Monday 7 October 2013

Call to make eldercare leave compulsory

Halimah: Growing need to support those caring for sick and frail amid ageing population
By Hoe Pei Shan, The Sunday Times, 6 Oct 2013

Speaker of Parliament Halimah Yacob yesterday urged the Government to legislate family care or eldercare leave. This, she said, will send a strong signal to employers about the growing need to support workers who have to take care of sick and frail family members.

"It would be really helpful for families if family care leave or eldercare leave is also legislated as, increasingly, caregiving of the frail elderly has become one big strain on work-life balance," she said.

During the keynote address on work-life balance at the 7th Singapore Children's Society Lecture at Singapore Management University, Madam Halimah pointed out to the audience of 200 how parents are already given childcare leave.

Since May, the childcare leave scheme was enhanced to give two days of paid leave annually to parents with Singaporean children aged between seven and 12. Those with younger children were already receiving six days of paid leave a year.

Saying that the childcare leave is given in the context of efforts to promote procreation, the Speaker called for a "more encompassing message that stresses support for all workers with family obligations".

The issue is even more important with the greying population, which has increased demand for care of parents and older relatives.

More than one in nine people in Singapore are aged 65 and above, from around one in 13 in 2002. A Health Ministry survey in 2010 showed that 8.1 per cent of Singapore residents aged between 18 and 69, or about 210,000 people, were providing regular care to sick or frail family members.

Yet family or eldercare leave - sometimes referred to as caregiver leave - has yet to be truly embraced in Singapore, with employers seeing it as more of an option than a growing necessity, said Madam Halimah.

This is reflected in a recent NTUC survey, the findings of which were released yesterday at a separate event. The survey showed that 77 per cent of working caregivers do not have eldercare leave, and 62 per cent do not have flexi-work arrangements.

NTUC assistant secretary-general Cham Hui Fong said the labour movement aims to get half of its unionised companies to provide flexible work arrangements or leave structures by 2015.

This could include expanding existing leave categories, such as compassionate leave or critical illness leave, to cover looking after family members who require medical attention.

Association of Small and Medium Enterprises president Chan Chong Beng, however, is concerned that any move to make caregiver leave compulsory could be difficult to implement and subject to abuse.

"There will be problems verifying the amount of time an employee needs to look after his family," he said.

"Parental care should come from the individual and not be government-mandated. Ultimately, it's going to add a lot of costs to the employers who have to give more leave."

3 out of 4 caregivers lack eldercare leave: Poll
By Priscilla Goy, The Sunday Times, 6 Oct 2013

The National Trades Union Congress yesterday shared findings of a new survey which showed that more than three-quarters of working caregivers here do not enjoy eldercare leave.

That is why one of the labour movement's long-term goals is to push for family-care leave to be made law, said NTUC assistant secretary-general Cham Hui Fong.

She said: "In this ageing workforce... I think there's a need for us to re-examine the leave schemes we have, to see how we can reconfigure them so that they are more inclusive, and you can take care of employees with young families, and those with old families."

Speaking on the sidelines of an NTUC family event yesterday, she said in the short term, NTUC aims to have half of the unionised companies here providing flexible work arrangements or leave structures by 2015. This could include expanding the scope of existing leave categories - such as compassionate or critical-illness leave when family members die or are in intensive care - to also cover looking after dependants who require medical attention.

The online survey, conducted in August by U Family - NTUC's family development unit - was aimed at finding out more about the needs of Singaporeans with caregiving responsibilities.

Some 3,635 caregivers aged 21 to 65 participated in the survey. Almost all, or 94 per cent, are working adults.

Of the 3,418 working caregivers surveyed, 77 per cent said they do not have eldercare leave, and 62 per cent do not have flexi-work arrangements. To take care of family members, they would usually apply for annual or medical leave, or adjust their work timings - arriving late or leaving early from work.

Among the caregivers who are not working, 72 per cent left their jobs to look after family members. About three-quarters said they would have reconsidered their decision to quit if they were given flexi-work arrangement options.

