Remember ME - You Me and Dementia

June 13, 2011

SINGAPORE: Who will look after our elderly?

SINGAPORE / Today / Singapore / June 13, 2011

The challenge is getting locals to fill jobs in the long-term care sector, to reduce reliance on foreigners

By Therese Leung and Sumytra Menon
Policymakers have recently vowed to reduce Singapore's dependence on foreign labourers, amid a growing backlash over the influx of foreigners who compete with locals for jobs. Yet, any immediate decrease in the supply of foreign nurses, nursing aides and health care attendants would have critical consequences on the welfare of the elderly who depend on them.

Foreign workers comprise the bulk of the long-term care labour force because these are the low-paying, labour-intensive jobs that few locals want. If we lose this supply of foreign staff, there would not be enough local workers to fill the immediate need. At the same time, we need to be mindful of public sentiment and find a better way to attract and retain more local workers in the long-term care sector.

What is the best approach to meet both objectives?

Up to 70 per cent of the 4,000 formal long-term care workers in Singapore are foreigners - mainly from the Philippines, Sri Lanka and Myanmar.

Roughly one-third of these foreign workers are registered nurses while the rest are healthcare attendants and nursing aides.

Elderly at a dementia daycare centre in Singapore (Photo courtesy: channelnewsasia)

Attracting a supply of local nurses, nursing aides and healthcare attendants to supplant these foreign workers would be difficult, especially in the short-term. Most of these jobs are low-paying, with local nursing aides and health care attendants earning around S$800 and S$1,000 a month.

Many local nursing aides and health attendants opt for acute hospitals, where they can earn a higher salary, instead of nursing homes. The prestige factor matters too because hospital jobs are perceived to be more respectable.

Moreover, strenuous, labour-intensive working conditions are common for health attendants in nursing homes, with staff responsible for changing nappies, tube-feeding and physically carrying a sizable number of elderly patients per shift. Attracting local workers to these types of jobs is hard but retaining them is even more difficult, given these less-than-desirable duties.

So what can be done?

Over the long term, Singapore must redesign the incentives for local workers to commit to the long-term care sector in order to lessen our dependence on foreign workers. We suggest a combination of structural changes to these jobs in terms of wages, career development, and supervision.

Research shows that increasing wage levels can improve the attraction and retention of local workers in the long-term care sector. Wage increases should not be given as a one-time bonus but rather integrated into a step-wise pay scale which rewards years of experience.

But higher wages alone will not do the trick. There should also be an opportunity to establish a career, with greater responsibilities and higher wages over time.

For instance, healthcare attendants could gradually move from doing physical tasks like the bathing and feeding of residents, into being a patient liaison. The key is to develop these perceived "dead-end" jobs into professional careers with advancement potential.

Good basic supervision is also a critical, but often overlooked, factor influencing the retention of long-term care workers.

Research shows that when managers respect their employees, help their staff out when necessary, work with them to solve problems and provide constructive feedback, it has a positive impact on how workers feel about their job. Most nursing supervisors may need training to improve their working relationships with their staff.

Changing the structure and perception of these jobs to make them more attractive to Singaporeans will take time.

But, even as the Ministry of Health embarks on its immediate holistic review of the systems and processes at nursing homes - in response to last week's outcry over a case of a patient's mistreatment at the Nightingale Nursing Home - the greater manpower challenge to the sector in the long run has to be addressed too.

The process must begin now in preparation for the future expansion of the elderly population. Today, one out of 12 Singaporean residents is at least 65 years old - by 2030, one out of every five will be a senior citizen.

The Government has done a commendable job preparing for this "silver tsunami" by building more elder care infrastructure, creating the Agency for Integrated Care and establishing the Community Silver Trust. They have also begun to invest more in the training of local nurses and healthcare support staff.

But there is still a significant amount to do if we want to better develop our local, long-term care workforce.

Therese Leung is an associate fellow at the Singapore Institute of International Affairs and a senior research fellow at the Centre for Health Policy & Management (CHP&M) at NUS. Sumytra Menon is an instructor at the Faculty of Law and adjunct senior research fellow at the CHP&M.

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