Caregivers

Overview

This overview provides a synopsis of the current knowledge base. Having considered all the information, we make sense of it by taking a stab at the following: 1) What are the priority issues that deserve attention, 2) What are opportunity areas that community or voluntary organisations can already take action on, and 3) What knowledge gaps deserve further investigation?

Definitions

Definition of Formal Caregiving

• Identify and define your target group or social issue, and state who is included or excluded to provide a sense of the scope of the issue. (For example, will the page on Animal Welfare include livestock? Or just focused on pets, community animals and wildlife?)
• It is usually easier to start with national guidelines, laws or reports from apex organisations.
• Include a comparison with how other countries define the issue if possible (e.g. Local definition of Disability does not include mental health conditions)

Key Statistics & Figures

• 210,000 people aged 18 to 69 provide regular care to family and friends, and this number is expected to rise (ST 23 Sept 2013)

Map of Key Issues

• The TOC can be articulated this way: If caregivers have the requisite skills and knowledge to take care of their dependents; are physically & mentally healthy; have strong family & peer support; adequate financial & work support; and make long-term plans for when they pass on; then they will be able to sustain the provision of care.
• Put a different way, we can also say: There are 4 key pre-conditions for parents to provide quality caregiving for the long term: 1) Caregiving Knowledge & Skills; 2) Health & Well-being, 3) Family & Peer support, 4) Financial and Work Support, and 4) Future Care Planning

Types of Programmes		Areas of Needs / Desired Outcomes
Information & Referral Training programmes Communities of Practice	→	Limitations and Relevance of Formal Caregiving	↘
?	→	Informal Caregiving	↘
Family Workshops	→	Potential Solutions	→	Caregivers sustainably provide quality care

Sub-pages

• If there are population segments that have substantial enough information or interest, then create sub-pages for them. e.g. 'Autism' can be a stand alone pages linked to the Disability pages if the autism community is keen to populate more autism specific information. Or, artists with disability can populate a 'Arts & Disability' page.
• Insert links to these sub-pages.

Limitations and Relevance of Formal Caregiving

• Limitations
• Relevance

Existing Programmes	Gaps & Their Causes	Possible Solutions
Information & Referral AIC Silver Pages	Awareness of services is high (National Surveyof Senior Citizens) but lack clarity on how the services actually work. Caregivers typically have to piece together multiple support services that may not be designed to work together (see NCSS 2016 Who Cares?)
Training grants Caregivers Training Grants
Training programme TOUCH Caregiver's Alliance Ltd SCCL Caregivers Workshop	Affordable because caregivers pay virtually nothing for these programmes, but the content can be improved for context-specificity (each caregivers circumstance is different and dependent on condition of care recipient). Are we faced with provider-centric training programmes rather than those that meet skill needs of caregivers? Accessibility of such training workshops may be an issue as caregivers may not be able to afford time or energy to attend formal courses.	Install caregiver programmes in institutions (e.g. Hospitals) where care recipient may be taken, and for physicians to assess caregivers own health when they take care recipients for medical consultations
Communities of Practice Sharing platforms for fellow caregivers to exchange tips TOUCH Facebook group		More to tap into the collective intelligence of care providers

Informal Caregiving

• Definition
• Key Statistics and Figures
• List of Caregiving Policies

Existing Policies	Details of Policies	Gaps & Their Causes
FDW Levy Concession	for Persons with Disabilities (PWDs $60 levy concession per month instead of $300 Can be used for 2 FDWs per household at one time Needs help with at least 1 ADL
Home Caregiving Grant (replaced the FDW grant as of Oct 2019)	$200 monthly grant Means-tested Care recipients with permanent moderate disability (needs help with 3 or more ADLs) Regardless of age	HCG is more flexible than the FDW Grant because it can be used for caregiving expenses (home or community-based service) and transportation; not just for FDWs Implications: would take the burden off FDWs as caregivers because there would be more alternatives that the caregiving grant can be used for However costs for hiring FDWs could still be lower than engaging local services + this grant only applies to those within a certain means not others whom may face similar situations
Caregivers Training Grant	$200 for each care recipient per year including to FDWs to attend training courses and receive certificate of attendance	Training courses available are on the pricey end especially for longer/in-depth courses Most focus on technical caregiving duties rather than psychological wellbeing
Eldercarer FDW Scheme	provides FDW with prior comprehensive training in eldercare Details Duration: 2 days of classroom training before starting work, 3 hours on the job training to show application skills Costs: $200-$500 (can offset with CTG) FDWs with nursing background will cost more	High costs Short length of training period will not guarantee continued FDW efficiency over time (especially since the general ones do not have prior nursing background → rudimentary knowledge and may thus not have much experience) Does not focus on psychological well-being of FDW which could decline over the course of their caregiving role

