In the shoes of 'invisible' workers: Caring takes a toll on the heart

It's not the physical but the emotional demands of caring for the elderly that get to you
By Toh Yong Chuan, Manpower Correspondent, The Sunday Times, 7 Dec 2014

It is 8am on a Tuesday when I report for work at the Touch Seniors Activity Centre in Geylang Bahru, dressed in polo shirt, jeans and sneakers.

The 16-year-old centre is at the void deck of Block 61, one of two blocks of one-room rental flats in the ageing Housing Board neighbourhood.

About the size of two five-room HDB flats, it has a common area lined with potted plants and rows of tables and chairs, where eight women and three men, all Chinese, are having breakfast of kaya-on-bread and Milo. In one corner, an Indian man is reading The Straits Times.

Three women are in the kitchen preparing breakfast. Everyone is dressed casually, two of the women in their pyjamas.

I am here as an untrained "programme assistant" to help the centre's six staff members run daily programmes for the elderly.

"I hope you can speak dialect," says centre director Julia Lee, 52, taking me to her tiny office. "Speaking dialect is a job requirement." The centre serves 740 people who are over 60 years old. Four in five are Chinese who speak either Hokkien or Cantonese, and the rest are Malays and Indians.

About half live in the rental blocks. One in five lives alone, and half live with their spouses and children. One in 10 is on public assistance. "Most are not working, either living off their savings or their CPF (Central Provident Fund) and they get financial help from the Government and VWOs," says Julia, referring to voluntary welfare organisations.

She introduces me to the staff - Betty Lee, Richard Chia, Yong Yin Hoong, James Lee and Carol Oh - all in their 50s, except for Carol, who is 32. Julia hands me a dark red polo shirt like the one all the staff are dressed in. "Wear this," she says. "You are one of us."

The dialect test

My first assignment was to man the general inquiries counter. And I realised quickly I was crippled because I speak only English and Mandarin, and just a smattering of Hokkien.

A Hokkien-speaking woman in her 60s came along, asking how to apply for the Community Health Assist Scheme card which will get her higher subsidies when she sees the doctor. I explained, then stumbled over the Hokkien word for "polyclinic".

From about 4m away, a woman having breakfast called out loudly, without even looking our way: "Peh soon chu!"

My client chuckled and said: "Her ears tokong (very good)!" I learnt then that I need not worry, because help was always near.

Almost all the elderly folk at the centre were tucking into the free breakfast. Most were chatty and cheerful, but there were some loners and quiet ones too.

Two men sharing the same copy of The Straits Times began bickering. "You did not put it back properly, every morning like this!" snapped one, stomping away.

Although this is an activity centre, dishing out meals and running exercise and games sessions take up only a fraction of the staff's time. What needs most time and effort are home visits. There are about 50 frail elderly persons living alone in the area, and the staff visit every one at least once in two days, if not daily.

My colleague Betty Lee, 56, took me under her wing as she set off after lunch on her rounds.

The Ministry of Social and Family Development requires such centres to visit frail seniors weekly. "But one week is too long," said Betty. "If something happens, we don't want to find out only from the smell." I knew she meant old people dying alone - since 2007, more than 50 have been found dead alone in their homes.

We headed first to the ninth floor at nearby Block 62. Betty knocked on the door of 77-year-old Madam Chew Pui Siew's flat but there was no answer. She knocked again and again, calling out for Madam Chew. "She was discharged yesterday after being hospitalised for a fall, so I want to see how she is doing," she said.

The next thing I knew, Betty was down on her hands and knees, squinting as she peered into the flat through the tiny gap below the front door. "Previously we could climb and peep through the louvres on top but now they are covered up," she said, miffed at not being able to make out anything indoors, disregarding the film of grey dust her hair had picked up.

"Never mind, we'll come back later," she told me. "We must see how she is doing today."

Over the next two hours, we visited four elderly people, spending about 30 minutes with each.

There was Madam Koh Ai Teng, an 84-year-old widow with failing eyesight who lives alone in an eighth-floor flat. She has four sons and two daughters, but prefers to live alone. She gets about with a walking stick and is usually at the centre every morning.

"She is an independent woman," said Betty. "If we don't see her in the morning, it means something is wrong."

