AWARE’s new report reveals that caregivers of elderly persons in Singapore face heavy financial burdens; proposed measures to support caregivers

Gender equality advocacy group AWARE released a new report which looks at the impact of eldercare on caregivers’ retirement adequacy revealed that limitations in caregiving that can be performed by foreign domestic workers and the underutilisation of formal care services create pressures on female family caregivers.

The report, ‘Make Care Count’ is based on research comprising 22 qualitative interviews with family caregivers and 22 sharings with academics, healthcare professionals, caregiver support networks and home and community-based care service providers.

Highlighting that the burden of caring for older persons tend to fall more on women as Singapore’s population ages, the number of women who cited family responsibilities as being the main reason for being out of the workforce rose by 9% from 263,000 to 286,500 in 2018 from 2016 according to data from the Labour Force Survey.

These women make up more than 90% of the people who are outside the labour force because of family responsibilities, said the report.

Experienced researcher from Duke-NUS Dr Rahul Malhotra noted during the launch of the report at the AWARE Centre highlighted a 2011 national survey which showed that most of the caregivers of older people aged 75 and above were women, a large proportion of whom were daughters, daughters-in-law, and wives.

He said, “‘Based on my reading of other research that has come out since I think it still remains a gender-biased story in terms of caregiving.”

Dr Malhotra elaborated that this is largely due to the traditional values of Asian societies including Singapore where the job of caring for the family, both of young children and older family members, is traditionally taught to be a woman’s job.

He noted that a bigger quantitative survey is being conducted on the national sample of caregivers which will hopefully be completed next year, adding that initial findings suggest that the caregivers of the elderly are still predominantly women.

Based on the report, AWARE found that the increased time spent on caregiving results in several changes in the caregiver’s employment status, from a reduction of working hours to a complete withdrawal from the labour force. This then presents a significant financial challenge to caregivers.

Many women experience a loss in personal income and CPF contributions with respondents saying they suffered a 63% loss of income. This translates to an annual loss of S$56,877.

Other changes include an increase in monthly expenditure from care-related costs which can be quite high. The report noted that caregivers caring for a person who needs help with fewer than three Activities of Daily Living (ADLs) spend an average of $866 a month, or 22% of their average monthly household income on care-related expensive. That number increases significantly for those taking care of someone who requires assistance with more than 3 ADL, on average about S$1,917 a month or 64% of their monthly household income.

As such, AWARE proposed eight recommendations in their report, grouped under four themes: ensuring a more equal distribution of care, allow working caregivers to better balance work and care, give financial recognition for caregiving labour, and reduce caregivers’ care-related out-of-pocket expenses.

The recommendations include:

  1. Regulate and license private providers of eldercare services including home-based care services by conducting regular sport-checks and assessments and publicly publishing the results.
  2. Ensure caregivers and are recipients have access to care-related information and care management services by expanding cluster support services.
  3. Set up a national database for family caregivers.
  4. Introduce statutory right to request flexible work arrangements.
  5. Intro eldercare leave, and family care leave for sandwiched caregivers.
  6. Intro anti-discrimination legislation to deal with age-related and other workplace discrimination.
  7. Introduce a caregiver support grant.
  8. Modify CareShield Life to: reduce the 3 ADL minimum; take into account effects of dementia; make premiums gender-neutral; increase payout level.

When answering questions on some of the recommendations proposed, Dr Malhotra reiterated that many women leave the labour force because of caregiving responsibilities. As such, he said that a key concern is in securing flexible working arrangements that will support caregivers.

He said, “Not only having flexible work arrangements but making sure that the employees are not hesitant in seeking them and asking for them and the employers are supportive of employees who seek them.”

He emphasised later, “‘there needs to be more done at the work-caregiving nexus.”

Dr Malhotra then said that things have improved overall with the ramping up of homecare and daycare services, and more nursing homes in the past five to six years. But in addition to the infrastructure, he says the quality of care is also a crucial factor to consider.

“So I think if more can be done in terms of putting an approval stamp on the quality of care in terms of some sort of ratings scheme,” he explained, adding there should be better communication of the quality and cost of care so that a layperson will know what to expect from a facility.

When asked what might be a challenge in implementing the recommendations suggested by AWARE, Dr Malhotra said, “Just looking at it from a broader perspective, not having any personal conversations…I think a big consideration is cost.”