General Limitations

1. Lack of psychological wellbeing services for FDW caregivers
2. FDWs only taught rudimentary skills under the Eldercarer FDW scheme → need a policy that caters to long term training
3. Training courses that are eligible under the CTG are pricey and not really value for money (given that it is one-off courses)
4. FDWs services may still be a cheaper alternative to local caregiving services even with the introduction of the HCG thus may not ease the burden of them becoming caregivers

Courses/skills/training for FDWs

Courses/Skills/Training for FDWs	Details of programme
Foreign Domestic Worker Association for Social Support and Training (FAST)	Items covered: Integration and orientation English (basic and advanced) Eldercare skills (3 days) Basic computer literacy Care for domestic household Healthier cooking programme Basic baking skills Maternal and Infant care skills Elderly Dementia Stroke care Care of Caregiver * Basic and advanced entrepreneurship Basic financial education Personality, development and communication Specialised health and pain management for elderly Business Management Specialist Home-Based Eldercare Programme* more rigorous and encompassing course contributes to professional enhancement of FDWs (able to earn certificates and scholarships) Subsidized decently for the number of sessions offered compared to other providers (e.g. Care -- $200 for 40 sessions [165hours] vs Aaxonn Home Eldercare Skills - $236 for 12 sessions [24hours])
Agency for Integrated Care Singapore (AIC) - Caregiver Training Courses	Items covered: Day-to-Day care (general and specific) Clinical course Dementia training Physical Disability training Psychosocial Wellness training Stroke training Learning and Developmental Disability (no courses yet)
AIC - Eldercarer Foreign Domestic Worker (FDW) Scheme	Items covered: Ageing Monitoring vital signs Day-to-Day care Activities, exercises and fall prevention Medical Assistance Communication with care recipient → enables a pre-trained FDW with comprehensive training in eldercare for a family → Duration: 2 days of classroom training before starting work, 3 hours on the job training to show application skills → Costs: $200-$500 (can offset with CTG) → FDWs with nursing background will cost more

General Limitations

1. Lack of prior experience on part of FDWs may render technical courses (e.g. clinical) less effective especially those taught within a short duration
2. Unclear whether provision of follow-up sessions to FDWs would be conducted if they do not acquire the skills properly within the allotted time
   • A study conducted on FDWs for persons with dementia found that one-off training may be insufficient to guarantee competency of FDW in handling daily caregiving and highlighted the need for refresher courses (Ngoc Huong, L. H., Chong, M. S., Munn Choo, R. W., Wai, J. T., & Philip Lin, K. Y., 2018)
3. Specialists Home-Based Eldercare programmes
   • Only small batches so far - 30 to 40+ - compared with a much larger proportion involved in caregiving
   • FDWs may be unable to commit to the 40 sessions given that some have to care 24/7 for their care recipients
     • Employers commonly perceive that FDWs are able to provide 24/7 care to care recipients while also maintaining the household (Yeoh & Huang, 2009)
4. Employers have the greater say in enrollment of their FDWs in such training and the outcomes of such training as social support matters
   • Studies show that FDWs can benefit from the support and cooperation of the employer + family members yet the uneven balance of power renders FDWs vulnerable to inadequate support (Ngoc Huong, L. H., Chong, M. S., Munn Choo, R. W., Wai, J. T., & Philip Lin, K. Y., 2018; Yeoh & Huang, 2009)
   • FDWs less able to take initiative in course choices most suitable to them especially if they are the primary caregivers --> employers may be out of touch with what the FDW is really going through and make assumptions
     • Caregiver esteem and self-efficacy likely to be boosted if employers showed affirmation of FDWs caring methods (Østbye et al., 2013)
     • “Self-efficacy gave FDWs a sense of mastery, especially when family members felt helpless with the senior's behavior.” (pg. 1274)
     • Many sites catered in English (not the native tongue of many FDWs) shows that employers are the expected target audience
   • Employers are unsupportive of the FDWs training/skill methods although they may have picked it up from legitimate courses.
     • Study implied that efficacy of skills and knowledge which FDW picked up could be negated by unsupportive family members who disapprove of the caregiving methods taught (Wai, J. T., Koh, G. C., Legido-Quigley, H., Ngoc Huong, L. H., & Philip Lin, K. Y., 2018)
   • Quality of eldercare is affected if employers and FDWs have strained relations which would lead the employee to hide their caregiving struggles (Wai, J. T., Koh, G. C., Legido-Quigley, H., Ngoc Huong, L. H., & Philip Lin, K. Y., 2018, pp 1271)
5. Most courses are generic and not customizable
   • General courses may cover the essentials/basics of what is expected but may not be enough for unique situations
   • Moreover since most FDWs do not have prior experience, they may lack experience to tweak the generic to fit the particular needs of their care recipient
6. Inadequate caregiving language training courses (mainly towards older people)
   • The general population of older people in Singapore speaks Mandarin, local Chinese dialects, Malay and Tamil (Heng, JL, Fan, E, Chan, EY, 2019)
   • The HOME study (Humanitarian Organization for Migration Economics, 2015) reported that 30% of FDWs experienced language-associated difficulties with their hiring families (Ngoc Huong, L. H., Chong, M. S., Munn Choo, R. W., Wai, J. T., & Philip Lin, K. Y., 2018, pp 1144)
   • English lessons observed to be a common course for FDWs to take but there is a lack of opportunity to take the other languages that seniors commonly speak e.g. dialect
   • Language deficiency leads to miscommunication which could lead to strained relationship between FDW and care recipient