Betty glanced quickly into a wooden food cabinet to see if there was enough food, checking the expiry date of two cans of sardines. "Why didn't you finish your meal?" she asked, pointing to a half-eaten styrofoam pack of rice, chye sim and tofu.

"I am keeping the other half for dinner," replied Madam Koh.

We then walked to the next block to visit Madam Neo Gek Hui. "She can be quite grumpy," Betty warned me as she knocked on the door.

The 87-year-old woman opened the door and let us into a dark, dingy flat with shuttered windows that reeked so terribly of urine and stale cigarette smoke that I almost gagged, but Betty appeared oblivious to the odour.

The widow has a daughter who is working as a professional, but they are not on good terms.

A heavy smoker, the old woman wasted no time in asking if I would help her buy cigarettes. She lost interest in chatting when she gathered we would not be supplying cigarettes. "I'm going to rest now," she said, hinting that we could go.

Outside, Betty said: "She's okay, except for her smoking, but at 87, what to do? Her flat is still neat, but she doesn't open her windows, that's the problem. Most of them are like that, they are afraid of dust."

A pile of soiled clothes

We went next to the 11th floor to see retired taxi driver Seah Keng Oon, a 73-year-old who had just undergone brain surgery. The divorcee has two sons and a daughter but lives on his own on $450 monthly public assistance.

His one-room flat had a wooden sofa, some tables and chairs and a bed so untidy I began straightening out the bedsheet. That was when I noticed the bed bugs, dead and alive, as big as grains of barley. Two landed on my arm.

Betty said softly: "Do not sit on the wooden or rattan chairs because the bugs hide there, and you need to shake yourself afterwards and make sure you don't take the bugs home." My arm seemed to itch right away.

On the eighth floor, we dropped in on Mr Boey Seng Tee, 71, who has early-stage Parkinson's disease. The unmarried retired cleaner lives alone on public assistance. His flat was an awful mess, with clothes piled nearly a metre high on the floor. His bed was untidy, with the pillow and some towels thrown over the crumpled bedsheet which was stained badly and stank of urine. Betty shook her head and said: "We just gave him a new bed and bedsheets last month."

We spent more than 30 minutes sorting out his soiled clothes, separating urine-stained underwear and singlets from clean clothes. He protested when we put a pair of trousers into the pile of dirty clothes, saying: "Still can wear, only wore for one week."

We threw the soiled bedsheet and pillowcase down the rubbish chute, swept the floor and picked up dead bed bugs. Mr Boey nodded off while we worked.

"It is a matter of time before he will have to be admitted to a nursing home," said Betty. "We'll just have to try and keep him here for as long as we can."

We headed back to the centre and washed our hands thoroughly with Dettol soap, but Betty wasn't done yet with our home visits.

We returned to our first stop, to check on Madam Chew Pui Siew. This time, her 55-year-old odd-job labourer son opened the door.

Seated in her wheelchair, Madam Chew told Betty: "I heard you knocking just now, but I was too weak to get up from the bed."

Betty spent 30 minutes talking to the son, explaining that some things needed to change now that his mother would be in a wheelchair for some time. Among other things, they would need a water heater, ramps from the kitchen to the toilet and adult diapers.

Betty told me: "It is very stressful for the son to look after the mother, so we'll try to visit her for 30 minutes every other day and give him a break."

My routine over the rest of the week was the same - manning the counter and helping with group activities at the centre, before visiting homes in the afternoons.

Memorable among the old folk I met was Mr Lee Ah Tong, a 67-year-old retired odd-job labourer who has no family and lives alone in his 11th-floor flat.

I visited him with another colleague, Richard, the only one Mr Lee allows into his home, which is chock-full of countless items he hoards.

"You'll have to buy something from him," whispered Richard as he knocked on the door. "Otherwise he won't let you in."

Inside, we had to make our way along a 30cm-wide path between piles of everything from bicycles to television sets, fans, lights, hi-fi sets, countless plastic bags and boxes, and the hammock Mr Lee sleeps in. I asked if he was a karung guni man and he seemed to take offence. "My things all good quality," he retorted.

I bought two torchlights for $8 and that improved his mood. He even agreed to pose for photos, putting on a shirt and cap. "You will help me to advertise?" he asked.

Richard said as we left: "He is a bit eccentric, but harmless. My only worry is that he smokes in the flat and things might catch fire. And he drinks too."

