Caregiving burden in foreign domestic workers

caring for frail older adults in Singapore

Group 4
Neo Jun Kai
Soh Wanxian Kimberly
Woh Joanne
Huang Xiangyuan
Liu Lina

Int Psychogeriatr. 2018 Aug;30(8):1139-1147

OUTLINE

1. The key findings of this study

2. Ways to better support and alleviate the caregiving burden of foreign domestic workers’
(FDWs) for caring frail older adults
3. How families are coping with the care of frail older adults during the COVID-19 pandemic when
the supply of FDWs is reduced.

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 INTRODUCTION
Singaporean senior caring relies on FWDs, studies in their burden needed
Ageing Singapore: No. seniors (>60 yo) will increased to 900,000 by 2030
No. persons with dementia (PWD) will increase to 187,000 by 2050

Benefits of senior caring by FWD: Seniors can stay at home, familial caregivers can keep a full-time job,
culturally acceptable, health benefits

Reliance of senior caring on FWD: ⅕ households employs FDWs, 50% FDWs specifically care for frail seniors

Health problems of FWD: High presence of physical and mental health problem
→ Caregiving burden

Gaps in current literature: Determinants of caregiver stress and coping strategies

Culturally sensitive caregiver interventions or health communication programmes

What are the factors associated with caregiving burden in FDWs

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looking after older adults in Singapore?
Methods

Study design: Cross-sectional convenience sample

Settings: An inpatient geriatric ward and outpatient geriatric clinic in a tertiary hospital in Singapore

Sample size: 221

Inclusion criteria: 1) caring for an older person aged 65 years and above;
2) providing care for at least 6 months;
3) 21 years old and above;
4) literate in English, Bahasa Melayu, or Burmese.

Data collection: Based on questionnaire

1) demographics (age, marital status, number of children, education, physical problems)
2) employment factors (working experience, reason to work in SG)
3) employer factors (employer demographics, language difficulty, accommodation, PWD caring)
4) caregiving burden (ZBI, subjective and objective)
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Key Findings | Lack of social support for FDWs
Issues identified
● Those who cared for persons with dementia
faced more difficulties.
● Those who encountered language issues were
5.46 times more likely to experience caregiving
burden.

Rationale

● Pressure exerted by family caregivers on FDWs to

perform most of the caregiving AND domestic
duties round-the-clock
● Language barriers can exacerbate challenging
behaviours in PWDs as their physical or
emotional needs are unmet
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Key Findings | Lack of social support for FDWs
Issues identified

● Nationality was the strongest factor associated

with caregiving burden
● Compared to Indonesian FDWs, Filipino and
Burmese FDWs were 9.73 and 4.69 times more
likely to express caregiving burden respectively.
Rationale Indonesian
Filipino

● This could be due to larger language barriers

experienced by Filipino and Burmese FDWs
● Many local elderly speak Bahasa Melayu which is
similar to Bahasa Indonesia

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Key Findings | Lack of coping strategies to challenges in work
Issues identified

● FDWs felt they could be doing more and

doing a better job at caring for the older
persons

Rationale
● Language barriers
● Lack of training and preparation especially
in caring for PWDs
● Lack of social networks that allow for
sharing of coping strategies

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Key Findings | Limited job satisfaction
Issues identified
● Lack of respite and sufficient social mobility
outside the home / privacy within the household
● Lack of confidence in caregiving
● Lack of “job security”

Rationale
● Lack of caregiving training and barriers such as
employer disapproval and limited time available to
attend trainings
● No mandated / regulated work hours
● Job scope misaligned with original expectations

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Proposals| To foster capabilities of FDWs

● Accreditation to certify skillset of FDWs so

that “matching” can be done prior to
better set expectations.
○ e.g. FDWs with nursing experience can
be paired to families employing FDWs
to care for PWDs
○ FDWs trained to care for PWDs can
command higher basic monthly salary
● Healthcare professionals/ Specialised
trainers in agencies can conduct training
sessions on taking care of the frail elderly

9 A dementia caregivers training & support groups progrsm provided by an NGO in HK

Proposals | To foster capabilities of FDWs
● Subsidies/support for employers to
○ Hire “trained FDWs”; or
○ Send FWDs to get trained in
language or dementia
caregiving skills before
deployment (conducted by
AIC); or
○ Send FWDs for refresher
courses after employment (not
just one-time off).

