do you respond to the perception that this model is only meant for a narrow segment?

This is a premium model, yes, but you must compare properly. At home, you hire a helper, a driver, nurses and cleaners, and the costs add up very quickly. Here, services are consolidated and consistent. More importantly, this is a model. If it works, it helps the entire ecosystem evolve. Government models have already improved over the years, and over time, costs can come down.

Ultimately, what would determine whether a place like this succeeds?

Execution. Today, I think we at Perennial Living are 70 per cent there. The last 30 per cent depends on how we operate on site. Just like a five-star hotel, people remember you, your name and your preferences. In eldercare, our staff must treat every elderly as if it is their parent. When you see the elderly happy, when staff know them and dignity is preserved, that is when you know you have done it right. If I can achieve that in Singapore, then I know that the model works.

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