By Day Four, I realised that most of the elderly at the centre are helpless, lonely and illiterate, and need help even for simple chores. The staff help to fill in forms, read letters, change light bulbs.

That week, I ran a bingo session, conducted a quiz flashing photos of landmarks to test their memory, joined in a dance class and morning exercises, visited and cleaned homes, checked blood pressure, pushed wheelchairs, and delivered food and medicine.

Programme assistant? I was a dialect-speaking jack-of-all-trades, just like everyone else.

Seniors activity centre? It was more a seniors services centre.

The brown box

I did not find the job tiring, but it became emotionally draining.

The frail elderly need a lot of care and attention. But those who are well want to be occupied and to be outside their flats with other people instead of being cooped up at home staring at the walls.

Julia said the staff have to draw the line and learn when not to get too close. "We don't give handphone numbers," she said. "There is an emergency system installed by the HDB which they can call if they need help, even at night."

But this is a job that demands a lot, especially as the seniors grow older, sick, more frail, and die.

One day I spotted a large brown box tucked away in a corner labelled "Last Office". It contained three sets of clothes: a white dress and two long-sleeved shirts.

Three people had left their clothes with the centre for safekeeping until their funerals.

"Their photographs are in our computers," said Julia. "We do this by special request. It is the last service we provide."

Death comes calling about twice a month - more than 90 have died since 2010. One in four is 80 or older.

On my last day, Betty spotted me slumped in a chair after we visited four homes and guessed it might all be getting to me.

"Let's take a break by getting out of the centre," she said. "We'll take Madam Koh to see her son."

She meant Madam Koh Ai Teng, the widow I had met on Day One.

Her 63-year-old son had been living in a nursing home near Moulmein for the past three years because of his diabetes and poor health. Madam Koh had not visited him all this time, but recently began saying she wanted to see him.

Taking seniors on such visits is not the job of the centre, but Betty, who is married with two grown-up children and a mother about Madam Koh's age, said: "I try to do these extra things where I can."

Madam Koh looked fresh and was dressed in a brown blouse and dark pants for her outing. I could smell the pleasant scent of talcum powder as she walked to my car, holding a paper bag tightly. I drove her and Betty to the nursing home,

We found her son lying in bed and as soon as Madam Koh saw him, she took out a packet of Khong Guan biscuits from her bag.

Her greeting to him was in Hokkien: "Are you hungry?"

He said: "Ma! You are here. How did you come?"

The old woman ran her fingers tenderly down his face, arms and legs, all the way to his feet.

"The skin is so rough," she said with a sigh.

His eyes welled up.

Hers too.

I stopped taking photos to leave mother and son alone and they spent over an hour speaking softly.

When it was time for us to leave, the son wheeled himself to the door, stood up unsteadily from his wheelchair, held on to the railings at the corridor and said: "Look Ma, I can stand, don't worry."

Madam Koh was silent on the ride back. But as soon as we reached the void deck of her block, she clasped my hand and Betty's for almost a minute.

"So sorry to have inconvenienced you," she said in Hokkien, and I understood every word. "Thank you for taking me to see my son."

I replied in Hokkien: "No need, no need."

And I looked away quickly, afraid they would see the tears in my eyes.

The names of most of the elderly people in this report have been changed

Sector needs more workers
By Toh Yong Chuan, The Sunday Times, 7 Dec 2014

The eldercare sector currently employs more than 4,000 workers and is expected to need four times more people by 2020, given Singapore's ageing population.

To meet the demand, the Singapore Workforce Development Agency (WDA) has a structured Workforce Skills Qualifications (WSQ) programme to train those without experience in this area.

The entry barrier is low - qualifications include Secondary 2 education and the ability to speak and write basic English.

It takes three months of full-time training for someone to pick up the basic skills to become a day-care or programme assistant, earning between $1,140 and $1,490 a month.

With more training, people can become programme managers, who bring home between $1,700 and $2,500 a month.

The WDA also trains suitable people to become centre directors, who earn $5,000 to $7,500 a month. Suitable candidates can go for graduate diplomas as well.

Various positions are available at senior activity centres, day-care centres for seniors and old folks' homes.

Their task is to look after the day-to-day needs of the elderly at these facilities, which includes providing meals and organising exercise and social activities.

