Elderly sick in Singapore turn to foreign, live-in caregivers

Myanmar live-in caregiver Than Than Sint helps Madam Tan Ah Sian, who has terminal gall bladder cancer, with daily activities like using the toilet. (The Straits Times/Nivash Joyvin)

Families with elderly folk are increasingly turning to live-in help in the form of foreign nurses.

Service providers interviewed said that demand for these nurses has surged in recent years and they expect the uptrend to continue.

These nurses, who come from the Philippines, Myanmar and Indonesia, are seen as an option for older people who have mild to moderate disabilities and need round-the-clock medical care. This includes people who suffer from dementia or have had a stroke.

Ms. Yorelle Kalika, chief executive of Active Global Specialized Care- givers, said: “Demand in Singapore has been growing steadily over the last three years.”

Mrs. Susan Ng, director of nursing at Sue Private Nurses Agency, said that demand for foreign nurses has increased exponentially as private nurses here usually do not want to stay overnight with their patients.

Mr. Jonathan Lai, general manager of Nicole Consultancy, which offers local and foreign nurses for its home nursing services, said that another factor is the shrinking pool of foreign maids.

And with Indonesia planning to stop sending live-in maids to Singapore from as early as next year, trained help may be the best alternative, he said.

However, despite the bright business prospects, agencies are not going on a big hiring spree, citing costs and quality concerns.

For Ms. Rena Ang, getting a live-in nurse to take care of her 70-year- old mother was a better option than a foreign live-in maid.

Her mother, Madam Tan Ah Sian, cannot walk without assistance.

Ms. Ang, 40, said: “Rather than getting a maid to look after my mother, we wanted someone medically trained and who has had past experience taking care of older people.”

Madam Tan was diagnosed with terminal gall bladder cancer in March last year and her condition worsened over time.

Now, she is not only unable to walk on her own but also needs help with activities like using the toilet and taking a shower.

For more than six months, Ms. Ang and her father, Mr. Ang Chin Lai, 69, took care of Madam Tan on their own. “Frankly, it was hard. One of us had to be in the house all the time,” said Ms. Ang, who runs her own business.

Caring for Madam Tan on top of their regular jobs was a strain for Ms. Ang and her father, a part-time logistics manager, and they decided to seek help.

Ms. Ang contacted Active Global Specialized Caregivers, an agency that brings in foreign home nurses.

She hired Myanmar live-in care- giver Than Than Sint, 42, after a number of telephone and Skype interviews.

Ms. Than Than Sint has been taking care of Madam Tan since May this year. Among other duties, she monitors Madam Tan’s condition daily, changes her painkiller patch and stays overnight with her in the hospital should she be warded.

Ms. Ang said: “A live-in caregiver needs to have a lot of patience and compassion. We’re very thankful for Than Than.”

Need for eldercare services

The number of people above the age of 65 in Singapore is expected to increase to 610,000 by 2020, even as the number of family caregivers shrinks.

By 2030, one in three people here is projected to need some form of eldercare service.

The Ministry of Health (MOH) announced plans in October to change “the centre of gravity” of senior healthcare from hospital to home and community, although this will take time.

It also intends to increase the number of healthcare workers here in 2020 by 30,000, with 10,000 of these in the eldercare sector alone.

But community-based eldercare options are still in short supply. The capacity to care for older people in their homes was 6,900 last year.

In contrast, there were 29,000 older people living alone in 2011 and this figure is estimated to reach 92,000 by 2030.

There is thus room for the private sector to move into, but any expansion will run into the same constraints that affect the healthcare sector as a whole, such as manpower shortages.

In the last 12 months, Active Global has doubled the number of foreign nurses it employs in Singapore to 400, and the number is expected to double again next year.

Ms. Kalika, who founded the company in 2012, said: “My estimate is that the number of potential clients is around 100,000 to 200,000.”

Ensuring high standards

However, despite the burgeoning demand, most agencies offering foreign live-in caregiver services in Singapore remain small, employing fewer than 50 caregivers.

Ms. Kalika said: “This is a labor- intensive industry and a lot of investment is required in terms of operating costs, such as provision for additional training.”

Active Global’s nurses do a refresher course or get additional training in caring for dementia or stroke patients, for example, by senior nurses who have worked in hospitals here.

Mrs. Ng of Sue Private Nursing, which has been operating for 10 years and contracts an average of 10 foreign caregivers a month to households here, said: “We make a lot of home visits to uphold the standard of care expected. These are done by local professionals. That’s why our numbers are small.”

Compared with getting a maid, more work has to go into deter- mining the fit of a caregiver with an employer. This is because, in addition to relevant skills and past experience, small things such as chemistry also matter.

Ms. Kalika said that in a high- pressure job like caregiving, friction can arise from the patient and caregiver being in close proximity all the time. Thus, the effort that goes into making the right match is important.

While maids may be the first resort for families needing caregiving help – they are relatively more affordable than specialized caregivers – the advantages of a live-in nurse are significant.

This is because maids may not be as adept as trained nurses at taking care of the sick or disabled.

Mr. Lai said: “We do see that there will be a big gap. Foreign maids will need to be trained in other skills, and nursing is one of the options.”

For Madam Tan, it was important to have a caregiver who she could communicate with easily.

She said: “I taught Than Than a bit of Hokkien and she picked it up quickly. Now, she knows how to ask me in dialect, li jiak ba buay? (have you eaten?).”

Ms. Than Than Sint said: “I am also lucky. I love Ah Ma (Madam Tan) and Ah Ma loves me.”