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 Proposals| To enhance social support for FDWs
● Helpline to be available for FWDs:
○ Provide both guidance (in caring for PWDs) and counseling
(for psycho-emotional support)
○ FDWs agencies to inform FDWs prior to deployment.
○ Employers should be made aware of such channels as well,
and to recognise when FDWs require such support
● Buddy / social support systems within neighbourhood /
estates
○ Facebook groups can be set up for FDWs within the same
estate to join, connect and support one another
○ Residents’ Committees (RCs) or Networks (RNs) can organise
various ethnic gatherings for FDWs within the estate
● Reframe Employers’ roles
○ Mentality shift towards a joint responsibility with FDWs
instead of total transfer of duty in caring for elderly
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Proposals | To increase FDWs’ job satisfaction
● Properly define job scope at the start of
employment
● Regulate / agree mutually on number of
work hours per week and define rest hours
● Increase employers’ awareness on
importance of providing affirmation and
encouragement to FDWs for their care giving
efforts

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How are families coping with the care of frail older adults during the
COVID-19 pandemic when the supply of FDWs is reduced

What’s done What kind of help is needed

● Quit full time job or change to part-time ● More targeted subsidies and financial assistance
to take care of frail parents - disbursement to the person who lost income
especially if their jobs were “non - more tax rebate for taking care of parents
essential” e.g Covid-19 Recovery Grant, Silver Support Scheme

What are the implications

Loss of income
especially for low- to middle- income families
who may require that additional source of
income

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How are families coping with the care of frail older adults during the
COVID-19 pandemic when the supply of FDWs is reduced

What’s done What kind of help is needed

● Switch to part time carer / targeted services ● Subsidies needed for such
e.g Homage services
- Takes care of frail older adults while family is ● Need employers to agree to
at work the flexible work arrangement
- Flexible hours

What’s the implication

● Shift in labour demand
- More ex-nurses return to work
- Increase no. of people that took up
diploma / skill upgrading for basic
eldercare
● Possible financial burden

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How are families coping with the care of frail older adults during the
COVID-19 pandemic when the supply of FDWs is reduced

What’s done What kind of help is needed

Social admissions into hospitals
● Targeted help: Medical social workers
usually assist to find out the needs
- Some issues may be resolved with
pharmacotherapy
- Some complex needs may require
community intervention or community
What are the implications hospital admissions
- Requires needs identification and co-
● Unnecessary risk of nosocomial creation of solutions
infections during admissions
● Waste of hospital resources that can
be better directed to patient care

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How are families coping with the care of frail older adults during the
COVID-19 pandemic when the supply of FDWs is reduced

What’s done What kind of help is needed

Nursing home / community hospital ● Increase capacity of nursing homes and
admissions community hospitals for those who really
need them
● Broaden eligibility for more to qualify for
subsidies
● Day care centres where older adults can be
What are the implications taken care of so that family members can
● Older adults unable to age in place continue working
● Possible accelerated decline in condition of
the older adults
● Not given the autonomy to choose where to
stay (breach of dignity)
● Unnecessary admissions are a waste of
resources
● Cost can be substantial especially if not
16 eligible for subsidies
● Possible long waiting time for enrolment
How are families coping with the care of frail older adults during the
COVID-19 pandemic when the supply of FDWs is reduced

What’s done What kind of help is needed

Enrolment in day care centres ● Broaden eligibility for more to qualify for
subsidies

What are the implications

● An additional source of financial
burden
● Some centres require the participants
to be ambulant / semi-ambulant
● Transporting to and from centres
might be a problem
● Some centres provide transport
services at additional costs
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How are families coping with the care of frail older adults during the
COVID-19 pandemic when the supply of FDWs is reduced

What’s done What kind of help is needed

● Home modification for frail older ● Seniors mobility and enabling fund disbursed by
adults to age in place safely AIC for financial assistance
- installation of grip bars ● Needs identification should still be done in prior
- removal of wall for wider access
- camera to monitor elderly at
home
What are the implications
● An additional source of financial
burden
● Care may not be as holistic

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Additional references

Agency for Integrated Care

Life.gov.sg

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 The End
Thank You!

Group 4