When Mum Can No Longer Be Left Alone

Food for Thought

Brunei’s ageing parents belong with their families. But love and responsibility alone cannot provide nursing, rehabilitation or endless hours of care. As LegCo confronts an ageing society, perhaps the real question is not who should care for Mum — but who will help the family when Mum can no longer be left alone?

KopiTalk LegCo Tracker · Second Meeting — Special Report (Ageing & Care)

Brunei is ageing faster than once assumed, and this LegCo session put elderly welfare back on the record. The question is no longer simply how many elderly Bruneians there will be, but whether families will have enough support to care for them.

By Malai Hassan Othman

Brunei has known for some time that it is ageing.

In its closing remarks summarising this Second Meeting's debates, the Legislative Council listed the welfare of the elderly — kesejahteraan warga emas — among the issues Members had raised.

The harder question the summary left open is more immediate: who will provide the care as more Bruneians grow old?

By 2050, nearly 29 per cent of Brunei's population is projected to be over 60 — 28.7 per cent, according to Brunei's own assessment submitted to the World Health Organisation's Age-Friendly Communities programme, up from around 14 per cent by 2028.

That demographic change will eventually be felt not only in hospitals, pensions and welfare budgets. It will arrive quietly inside ordinary Bruneian homes.

The difficult moment may come when Mum survives a stroke, receives treatment and is eventually considered well enough to leave hospital.

She is home.

But she cannot be left alone.

She may need help bathing, eating and moving. There are medicines to manage, appointments to attend and rehabilitation exercises to continue.

Her children have families of their own.

They also have jobs.

That is where an ageing statistic becomes a family question — and where Brunei's own care system deserves closer examination.

Much of Brunei's geriatric care today still runs through hospitals rather than dedicated elder-care infrastructure — a pattern common to health systems still building specialised elderly-care manpower and services.

The Bridge Between Hospital and Home

In Council, Minister of Health Yang Berhormat Dato Seri Setia Dr Haji Mohammad Isham bin Haji Jaafar outlined plans involving the Tutong hospital.

The extension building of its National Isolation Centre is planned for conversion into a rehabilitation centre, or step-down hospital, alongside several other healthcare facilities.

The project remains at the planning stage.

It was not raised in Council specifically as an elderly-care initiative.

But a step-down hospital is precisely the kind of bridge relevant here: for patients who no longer require acute hospital treatment but are not yet ready to manage safely at home.

Tutong also appears in Brunei's ageing landscape for another reason.

The World Health Organisation's Age-Friendly Communities programme selected the district as Brunei's pilot site, examining accessibility, safety and ease of movement for older residents, including transport and footpaths.

That points towards a familiar formula in social policy: shared responsibility involving Government, families, communities and other sectors.

On paper, that makes sense.

In practice, much of that partnership may already be operating quietly and largely unpaid — inside the family home.

When Hospital Care Ends

Hospitals treat illness.

Families often deal with what happens afterwards.

For an elderly stroke survivor, discharge does not necessarily mean recovery. It can simply mark the point when much of the responsibility moves from hospital to home.

Someone must prepare meals, supervise medication, help with bathing, arrange transport, accompany Mum to appointments and watch for another medical emergency.

That someone is usually a son, daughter, spouse or another relative.

The principle of family responsibility itself is hardly controversial in Brunei.

Within Islam and Malay culture, caring for ageing parents is deeply embedded in filial responsibility, respect and obligation. Brunei's MIB environment reinforces rather than diminishes that expectation.

The policy question therefore should not become whether families should care for their elderly.

That responsibility is already deeply understood.

The harder question is whether families will have enough support to continue fulfilling it as elderly care becomes longer, more complex and more demanding.

The Worker Government Also Needs

There is an uncomfortable demographic paradox here.

Brunei needs productive workers.

An ageing Brunei will also need more caregivers.

Increasingly, they may be the same people.

The daughter caring for an elderly mother may also be the employee Government and industry want participating fully in the workforce.

The son repeatedly taking his father to medical appointments may simultaneously be a supervisor, technician, teacher, civil servant or business owner.

Neither responsibility disappears because the other exists.

This is where elderly-care policy begins to overlap with manpower and productivity policy.

The cost of ageing therefore cannot be measured only through healthcare expenditure.

Some of it may eventually appear as working hours reduced, leave taken, careers interrupted and family members quietly reorganising their lives around care.

Much of that contribution is unpaid.