They do not look after the medical or health-care needs of the elderly. Those are left to doctors, nurses and health-care assistants.

Staff at senior activity centres across Singapore also visit elderly people who are too frail to leave their homes, to check on their well-being.

The Government first set up senior activity centres in 1991, and they are run by voluntary welfare organisations. There are about 60 such centres now, and more are in the pipeline.

In addition, the WDA has a five-month conversion programme to draw in mid-career Singaporeans and permanent residents who want to switch to working with the elderly. A monthly training allowance is provided, and trainees are bonded for five months.

Since 2009, the WDA has trained about 100 people, who now work at eldercare centres as managers, supervisors and programme coordinators. It is currently reviewing the programme.

Jobs in the eldercare sector are open to both Singaporeans and foreigners.

Emotionally draining

I did not find the job tiring, but it became emotionally draining. The frail elderly need a lot of care and attention. But those who are well want to be occupied and to be outside their flats with other people instead of being cooped up at home staring at the walls.




ABOUT THE SERIES

This is the last of a three-part series in which manpower correspondent Toh Yong Chuan stepped into the shoes of workers in the labour- intensive services sector. Over the past two Sundays, he reported on his stints as a security guard and taxi driver.

To prepare to be an eldercare worker in the seniors activity centre, he volunteered at an old folks' home over several months.

Yong Chuan was paid $394 for his week at the Touch Seniors Activity Centre. He earned $3,029 from his three stints and donated all of it to The Straits Times School Pocket Money Fund.

Post by The Straits Times.

In the shoes of 'invisible' workers
Even a short stint lays bare the hardships they face in tiring and ill-understood jobs
By Toh Yong Chuan, Manpower Correspondent, The Sunday Times, 14 Dec 2014

I met security guard Edmund Chua in August 2012. The 57-year-old stood out among the many workers I had met as part of my job covering manpower for The Straits Times.

As we talked, he told me about the long hours he puts in - 12 hours a day, six days a week - doing a job that many look down on. And he was describing how tired he was.

Then he stopped, sighed, and said wearily: "Mr Toh, you are a reporter, how would you understand what we go through?"

Days went by. Weeks even. But for some reason, what Mr Chua said stayed with me. He had pricked my conscience, and planted the idea of putting myself in the shoes of low-wage earners and people doing "invisible jobs".

It took two years, but I finally managed to do just that. Over the past three Sundays, I have reported on my stints as a security guard, a cabby and an eldercare worker.

I picked those jobs because they represent three distinct segments of the services sector, which employs about two in three workers here.

Security guards are low-wage workers in an industry that has to battle low morale and cope despite a shortage of about 10,000 people.

Eldercare jobs are unglamorous but workers in this area will become increasingly essential as Singapore's population ages.

Taxi drivers? Practically everyone who has taken a taxi in Singapore has a long list of complaints about cabbies and usually an unflattering opinion of them.

I spent 11 days in July as a cabby, another four days that month as a security guard at a District 9 condominium and a Little India worksite, and five days in August as an eldercare worker at the Touch Seniors Activity Centre in Geylang Bahru.

These experiences gave me a greater insight into the three jobs than I had imagined possible.

Last month, a week before my report on being a cabby appeared, the Land Transport Authority (LTA) announced that it would be raising the number of on-the-road hours for taxis next year.

From next month, every taxi operator here has to ensure that at least 85 per cent of its fleet meets a daily minimum mileage requirement of 250km on weekdays, and is on the road during all peak periods - up from 80 per cent now.

I had spent less than a fortnight as a cabby, but the news made me groan because I knew immediately what it meant for more than a third of Singapore's taxi drivers.

Of the 28,000 taxis on the road here, 10,000 are driven by cabbies who have no relief drivers. These cabbies prefer to work alone, to avoid issues such as relief drivers who do not turn up or who fail to maintain the cars well.

I was among these one-man-show cabbies, and to meet the existing requirements, I had to stay on the road for 10 to 11 hours a day. The new requirement means such cabbies will have to drive for 12 hours or more a day.

I would split my shift, driving in the morning and then again in the evening and at night. I was exhausted by the end of each day, and late one night, I almost had an accident after having been on the road non-stop for six hours.

I wonder if the LTA or taxi firms track whether cabbies who drive solo tend to be in more accidents, or how fatigue affects cabbies.