Dr Mary Ann Tsao, chairman of Tsao Foundation, which specialises in eldercare, said she has come across "so many people who have lost their jobs or are stressed about losing employment because they take time off to look after their parents", so such legislation would "simply be common sense".

To ease employers into the new leave structure, should it become law, it could be introduced through sick-leave entitlement, said Dr Tsao. Her foundation, for instance, allows all its employees to use up to five of their 14 annual sick-leave days for family care.

But she added: "Ideally, employers should be required to give workers a certain number of days off separately for family care, like child-care leave because they are both family responsibilities and you have to give people time off if you want to retain them in the workforce."

Family-care leave: Use law, carrots to get buy-in

The AWWA Centre for Caregivers applauds the call by Speaker of Parliament Halimah Yacob to make eldercare leave compulsory ("Call to make eldercare leave compulsory"; last Sunday).

We are also heartened that the labour movement aims to get half of its unionised companies to provide flexible work arrangements or leave structures by 2015. This augurs well for caregiving employees seeking more support and flexibility from their employers to help them better perform their family duties.

There is also a need to address the concerns raised by the Association of Small and Medium Enterprises - that compulsory caregiver leave could be difficult to implement, open to abuse and add to employers' costs.

At the same time, caregivers have shared that taking family-care leave is frowned upon by employers, who have cited the lack of a law mandating such leave.

Many caregivers have left the workforce to care for their loved ones. This affects them financially and potentially undermines their re-employment prospects.

Mandatory family-care leave is likely to be better embraced if the public sector, the largest employer in Singapore, leads the way.

Beyond legislation, the initiative will require sustained engagement with employers - not just by policymakers, but also by working care-givers.

Beyond clear legislation, appropriate incentives and recognition schemes can be initiated to encourage compliance, while instituting relevant safeguards to deal with errant employers or employees violating the spirit of the law.

We should also look at national-level recognition for family-friendly companies.

The Ministry of Manpower could work with umbrella organisations in the human resource sector to recognise organisations' successes in implementing such leave schemes. Perhaps a special award is in order.

Together with family caregivers across Singapore, we look forward to such legislation being passed in Parliament.

Manmohan Singh
AWWA Centre for Caregivers
ST Forum, 13 Oct 2013

Should S'pore legislate eldercare leave?
The stress of looking after ageing parents takes its toll on their children juggling work and family needs, but employers fear more statutory leave will add to costs. Tham Yuen-C looks at whether legislation is the answer.
The Straits Times, 19 Oct 2013

LUNG disease, high blood pressure, prostate problems, difficulty walking. These are the health problems of just one man, aged 89.

It means he has to go to the hospital many times to see multiple doctors: cardiologist, lung specialist, kidney specialist, a urology and diabetes specialist.

And who takes him? His dutiful daughter-in-law.

And at home, who cares for him? She does, too. She is the main person tending to his needs, preventing him from falling, cooking for him and making sure he takes his medicine.

National University Hospital geriatrician Reshma Merchant, citing the example, says: "It is almost like a full-time job."

This is not an untypical prospect for many children in rapidly greying Singapore, who will end up caring for an elderly parent or family member - all the while juggling this with going out and earning a living too.

It is against this backdrop that Speaker of Parliament Halimah Yacob called for eldercare leave to be made compulsory by law two weeks ago.

But is Singapore ready for such legislation? And will it help caregivers?

Mounting pressures

SINGAPORE hit a demographic turning point last year when the first baby-boomers crossed into old age. The proportion of those older than 65 is expected to grow from 9 per cent in 2010 to 20 per cent by 2030 - the fastest-growing age group.

But who will look after them? As Madam Halimah points out: "(Caregivers) struggle daily to balance their work and their family needs. Some also have other responsibilities such as childcare, and their struggle is worse."

In an NTUC survey of people who provide care to family members, 27 per cent of those polled had multiple dependants.

Yet, today's smaller families have reduced the support network of siblings whom caregivers of elderly parents can call on.

"Families now have less capacity to provide care," says Dr Mary Ann Tsao, chairman of the Tsao Foundation, which provides eldercare services and which advocates ageing well.

Longer life expectancy complicates the problem.

