This post was originally published on The Straits Times on 26 July 2019.

by Corinna Lim, executive director of AWARE, and Carrie Tan, executive director of Daughters of Tomorrow.

Singapore has traditionally been heavily dependent on foreign workers in the long-term care (LTC) sector. This renders the workforce unstable, as foreign workers are easily drawn to nearby countries that offer better pay for direct care workers.

Around 70 per cent of direct care workers in Singapore’s LTC sector are foreigners – compared with 32 per cent in Australia, less than 10 per cent in Japan and 5 per cent or less in Hong Kong and South Korea.

A recent poll, conducted by philanthropic organisation Lien Foundation with 250 direct care workers and 50 hospital workers, found that among this group, the average tenure of a foreign worker in an LTC job was 2.8 years, compared with 3.4 years for locals (Singaporeans and permanent residents). This tenure is much lower than that of hospital workers as a whole: The average tenure for the combined local and foreign hospital workforce is 7.8 years.

At an industry dialogue on July 3, women’s rights organisations Aware and Daughters Of Tomorrow teamed up with financial service multinational corporation JP Morgan to present learnings from a joint eldercare workforce programme.

The two-year programme was aimed at providing workforce readiness training and employment for low-income women (Singaporeans, permanent residents and long-term visit pass holders) in the eldercare sector.

Despite the relative success of the programme, in which 35 women were placed as direct care workers, the initiative revealed challenges local workers face in joining and remaining in the LTC workforce. They are:

LONG HIRING PROCESS

Filling eldercare roles typically involves a long hiring process, which includes applications, interviews, health check-ups and placement. All in all, it can take up to eight weeks. Job seekers applying for multiple roles will generally accept the offers that come through first, which means eldercare jobs will likely be at a disadvantage compared with jobs in other sectors with a faster hiring process.

LOW PAY

Eldercare jobs do not pay well compared with other jobs that low-income women are eligible for, such as childcare assistants, or jobs in food and beverage, retail or cleaning. A local worker in hospitality turning over rooms in a hotel is paid $1,600 to 1,800 a month, whereas an eldercare worker assisting with showering, feeding and toileting duties is paid $900 to 1,400 a month.

Although wages for direct care workers have increased over the past few years, they are still not attractive enough to draw the volume of applicants the sector requires. (The Lien Foundation study estimated that the LTC workforce needs to grow by at least 45 per cent between 2017 and 2020).

EXTENSIVE HOURS

Working in LTC often means providing 24/7 residential care. However, women with family responsibilities are often unable to commit to the necessary evening and weekend shifts. Aware and Daughters Of Tomorrow’s research has shown that many low-income women are also unable to make adequate childcare arrangements in order to commit to shift work. Having said that, some eldercare employers in the programme were able to address this challenge by accommodating their workers with flexi-hours.

MISCONCEPTIONS ABOUT ATTIRE

A prevalent belief among healthcare employers was that headscarves are linked to the spread of infections. Accordingly, some employers were hesitant to hire LTC workers who wear a tudung or hijab. However, we found that hospitals in many Muslim countries do not have similar concerns and freely employ women who wear headscarves.

For our programme, we conducted a systematic review of the numerous studies investigating links between clothing and infection transmission, and did not find any compelling evidence to show that healthcare workers’ uniforms or workwear (including headscarves) contribute to healthcare-associated infections, or pose any additional risks to patients or staff.

With this review, we managed to convince a number of employers to employ workers who wear headscarves and look forward to more employers adopting similar flexibility in their hiring.

LONG-TERM VISIT PASS MYTHS

Another misconception we discovered was the belief that long-term visit pass (LTVP) holders – typically foreign spouses of Singapore citizens – contribute to an employer’s foreign worker quota.

As our programme included LTVP holders, we were able to clarify this with the Ministry of Manpower. We then helped disseminate this information to employers to disabuse them of the notion that hiring LTVP workers is tantamount to hiring foreign workers.

The success of the programme was seen in the low attrition rate among the care workers it placed: Of the 35 women placed, only one left her job in the first six months. Achieving this required a close working relationship with human resources and operations teams of LTC providers, enabling participants to transition successfully into working life after years of unemployment.

Despite the success of this pioneering effort, longer life expectancies and growing rates of chronic conditions point to a rising demand for direct care workers who provide the majority of hands-on, non-medical care to older adults.

The dismal combination of low wages, shift work and misconceptions about hiring certain workers makes it difficult to match demand with supply.

The pressing challenges surrounding supply and quality of care beg further reflection. How do we care for our elderly and balance that with affordability?

What opportunities are there for collaborations between LTC providers, volunteer welfare organisations and civic initiatives to innovate and excavate new local pools of talent for our future “care force”?

How can the Government support the evolution of care in Singapore with policies that improve the wages and conditions for local workers? Can we tap the pool of women on LTVP who are localised and living here with their Singaporean children? Can sector training subsidies and retention bonuses currently available for Singaporeans and permanent residents be extended also to women on LTVP?

The ability of the sector to retain care workers, and attract more to meet demand, requires more work and collective effort. We are all likely users of LTC in the future as we age.