AWARE’s sixth annual set of recommendations for the national Budget was submitted through the public consultation portal REACH on 26 February. In it, we focus our attention on the disproportionate impact of the ageing population on women, because of society’s reliance on mostly-female family members to meet burgeoning eldercare needs. We urge the government to budget for care as a social good, rather than leaving its costs for families to address on their own.

“We need to invest in a care economy to meet older people’s needs in a timely and holistic manner,” said Dr Vivienne Wee, Research & Advocacy Director of AWARE. “In addition to improving the quality of eldercare and preventing the ballooning of avoidable costs, this will remove the pressure on women to drop out of the workforce to provide unpaid caregiving, at the risk of their own impoverishment.”

Executive summary of recommendations

1. We all know that the Singapore population is ageing. However, little attention is given to the disproportionate impact of this demographic trend on women. Society relies heavily on the unpaid work and substantial sacrifices of mostly-female family members to meet burgeoning eldercare needs. Government statistics suggest that at least ten times more women than men are out of the labour force due to care-giving provided to families and relatives. As a result, these family caregivers not only lose income, but themselves become the dependents of other working family members and very often have inadequate savings for old age. This negative economic impact is borne not only by them but also by society as a whole. The effects include labour shortages, impoverished older women, and a burden placed on limited family resources, thereby limiting the use of these for children and other family members.
2. Singapore should therefore budget for care as a social good, rather than leaving its cost to families to address on their own. By taking far sighted measures to invest in a care economy, we can achieve the following:
   • Meet the needs of older people in a timely, holistic and accessible manner, preventing the avoidable ballooning and escalation of social costs associated with eldercare
   • Ensure that women are not forced to drop out of employment to provide care-giving, thereby maximising labour force participation and overall societal economic output; and
   • Free up resources for children and the development of working adults, potentially reversing the decline in fertility that accelerates the ageing population.
3. Investing in a care economy will also reduce economic inequality, producing a fairer and more cohesive society. To this end, we make six recommendations:
   • Create or designate a coordinating office so that older people receive coordinated, person-centric care. Elderly persons have complex needs that require different services from different providers. Navigating the fragmented services demands substantial work from unpaid caregivers, who need time, an understanding of the care receiver’s needs, knowledge of the service and subsidy landscapes, and English ability. This places a significant burden on caregivers and, moreover, carries the risk that care receivers receive haphazard, inefficient and inappropriate care.
   • Provide free health screening and primary healthcare for chronic illnesses to ensure early intervention so that the overall care burden is reduced for caregivers. We recommend that primary health screening be made free to encourage more early intervention, hereby reducing the need for acute care. This will tremendously reduce the care burden by addressing preventable outcomes well in time, e.g. avoiding amputation from diabetes, which requires a much greater level of round-the-clock care.
   • Provide holistic assessment of older people’s care needs and state support for adequate care-giving, including home care provision. Successful models of comprehensive eldercare include AIC’s SPICE and AWWA’s care services. Ramping up the scale of their provision (or instituting new, similar programmes) would help to meet societal care needs on a wider scale. In addition, despite the efficacy and efficiency advantages of home care, it is not given enough financial support relative to the nursing home model, and even nursing homes remain unaffordable for many. Substantial state investment is needed on all these counts.
   • Support family caregivers through compensation, eldercare leave and flexible work arrangements. The value of family care should be materially recognised by the state, so that those who provide it do not risk personal impoverishment. Whether through CPF credits or a state allowance, this support should be a collective responsibility, not a problem to be solved household by household. To enable more people to combine care-giving with employment, options for eldercare leave and flexible working should also be mandated and supported.
   • Means-test individuals, not households, for social and care assistance for Intermediate and Long Term Care (ILTC). Exclusion of applicants from support based on gross household income or value of their residence is inappropriate, as that household income or property value may not translate into financial support for them. The Legal Aid Bureau uses a more nuanced form of person-centric means-testing, which could be adopted for social assistance for ILTC for greater inclusivity.
   • Invest in the care sector through Long-Term Care Insurance, better support for care workers, and training for family and non-family carers. Medishield Life should cover non-catastrophic illness, rehabilitative services and medication diagnosed after discharge, as these have long-term care implications that families may not be able to address on their own. More investment in work conditions, pay, training and quality in the sector will also go to improving the quality of care enjoyed by older people and alleviate pressure on family carers.

More details can be found in the full text of our submissions.

Recommendations that we have made for the national Budget in recent years can be found on our website: 2015, 2014, 2013