Although improved medical care has allowed older people to live longer, it is "not a disability-free life", says Dr Tsao.

By 2030, many of the 900,000 baby-boomers will have turned 80, putting them at higher risk of falls and chronic diseases such as diabetes, kidney failure and stroke.

Worse, these conditions can predispose them to dementia.

Today, about 28,000 people here above 60 suffer from the brain disorder that robs them of their memory, intellect and personality.

Dr Merchant has seen it take its toll on adult children of patients. "They work full-time during the day, and at night, they care for their loved ones who wander around and shout."

The Organisation for Economic Cooperation and Development, in a 2011 report about long-term care, found that caregivers across its member countries were 20 per cent more likely than non-caregivers to suffer mental illnesses. They often also endure overall health deterioration.

Here, the situation is no different, says Madam Halimah. These caregivers can end up having to quit their jobs. Mandating eldercare leave will provide workers with much-needed flexibility to manage these family demands, she adds.

Will it work?

EMPLOYERS, understandably, are wary. Singapore National Employers Federation (SNEF) executive director Koh Juan Kiat asks: If such leave is legislated, how many days will be enough?

His union of employers polled 270 firms and found that most of those with eldercare leave capped it at two days a year.

This is unlikely to help those with sickly parents who require constant care and frequent hospital visits, says Mr Koh.

Eldercare leave could also disadvantage the very people it aims to support, by not giving them a fair chance at employment, says Mr Chan Chong Beng, president of the Association of Small and Medium Enterprises (Asme).

"It would affect an employer's decision, for sure. Comparing somebody who doesn't take any of this leave and somebody who takes it 10 times, how would you assess it?" he says.

But the main concern of business owners and employers is that more statutory leave will increase costs.

The Ministry of Manpower is aware of this. Responding to Madam Halimah's call, a spokesman said: "We are mindful of the need to strike a balance between supporting workers in taking care of family members and not to impose too many obligations on employers that ultimately affect workers' employability."

Already, companies have had to contend with newly legislated family leave benefits - adoption, maternity and paternity leave - announced earlier this year as part of the Government's push to encourage people to start families.

It has resulted in lost work days at some firms, says Mr Koh.

There are other complexities too, say legislation opponents.

Unlike childcare leave, which cuts off at age seven, eldercare leave would be needed for an uncertain period, so deciding on limits and criteria would be tough and, at best, arbitrary.

Former Cabinet minister Lim Boon Heng, who headed the Ministerial Committee for Ageing before retiring in 2011, often cited this reason in Parliament to urge patience on the issue of leave.

Then there is the possibility of abuse of the leave benefit, note SNEF's Mr Koh and Asme's Mr Chan. Without a fixed system, like medical certificates for sick leave, employers would be none the wiser if an employee went to a movie instead.

Inaction also costly

BUT safeguards can be put in place such as requiring a note from doctors, says the director of the Asian Women's Welfare Association (Awwa) Centre for Caregivers, Mr Manmohan Singh.

Also, by not doing enough to help caregivers achieve work-life balance, companies could face stiffer competition for workers.

The NTUC survey found that among caregivers who stopped working, 21 per cent had quit to take on the duty of caring for an elderly family member full-time.

As it is, the proportion of working adults is falling - so losing more of them to become caregivers does not bode well.

Offering eldercare leave, therefore, could turn out to be a good human resource strategy.

Dr Tsao says: "It would make companies more competitive in recruiting and retaining staff, and grow their reputation as forward-thinking, family-friendly (and) socially responsible. A grateful employee (also) will be more loyal, work harder and be more likely to have the company's best interest in mind."

Going by a yearly MOM survey, the trend is catching on, even without legislation: As of last year, one in six companies provided such benefits, up from one in 16 in 2008.

Singapore's largest employer, the civil service, has formalised eldercare leave. Starting last year, employees can use two out of 14 days of unrecorded leave towards eldercare.

Other companies will be pressured to follow suit, says health economist Phua Kai Hong of the Lee Kuan Yew School of Public Policy: "We're basically competing for scarce labour. It's all about the market and competition."