Employment rights regarding FDWs

Power Imbalances between employer and FDWs

• Propagation of patriarchy: A "genderized mode of labor substitution" where middle-class women place their reproductive burdens onto less privileged women similar to how males did so to them for public sphere advancement (Huang & Yeoh, 1998)
• Potentially enhanced by state policies
  • Bond payment (employers need to give the state $5000 to receive work permit for FDWs; pay monthly levy of $300)
    • Payment permits even extreme actions that employers impose on FDWs to check their behavior and not jeopardize the monies given to the state --> state-sanctioned power (Hing, 1996)
  • Work permit employer leverage
    • May supersede agreements that guarantee proper rights to FDWs signed in their home countries
    • Employers allowed to repatriate FDWs at will
    • FDWs can only transfer employers with approval from current employer - would endure ill-treatment
    • Expensive agency fees
    • Newcomer FDWs especially vulnerable due to language barrier and lack of experience
• Implications
  • Creates opportunities for disrespect and even inhumane acts against FDWs
  • Reduces FDWs to mere status symbols
  • Basic rights such as rest days compromised (http://twc2.org.sg/wp-content/uploads/2019/08/maid_to_last.pdf)
  • Devalues liberating factors of migration
    

Psychological well-being services for FDW caregivers

• • • • • Employment rights regarding FDWs
        • Recognising power imbalances between employee and FDWs
          • Lack of power to negotiate for rest, skills upgrading
          • Family members as primary caregivers and FDWs as secondary caregivers - but the roles are often possibly (?) switched and FDWs end up taking over as the primary caregiver
        • Lack of psychological well-being services for FDW caregivers
          • Peer-support groups, seeking professional counselling (FDWs not considered as primary caregivers)

Potential Solutions

• Suggested Research Directions
• Secondary Caregivers & Support from Community
• Public Awareness & Support
• Customisable trainings and courses

Existing Programmes	Details of Policies	Gaps & Their Causes	Possible Solutions
Category A
Category B
Category C

General Limitations

• insert
• insert

Secondary Caregivers & Support from Community

• Desired Outcome: Shared responsibilities with secondary caregivers, family and larger community
• Synopsis: [To insert]
• Statistics: Increasing reliance on foreign domestic workers to provide caregiving. But 18% do not have any other person to assist them, 44% has one other person, and 27% have tow other persons (Ng Guat Tin 2006: 11)

Existing Programmes	Gaps & Their Causes	Possible Solutions
Sharing Caregiving Load SCCL Workshop - 'Caregiving is a Shared Family Responsibility'	Primary caregivers tend to should burdens on their own because of cultural norms such as expectation that caregiving is a responsibility they should shoulder on their own (See NCSS 2016: 43). Stress and anxiety is caused not just by executing these responsibilities, but also by the lack of clarity about such roles and responsibilities.	Help caregivers develop trust with ability to share and delegate responsibilities with secondary caregivers or others. Normalize such conversations about caregiving roles and responsibilities (NCSS 2016: 47) Tap into RCs, CCs

Sharing Caregiver Load

• SCCL Workshop - 'Caregiving is a Shared Family Responsibility'
• insert

Category B Programmes

• insert
• insert

Category C Programmes

• insert
• insert

Public Awareness & Support

• Desired Outcome: Need for public to be aware of and be emphatic of the heavy burden of caregiving
• Synopsis: [To insert]
• Statistics: [To insert]

Existing Programmes	Gaps & Their Causes	Possible Solutions
Public Education & Advocacy
Awards & Recognition AWWA's Model Caregiver Awards

Public Education & Advocacy

• insert
• insert

Awards & Recognition

• insert
• insert

Category C Programmes

• insert
• insert

Resource Directory

https://www.sgassist.com/care-connect/

A one-stop service hotline catered for all care-related needs.