SINGAPORE – As Singapore works to ramp up capacity and reduce wait times in the adult disability sector, service providers say persistent issues such as limited funding and manpower will make this an uphill task.

Physical space is often limited and staff turnover high, while client exit rates are low, especially in day activity centres (DACs) for those with higher support needs who cannot work.

The challenges are growing with the rising prevalence of autism, as those with this condition generally have moderate to higher support needs, said SPD chief executive Abhimanyau Pal.

Mr Bernard Chew, CEO of St Andrew’s Autism Centre (SAAC), said that funding constraints also make it difficult to hire and retain trained professionals, especially in DACs. SAAC runs two such centres in Siglap and Sengkang which serve 124 people with autism.

“It is a big concern for the families, and for society when the aged parents pass on,” said Jalan Besar GRC MP Denise Phua, who is president of the Autism Resource Centre and chairs Autism Association (Singapore). “We cannot afford to do business as usual.”

On March 6, it was announced that the Ministry of Social and Family Development (MSF) will add 500 DAC places and another 500 places to sheltered workshops by 2030.

Sheltered workshops provide training or employment for people with disabilities who can work, but are unable to take up open employment.

To start, 50 DAC places will be added at Minds Jurong Training and Development Centre by 2025. About 100 sheltered workshop places will also be added to the APSN workshop at Kembangan-Chai Chee Community Hub in 2024.

There are currently eight sheltered workshops with a total capacity of 1,700 places, and 32 DACs with a total of 1,800 places.

As at December 2023, around 1,680 persons with disabilities were enrolled in sheltered workshops, and 1,560 persons were enrolled in DACs.

About 190 people were waiting to enter sheltered workshops, while 250 people were on the waitlist to enter DACs.

The estimated wait time to enrol in a sheltered workshop ranges from six weeks to a year, while that for DACs ranges from one month to five years, according to service matrices on disability agency SG Enable’s website.

Parents weigh in

One parent told The Straits Times that his son’s experience at a DAC changed drastically after the centre’s supervisor and a coach he was familiar with both left.

The retiree, who wanted to be known only as Mr Robert, said his 37-year-old son Jonathan (not his real name) has autism and obsessive-compulsive disorder, and had been in a DAC for the last eight years. After the new coach got frustrated with him, Jonathan refused to go to the DAC for five months.

Mr Robert wanted to pull Jonathan out of the centre, but was advised against doing so by other parents as it would be difficult to re-enter a DAC once he leaves.

He added that after the staff changes, he found the programmes less engaging and inflexible, even for minor changes such as teaching clients to bake a different flavour of cake.

Another parent, Mr Anand Lal Rajkumar, expressed his hope that his 17-year-old son, Krish Anand, will get a place in a sheltered workshop when he graduates from Minds’ Towner Gardens School at the end of 2024.

“If a child is able to work and make an income for himself – even if it’s sweeping roads, measuring flour or carrying bread to an oven – it means he’s better off,” he said.

His concern is that Krish, who has autism, will not get a place as sheltered workshops are selective due to the high demand for their services.

“We can afford the fees for DAC, but it’s still costly. We have to think of ways to earn money,” said the 54-year-old. His wife is a senior manager in a local firm, while he works as a swim coach and owns a small business.

Mr Chew said that the need for a place in such centres is especially pressing for lower-income families, since many caregivers have to leave work to look after their child after the child graduates from special education (Sped) schools. Those who stay at home and do not receive any services will likely regress, he added.

He said that social service agencies (SSAs) feel the pressure to raise funds to increase capacity, but may hesitate to raise fees since these already pose a challenge to some families.

Fee caps introduced two years ago keep fees affordable for DAC clients with per capita household incomes of $2,800 per month or less. But for middle-income families, attending a DAC can cost more than $1,900 a month.

MSF has said that together with co-funding from the Tote Board, SSAs are provided the full costs of providing DAC care for Singaporean clients from lower-income households. For the rest, any unsubsidised portion of the cost after means-testing has to be raised by SSAs through fees paid by caregivers, or donations.

At present, parents waiting for a DAC or sheltered workshop place can find activities for their children at touchpoints in the heartland, such as Enabling Services Hubs and Minds Hubs.

One such parent, Mr Ho Tong Fatt, turned to activities such as crafts at the Minds Hub and Minds Me Too! Club to occupy his autistic son while he waited for a spot in a DAC after leaving Pathlight School in March 2023. Mr Lucas Ho, 20, is undergoing a job trial to assess if he is a good fit for a sheltered workshop.

His father said: “Minds Hub activities seem to have more and more participants, so quite a number of times we’re not successful in getting a slot. But Me Too! Club, as it is based on membership, has no such issue.”

Mr Pal said the Enabling Services Hub in Tampines and satellite office in Bedok could help to shorten the wait list for DACs by referring only those with higher support needs to the DACs.

Tackling the problem

Industry observers suggested several measures to alleviate issues faced by the sector.

For instance, Ms Phua proposed bringing in qualified foreign manpower as an interim solution to the manpower shortage, similar to what is done in the healthcare sector. “Then, develop a manpower plan to grow our own timber and identify, train and fairly compensate different tiers of local support staff,” she said.

Mr Chew said that more can also be done to strengthen professional development and competencies of those who work in adult disability services, to mirror the Ministry of Education’s efforts in growing the Sped sector.

He added that high operational costs are involved in maintaining ideal staff to client ratios in DACs to maintain the quality of services.

Ms Ang Li May, CEO at Bizlink Centre, which supports people with disabilities through training and employment, said the organisation has tapped programmes to train staff.

These include the Institute of Technical Education’s work-study diploma in community engagement and development, and the Autism Resource Centre’s certificate in autism.

On funding, Ms Phua suggested that instead of purely means-testing, the Government could consider the universal funding of the core base expenditure for such centres, such as management and rental, then topping this up with means-tested funding.

Said Mr Pal: “We look to the Government for more mainstream funding, as more manpower will inevitably be required to optimise staff-to-client ratio.”

To get around the issue of limited space in its centres, SPD piloted an initiative where volunteers take DAC clients into the community a few days a week, and venue partners such as libraries provide activities for them.

SPD’s sheltered workshop also offers training, with support from an SPD staff member, in the premises of employment partners such as Vital, an agency at the Ministry of Finance which provides corporate services for the public service.

A different service model

Service providers said the sector would benefit from a review of current service models.

Mr Chew suggested building a supported employment sub-sector, which SAAC is starting with vocational training in baking, laundry and urban farming for DAC clients. These programmes break work processes into simple steps for those with moderate autism.

He said this is a lower-cost alternative to DACs. “We don’t have to think about generating profit, the programmes just need to be funded sufficiently to be sustainable.”

The Enabling Masterplan 2030, the latest road map to support people with disabilities, had said MSF is reviewing the sheltered workshop model to ensure it remains relevant in 2030, amid increasing automation.

Ms Phua said new solutions can help meet demand for adult disability services.

She added: “We should tap the good developments in the senior services sector such as active ageing centres, Healthier SG and home-based support.

“There are opportunities to leverage and integrate services such as home-based healthcare for the elderly and the younger disabled.”