Other ways

HIS suggestion is first to educate employers, failing which the Government can try engineering the system through providing economic incentives and disincentives.

To that end, MOM introduced the Work-Life Grant in April this year to help defray the costs of implementing flexible work arrangements, said the ministry's spokesman.

In fact, many companies already have unofficial flexible work arrangements which allow employees to take time off to care for ailing family members, contend Asme and SNEF.

Says Mr Chan: "SME employers are sympathetic. They have family members who are old, too."

Holding off on legislation allows companies to work out benefits that suit their staff profile, adds Mr Koh.

For the group of caregivers who are most stretched, he adds, flexibility probably works better.

Others say more should be done to help caregivers, such as building more community hospitals and senior day-care centres.

Nearly 250,000 people here are over 70, but there are only 3,000 places available at 60 eldercare centres islandwide.

Mr Choo Jin Kiat, executive director of O'Joy Care Services which provides counselling and health services to the elderly, says the bigger issue is helping caregivers emotionally and helping them find jobs once they are ready to work again.

Wider message

THE Government has long objected to paying allowances for family caregivers. Mr Lim had warned it could "unwittingly monetise family obligations".

Indeed, Mr Choo says passing laws on eldercare leave could end up looking like the Government is legislating filial piety. "Caregivers should look at their annual leave of 21 days and see how they can use that," he says.

Awwa's Mr Singh counters that caregivers also need respite.

"Most of us just accept and carry on, but when it comes to the crunch, some people lose it even with their own mum," he says.

Plus, says Dr Tsao, helping families cope this way will not have the unintended impact of cash support: "Eldercare is simply asking companies to share some of the collective responsibility (of caring for the elderly), that's all."

Proponents say legislation will also take away the stigma caregivers may feel when asking for unofficial time off work.

But more important than the show of support for caregivers, it also helps throw the Government's weight behind, and garners society's support for, the concept of "ageing in place".

Says Madam Halimah, who re-ignited the debate with her call: "I see eldercare leave as part of the holistic effort to support ageing in place, so our frail elderly do not end up in nursing homes, which is not good for them, as well as (straining) resources as more nursing homes will have to be built."

Caregivers soldier on amid tears, toil and burnout

FOR two years after her mother suffered a stroke that led to dementia, Ms Jasmine Chua got only seven hours' sleep a week.

Her mother kept waking her up to talk - never mind that Ms Chua had a busy job in the daytime as a clinic assistant.

The lack of sleep left her frustrated. She recalls: "You've to leave everything behind and concentrate on your work. If you think about it, you feel stressed."

Ms Chua, 42, is an example of the struggle to juggle work and caring for an aged, sick parent. She is among the quarter of caregivers here who are single - and mostly women. The duty of care often falls on them as society expects a woman to care for the family, and for a singleton to shoulder a heavier burden than married siblings.

They become emergency responders, nurses, counsellors and chauffeurs. They do the dirty work of cleaning a loved one who has soiled himself.

As they balance two full-time jobs at work and at home, they wrestle with anxiety, frustration and burnout. Ms Chua felt hurt when friends said she should just send her mother to an old folks' home. A relative said the woman was better off at the Institute of Mental Health.

"They don't understand why her mood changes," Ms Chua says, protectively.

Yet soldier on, this band of caregivers must. A sense of duty propels many, like Ms Adeline Chan, 66, who cared for her father until he died last year at the age of 95. Her mentally alert father appreciated her sacrifice. Worried about troubling her, the self-taught technician - who fixed radios, irons and fans for neighbours even in his 80s - tried to get by on his own and urged her to find a full-time job.

She would check on him every lunch break from the job she held then, working in the office of a gynaecologist.

Once, he did not answer her phone call and she panicked. Rushing home in a cab, she found him sitting at a bus stop. He had lost his key, but did not wish to bother her at work.

Some nights, a sound from her father's room would stir her from sleep. She would see him fiddling with a bag he wore after an operation for colorectal cancer. The bag that collected his stools had leaked. "He wouldn't wake me up," she says. In the quiet of the night, she bathed him. "Sometimes he felt that he was a burden to me but I did tell him, 'Don't take it as a burden. When I was young, you served me. Now it's my turn to serve you'."