My four days as a security guard taught me enough to not only appreciate the long hours that these workers clock, six days a week, but also realise how meaningless some of their tasks are.

Why waste scarce resources on manning carpark barriers, endless and aimless patrols, or issuing passes to contractors? Some of these tasks could easily be automated.

A week of working with senior citizens and needy, frail elderly in rental flats brought home to me how tough it will be to look after Singapore's swelling ranks of ageing people.

You cannot automate looking after old people in various states of physical decline. Caring for them means everything from spending time chatting with them to keeping them engaged with games and exercise, as well as checking on their living conditions and fixing things that go wrong.

Today, 4,000 people work with the elderly and, by 2020, Singapore will need another 12,000 such workers. Where will they come from, when the labour market is so tight, and young people and existing workers could well find the vocation unappealing?

Many readers ask what has struck me about how to make life better for cabbies, security guards and eldercare workers.

For taxi drivers, more can be done for their personal welfare, and I'm going to say public toilets are No. 1 on my list.

Petrol stations are where cabbies stop for relief, and some toilets at petrol stations are simply awful. And when you hit a no-petrol-station zone such as Orchard Road or the Central Business District, there are no easily accessible public toilets for cabbies. Something needs to be done.

I also worry for cabbies who have to cover daily rentals that go as high as $134 even for regular cabs, and who have no safety net such as the Central Provident Fund or health insurance.

Taxi company SMRT waived the rental on my cab during my fortnight as a driver, to let me donate all my takings to charity, but if I had needed to pay the rental fee, it would have sucked up six to seven hours' worth of my earnings each day.

The National Taxi Association, which represents more than 13,000 cabbies, must be commended for providing some low-cost health and dental care packages and for giving cabbies social benefits that other union members enjoy, such as shopping rebates at NTUC FairPrice.

I hope taxi companies can do more to find ways to give cabbies some of the benefits that employed staff often take for granted.

For example, SMRT gives some of its drivers up to 12 rent-free days a year. This allows them to rest without having to worry about covering the rental. Other taxi firms also give rent-free days, but it is not known to what extent.

For security guards, the top priority must surely be to break the dreadful work cycle of 12 hours a day, six days a week.

Labour laws say workers cannot put in more than six hours without a break, but allow exceptions for workers such as security guards, who can do up to eight hours at a stretch.

It is no surprise that even though there are 70,000 people qualified to work as guards, only 33,000 actually do so.

There is a shortfall of 10,000 guards. Cutting the long hours might be the first step to drawing trained guards back to work.

For eldercare workers, emotional support is crucial because it is draining to work so closely with the elderly and the sick every day.

To cope, the staff at the centre where I worked have formed their own peer support network, and they also make the effort to have breakfast together as a team.

Eldercare workers cannot be left to feel isolated. Voluntary welfare organisations that run eldercare facilities need to form support networks for their staff, especially when some senior activity centres have as few as two workers.

Looking back at my three stints and seeing the response from many readers who wrote to me or posted their comments on The Straits Times' Facebook page, I realise that cabbies, guards and eldercare workers are not the only "invisible workers" among us.

Numerous readers told me there are many more jobs that are not well understood. They suggested examining the working lives of the coffee shop boy, gardener, childcare teacher, garbage truck driver, parking enforcement officer, car repossession man, car valet, town council customer service officer and hawker, among others.

What they were saying, really, is that there are many workers who serve the public in often difficult conditions and who deserve acknowledgment, appreciation and improved working conditions or benefits.

Some readers felt it would be good if politicians, policymakers and those who make the rules that affect our invisible workers also tried out such jobs for a short time.

When my cabby story was published online, reader Tan Kah Kiat responded on the newspaper's Facebook page and asked: "Why never jio Tuck Yew drive taxi also?" He meant, why hadn't I invited Transport Minister Lui Tuck Yew to drive a cab as well.

It is not hard to understand the sentiment behind such comments.

Edmund Chua the security guard was right when he set me on this journey of discovery: It's hard to understand the invisible workers in our midst until we walk in their shoes.

Great job stepping into others' shoes

Mr Toh Yong Chuan did a great job putting himself in the shoes of a security guard, taxi driver and eldercare worker.

He showed that the welfare of security staff can be better managed.