Much of it barely appears in conventional economic statistics.

Family Care Does Not Mean Family Care Alone

This distinction is particularly important in Brunei.

Residential elderly care exists, but it has never become the country's dominant model.

Seria is home to Brunei's only old persons' home, a longstanding exception within a much stronger social norm that elderly parents remain with their families wherever circumstances allow.

Its existence should not turn this discussion into an argument for institutionalising elderly Bruneians.

Nor should an ageing society automatically mean building more old persons' homes.

The more relevant question is what support should exist between hospital and home.

That space can be considerable.

An elderly person may no longer require hospitalisation but still need nursing assistance, rehabilitation, physiotherapy, supervision or help with everyday activities.

Families provide love, companionship and responsibility.

They cannot automatically provide professional nursing and rehabilitation expertise.

A stronger care system can therefore support family responsibility rather than replace it.

What Ageing Societies Have Learned

Brunei is hardly alone in confronting this problem.

Japan offers a useful comparison. Strong traditions of family responsibility have had to coexist with one of the world's most advanced ageing populations.

Its Community-based Integrated Care System brings medical care, long-term care, prevention, housing and everyday support closer to where elderly people live.

It is designed, where possible, to help people remain within familiar surroundings. Japan also recognises the need to support family caregivers, including those balancing care with employment.

The lesson is not that Brunei should copy Japan.

It is that preserving care within the family may require a support system around the family.

Singapore's Age Well SG similarly emphasises helping seniors remain within their homes and communities while linking housing, transport, active ageing and care.

Malaysia, culturally closer to Brunei, is developing its own long-term-care ecosystem through its National Ageing Blueprint 2025–2045 and Thirteenth Malaysia Plan.

Neither model can simply be transplanted here.

Brunei's population, institutions, resources and MIB framework require a Bruneian solution.

But the underlying point is relevant.

The choice is not simply between looking after Mum at home and sending Mum somewhere else.

There is considerable space between those two extremes.

Sometimes the Carer Needs Care

Denmark offers one particularly useful idea from Europe.

Alongside practical home assistance for elderly people, family caregivers can receive respite or temporary relief when caring responsibilities become difficult to sustain continuously.

The principle is simple: temporary support for the caregiver can help the elderly person continue living at home.

Respite care does not necessarily weaken filial responsibility.

It can help make that responsibility sustainable.

A daughter receiving occasional professional assistance has not abandoned her mother. A son needing several hours' relief from caring for his father has not surrendered responsibility.

Sometimes helping the caregiver is precisely what allows the family to continue caring.

Towards a Bruneian Continuum of Care

None of this means Brunei needs a Japanese, Singaporean, Malaysian or European elderly-care system.

The better question is what a Bruneian continuum of care might eventually look like.

The Tutong step-down hospital could become one part of it.

Home nursing could be another.

So could rehabilitation, physiotherapy, caregiver training, medical transport, community health visits and carefully designed respite support.

Brunei is not entirely starting from zero on the evidence side either.

The Centre for Strategic and Policy Studies, working with the Ministry of Health, is running a National Successful Ageing Survey through 2026.

It is gathering data from 1,100 respondents across all four districts to help build a National Five-Year Roadmap for Successful Ageing.

That baseline could eventually help test whether Brunei's elderly-care system is working — not merely whether programmes and facilities exist.

The objective need not be to move elderly people away from their families.

It could be exactly the opposite:

to help families keep them safely at home for as long as possible.

That distinction matters.

It allows modern elderly-care policy to reinforce the values Brunei wishes to preserve rather than appearing to compete with them.

The Question LegCo Has Put Before Us

Nearly three in every ten Bruneians could be over 60 by 2050.

That future will require more than hospital beds.

It will require geriatric expertise, rehabilitation, community support and perhaps a clearer bridge between acute medical treatment and long-term family care.

Most importantly, it will require recognition that the family caregiver is part of the ageing equation too.

For decades, Brunei's family structure has absorbed much of elderly care without requiring it to be described as a national care system.

Families simply cared.

That principle remains powerful.

But demographic change is making the practical demands behind it harder to ignore.

The success of Brunei's future elderly-care policy therefore need not be measured by how much responsibility Government takes away from families.

A better measure may be how effectively Government enables families to fulfil the responsibility they already accept.

Because when Mum can no longer safely be left alone, her children already understand their responsibility.

What this LegCo session has brought into sharper focus is whether the care system will be ready to help them carry it.