Caregiving in Singapore
Close familial relationships are crucial in caring for the elderly, disabled and disadvantaged but professionalising the caregiving industry is perhaps even more important
There is a Chinese idiom – 养儿防老 – that means “to raise children to provide for or guard against troubles in old age”. It highlights an underlying assumption in numerous East Asian countries and Chinese diaspora communities: children are expected to take care of ageing parents.
In Singapore, that expectation has become a default way of thinking as a result of constant messaging from the government, but social workers on the island-state do not necessarily agree with that line of thinking.
“We’re so used to falling into the default mode that ‘the family should bear the burden’, we’ve not been proactive in thinking about the systemic or structural support that a community or civic society or NGOs can effect or provide,” says Chia Ai Ling, programme director at social services agency, SG Enable. “In the Asian context, there isn’t always the concept that when one grows up one should live on his or her own. If you’re unmarried, it’s perfectly fine to live with your parents.
“It’s becomes unspoken that in such cases, family should take care of the elderly. The question is: is the family equipped to do that? Is family really the best people?”
Caregiving: Family is not always the best option
Chia made those remarks at a recent panel discussion during the launch of research reports on three vulnerable groups of people – single-parent families, people with physical disabilities, and the elderly – by the Lien Centre for Social Innovation under the umbrella of SMU Change Lab. Vivienne Wee, research and advocacy director at gender equality advocacy group AWARE, echoes Chia’s sentiments about the suitability of family members bein primary caregivers for the elderly.
“At the moment, caregiving is kind of relegated to informal and unpaid family involvement,” Wee laments. “That’s why when it comes to caregiving, domestic workers are considered as caregivers, or the unmarried daughter. Is the family really equipped? Do they know how to do bed transfers of paralysed folks in the proper manner?
“Nursing is a professional job and yet untrained family members are expected to do it. We need to professionalise caregiving.”
For some families, hiring help to care for the elderly means employing foreign domestic workers who might not necessarily be trained for such duties, but who cost less than a certified nurse. These foreign domestic workers are sometimes expected to perform duties that are beyond the agreed upon job scope, but they have little legal protection or recourse.
“Foreign domestic workers are not protected under the Employment Act,” Wee explains. “That means they cannot avail themselves of the rights and protections that are provided in the Employment Act. To be fair, the Ministry of Manpower has implemented spot checks but they require the employer to bring the worker to designated places to be questioned regarding whether she is getting fed or if she’s getting eight hours’ sleep etc. Some of these workers don’t turn up because the employers don’t bring them.”
Connecting via I.T.
Even if the physical needs of the elderly are taken care of, their mental health must not be overlooked. Tan Chi Chiu, chairman of the Lien Centre for Social Innovation and panel moderator, asked if Information Technology (I.T.) could play a role in keeping the elderly connected with one another and thereby improving mental health.
“Some of these people don’t even have phones because they can't afford one,” says Wee. “Some of them have unpaid utilities bills for months on end, and they end up being in arrears. Unless these services are made affordable or even free, I.T. as a way to connect these communities is not an option.”
But according to Keith Lee, director at AWWA Family Service Centre, I.T. is not always incompatible with the elderly. “I’ve been fortunate enough to work with seniors who have successfully used I.T.,” he says. “We are seeing increasingly I.T.-savvy seniors who ask for Wi-Fi passwords. They also know how to go to the App Store to download free games.
“You just need to give the new learners baby steps to take. For example, expose them to big screens, and take them on walkthroughs on how things work instead of explaining in words. To you it might be a simple thing, to them it’s an ego booster.”
On top of changing how the elderly think about I.T., Lee also pointed out how his organisation help change their views on social norms.
“I’m glad to share that I’ve seen three elderly couples get married at the age of 70 or older. We are advocating the idea of social companionship as being an acceptable thing. Don’t think of it as a stigma. It was a tough start but we’re making progress. We are creating a culture that views elderly dating as being acceptable.”
Much of that progress is the result of committed social workers who do the hard work on the ground. However, turnover is high in the social service sector in Singapore due to a very heavy workload.
“People I talk to always tell me the counsellors are overloaded, and that the case loads are impossible to manage,” Chia laments. “The burnout rate and the attrition rate are something to look at. It is an essential service.”
Lee elaborates: “Social workers are involved in a lot of paperwork. In Singapore, in terms of how we evaluate a client's eligibility and needs, it leads to a lot of forms and paperwork. The actual intervention happens only after the paperwork is cleared.
“But I’ve always been a stubborn kid, so I do it in reverse. I put aside the forms and work with the client first. This is where I challenge the system, and I want to get the system policymakers to be aware of what’s happening on the ground.”