Many are not paid when they go on medical leave. I know of someone who underwent a heart bypass and had to recuperate for three months without pay - just when he needed money the most.

I wonder how such companies get away with it.

Mr Toh also highlighted the daily challenges that taxi drivers face.

It is not easy to focus on the road when one has to sit in a vehicle for hours, and this must take a toll on one's health.

Lastly, taking care of the elderly will be a challenge for members of Generation Y, many of whom have limited proficiency in dialects.

Despite this, a strong conviction to help is key in the provision of quality care.

Yeow Chun Fey
ST Forum, 14 Dec 2014

Lessons from series on 'unglamorous' work

Mr Toh Yong Chuan won my admiration not just because he immersed himself in the jobs of a security guard, cabby and eldercare worker, but also because of his empathy towards those in these shunned professions.

The final instalment of his series, where he worked as an eldercare worker, moved me to tears.

My heart goes out to the elderly folk who are abandoned, lonely and frail, as well as their caregivers.

I hope Mr Toh's articles will deepen understanding of those who are earning their living doing "unglamorous" jobs, and who often face more criticism than appreciation from the public.

Mr Toh's stint as a security guard taught us the importance of being humble.

His work as a cabby revealed how demanding and ungracious society has become.

Finally, his job at an eldercare centre makes us wonder how family members can abandon their loved ones.

These episodes have a bearing on what kind of society we wish to have.

Francis Cheng.
ST Forum, 14 Dec 2014

All can play a part to help

Mr Toh Yong Chuan gave an accurate description of the living conditions of some seniors, and the job scope of a typical eldercare worker in a seniors activity centre ("Caring takes a toll on the heart"; last Sunday).

Many seniors are living on their Central Provident Fund savings, if any, or financial aid from the Government or charities. Such limited assistance provides them with only very basic meals.

Their home may be a small rented flat filled with broken furniture and smelly clothes, and is often infested with bed bugs.

Charity organisations and volunteers can explore more ways to assist these seniors. Companies can also consider making regular donations to assist these centres in their daily operations.

Society has to recognise the role of eldercare workers. Their work requires enormous patience and love. The emotional toll they bear cannot be overlooked.

If the situation permits, retirees can volunteer their time and effort to assist these workers regularly.

With efforts from all, we can help these seniors. After all, they are Singapore's pioneers.

Lim Lih Mei (Ms)
ST Forum, 14 Dec 2014

Draw the right people to sector

I thank manpower correspondent Toh Yong Chuan for opening our eyes to the sacrifices and everyday accomplishments of those in the eldercare sector.

Workers in this sector have a huge responsibility that goes beyond social work. They have to ensure that our seniors age gracefully, while meeting their very specific demands. The emotional toll can be enormous.

It is good to know that the Government has stepped up efforts to attract more people to this field, but we can do more in terms of remuneration. When one pays adequately, one will get good people.

Given Singapore's ageing population and the growing demand for eldercare, it is important to attract not just the numbers but also people with the right mindset and motivations. This helps to reduce staff attrition, which is prevalent in the social service sector.

After reading the article, I asked myself: What can I do to help?

As a community, we all have a very important role to play in caring for those around us, and not just our loved ones. We need more hands and hearts to come together to share some of the responsibilities, which in turn will free up staff to focus on more quality activities.

S. Shaikh Ismail
ST Forum, 14 Dec 2014

Caregiving can be fulfilling experience

Mr Toh Yong Chuan's article last Sunday gave us an insightful peek into how professional caregivers take on the noble task of caring for elderly folk, many of whom are struggling with sickness and isolation.

The task is physically and emotionally draining. Moreover, many of the elderly and the sick tend to be bad-tempered and stubborn, and are not easy to get along with.

Yet, with the unflagging support of caregivers, these folk can enjoy a better quality of life, for nothing beats the human touch.

Providing love, understanding and care for our seniors can be a fulfilling experience. Our parents gave us life, and it is only proper that we provide them with a better quality of life in their twilight years.

It saddens me to read of elderly folk who are left to fend for themselves when they become sick.

While nursing homes and eldercare services can lighten the load of caregivers, we must never forget to give our seniors the emotional support that can lift the human spirit and allow them to enjoy more good years.

Raymond Anthony Fernando
ST Forum, 14 Dec 2014

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