SINGAPORE – Almost half of the foreign domestic workers (FDWs) in Singapore hired as caregivers to the elderly with chronic diseases, such as diabetes, hypertension and high cholesterol, are not confident about supporting their healthcare needs or skilled enough to do so.
Among the 104 foreign caregivers recruited for a local study conducted by SingHealth Polyclinics (SHP), 45.5 per cent and 40 per cent of those who were needed to carry out blood pressure and blood glucose monitoring, respectively, lacked the confidence to do so.
Nearly two in five (36 per cent) of those who need to supervise the seniors’ medicine intake were apprehensive about doing so, according to the study, which was published in 2022 in BMJ Open, an online, open-access journal dedicated to publishing medical research from all disciplines and therapeutic areas.
The study, conducted between May and June 2018, interviewed FDWs from Indonesia, the Philippines and Myanmar, most of them in their 30s. The average age of their care recipients was 81 years old. The interviews were carried out at four SingHealth Polyclinics – Bedok, Bukit Merah, Outram and Tampines.
Clinical Associate Professor Tan Ngiap Chuan, director of research at SHP and vice-chair of research at the SingHealth Duke-NUS Family Medicine Academic Clinical Programme, said: “Poorly managed chronic diseases can lead to complications and morbidity. To prevent that, and deliver competent eldercare in a rapidly ageing population, there is the need to train FDWs in the necessary skills to care for our elderly.”
He added: “With the findings, we are exploring the options of how we can empower FDWs to better support the older Singaporeans. Currently, it is not really systematic when it comes to the level of competency of these helpers.”
To do so, a polyclinic-based training workshop has been developed to empower FDWs with knowledge and skills to perform geriatric care tasks. It will be piloted at Eunos Polyclinic in late 2023 to early 2024.
Singapore’s population is ageing rapidly, with the proportion of citizens aged 65 and above increasing to 18.4 per cent in 2022. By 2030, about one in four citizens, or 23.8 per cent, will be aged 65 and above.
For many families here, FDWs are usually hired as additional family caregivers, with almost half employed for the purpose of looking after older family members, apart from managing household chores.
The boundary between care work and domestic tasks is usually blurred, and over half of domestic helpers do not have geriatric care experience or formal training, but families hire FDWs despite concerns that the latter lack proper training in caring for frail older adults.
“They are selected solely on their profiles provided by commercial hiring agencies, including nationality, age and previous working experience. Here, the evaluation of their competency in providing geriatric care is lacking in the hiring process,” Prof Tan said.
Ms Ang Kim Wai, a nurse clinician at SHP-Tampines, said that in her 19 years of work at the polyclinic, close to 30 per cent of her patients were accompanied by at least one foreign domestic caregiver when visiting the polyclinic.
Ms Ang, who is also the main author of the research paper, said that although the FDWs in her study were aware of healthy lifestyle practices, such as cutting down on salt and oil intake, using whole grains, and the benefits of exercising, most of them still need specific training in performing health-related tasks, such as giving medicine and monitoring blood pressure and blood glucose for the elderly.
“The study revealed that almost half of them were unfamiliar with the use of measurement devices, possibly due to the lack of related training. The more knowledgeable the FDWs were, the more they are confident in accomplishing the healthcare-related tasks, which will ultimately benefit the patient,” she added.
When his domestic helper of eight years retired and returned to the Philippines in 2021, all Mr Fabian Lim wanted was an FDW who was reliable to take care of his mother’s daily needs while the rest of the family was at work.
His mother, Madam Kow Whatt Neo, 68, had a stroke 12 years ago that weakened her right side.
Mr Lim, 40, who works in logistics as a freelancer, said his mother suffers from short-term memory loss, often forgetting to swallow while eating or drinking. “She needs to be supervised.”
Fortunately, the family found that support in Ms Sosima Donato, who had worked in Singapore for 15 years as a domestic helper and had cared for three elderly people before she started work for the Lims in early 2021.
Ms Donato, 46, a Filipino, whom her employers fondly call Soosi, takes care of Madam Kow’s daily needs, including logging her blood pressure three times a day, managing her medication, massaging her arms and legs, and supervising her during every meal to make sure she does not choke.
Ms Donato said she also learnt by watching how nurses take blood pressure measurements and how therapists work with Madam Kow whenever she accompanies the elderly woman to the clinic.
Said Mr Lim: “Soosi is a quick learner, and if all goes well, we are even planning to take her and my mother to Vietnam for a short holiday in January.”
Ms Donato hopes to learn more about how to take care of Madam Kow, whom she addresses as “Mummy”, and is looking forward to attending classes should the workshop be held on weekends when she gets her day off.
Seeing how domestic helpers usually get their days off on weekends, Prof Tan said the polyclinic-based training workshops, which will be free initially, will not be more than two hours and will probably be held on Saturdays.
“We are hoping that employers will see the value of allowing their helpers to attend these workshops,” he said, adding that SHP will scale up the workshops once the acceptance rate rises.