One night in April last year, he collapsed. When she visited him in hospital, he did not ask why she wasn't at work.

He was brought home later, and passed away two weeks after that. His daughter would grind food and pound tablets into a liquid that she fed through a tube in his nose.

Recently, Ms Chan cleared her father's belongings from her three-room flat, keeping only three radios he had fixed. It was the first time in 10 years she had taken leave to look after her own affairs. "My leave and time off were always reserved for emergencies. I didn't take leave for pleasure," says Ms Chan, who helps with office work and coordinates programmes for the elderly at the non-profit Caregiving Welfare Association in Ghim Moh.

Such devotion presents a dilemma for those who wish to fulfil other personal goals or remain in their careers.

Secretary Christine Chiang, 43, wants to get married but worries that it is quite an expectation to find a man happy to accept her family situation.

She dreads the day when she will have to take over permanently her father's role of caring for her mom, who has dementia and no control of her bowels. Both are 72.

When younger, Ms Chiang studied Korean in South Korea, and wished to continue to live abroad and explore the world. But she came back in 2010 to be with her parents. The sole breadwinner relieves her father at night and on weekends.

She still meets up with friends and goes on overseas holidays. Once, three hours before she was to leave for the airport, her mother started walking around the house, refusing to heed instructions. Fearing a stroke, they took her to hospital. Ms Chiang carried on with her holiday. Her mother was discharged after four days. An infection had caused the high fever and unusual behaviour.

She says: "If my father is not around, it'll be terrible. I'd have no personal time. I'll put her in a nursing home so that she can get proper care. But I'll have to pay a lot for it."

Others have given up career advancements. Account manager Ana Dhoraisingam turned down a Hong Kong posting to be with her family here. She built her career while caring for her grandma who died in 2001, and now cares for her 88-year-old father who lives with her in a terraced house. Back then, she shuttled a couple of times a day between her office in Shenton Way and her grandma's home in Upper Aljunied, to inject the woman with a cocktail of antibiotics she had been taught to mix. Doing this at home limited her grandma's exposure to highly resistant superbugs at the hospital. She had caught one that infected her lungs.

Life is easier now. When Ms Dhoraisingam travels abroad for work, her dad's doctors - a physician at Novena Medical Centre, a geriatrician at Tan Tock Seng and a cardiologist at Mount Elizabeth - update her after each check-up, which her dad insists on going to on his own. She knows many can't afford the support system she has: "In private care, you've the ability to be more prescriptive with the doctors, to call up and say, 'I need to speak to the specialist.'"

She sees another disparity: a single woman asking for time off to care for an aged parent, while her colleagues have mandated childcare leave. So she is all for mandating eldercare leave: "Filial piety and caring for our elders is expounded by our Government as the responsi-bility we have to embrace, but why then do employment laws not keep up with it?"

Another single caregiver, Ms Kamalini Ramdas, 41, says doing so will relieve the anxiety of employees who wonder what bosses will think of them if they ask for time off, and push employers to make back-up plans. It will avoid a situation like the one when she had to accompany her sick mother who was transferred from one hospital to another. Her superior let her go for a few days, but she believes it strained their relationship as they were rushing a big project due soon.

The social geographer thinks she will live in a retirement home eventually. She makes time now to cultivate friendships, believing friends will rely on one another in the future. This is also why she believes eldercare leave should not be restricted to caring for parents, but should also include relatives, neighbours and friends. As the caregivers' stories indicate, such leave would be just one piece of a whole support system.

As for Ms Chua, tending to her mother, she has not looked so far ahead, but knows what she needs to go a longer distance. After two years of being sleep-deprived, she joined a caregivers' support group and saw the light: She had forgotten to care for herself. It was all right to take a break from care-giving. It was normal to feel fed-up.

She learnt to pacify her mom, who often imagines people have stolen her money. Ms Chua does this by passing her money, pretending it was hers all along. These nights, they banter easily. If they run out of topics, she reads from the newspaper. But only the positive stories, she adds with a grin.

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