SINGAPORE: Nursing home staff are overworked and underpaid, with workers in some cases taking care of up to 30 residents per night, revealed a study by the Lien Foundation and the Khoo Chwee Neo Foundation on Wednesday (Oct 5).
Most of them are foreigners, with untrained fresh hires being paid as little as S$350 a month, excluding food and lodging, the report said, adding that this is less than what most domestic workers are paid. Some nursing homes also do not pay gratuities or night allowances, unlike hospitals.
The study also pointed out that the cost of hiring each worker is much higher than this. Employers have to pay the Government up to S$450 per month per head in foreign worker levies for work permit-holders. The levy falls to S$330 per worker per month for skilled foreign workers like nurses who are on an S-Pass.
So while a new worker may still be paid only S$350, the cost to the employer - including the worker levy and accommodation - can be around S$1,100 or more per worker per month, similar to the lowest-wage local workers.
However, according to the report, low pay is not the only hurdle to attracting capable staff.
Because of the nature of work and odd hours, many Singaporeans continue to shun working in the long-term care sector, said the report citing nursing home operators interviewed.
“The difference in pay has dwindled over the years. But I think it’s also about the type of job,” said Ms Loh Shu Ching, CEO of Ren Ci's nursing homes. “In hospitals, you get to be on the cutting edge of medicine. You get to use technology. You get to encounter complex medical problems. There are more learning opportunities too.
“In a nursing home, on the other hand, staff may view jobs as mundane, menial and routine. Many homes only have enough manpower to just shower, change and feed residents and serve them medicine.”
With the Ministry of Health’s minimum staffing requirements, a nursing home must employ at least 12 workers on shift throughout the day for every 24 Cat 4 residents – those that tend to be bed-bound or severely ill. As most homes have three shifts, on average, four workers per shift look after 24 Cat 4 residents.
But because of heavier daytime workloads, nursing homes tend to deploy more staff during the day, explained the two foundations. Therefore, at one nursing home, there could only be one staff member on duty for every 32 residents.
Madam Low Mui Lang, Executive Director of the Salvation Army’s Peacehaven Nursing Home said the ratio is not enough.
“If I have three workers per shift during the day to look after 24 residents, and one of (the residents) is agitated, unwell and possibly a fall risk, then I need one staff member to keep a constant watch over that one patient, leaving the two others to manage 12 residents each,” she said.
The Ministry of Health has also been providing homes that accept subsidised residents additional funds to hire up to 33 per cent more care staff above the minimum requirements through the Replacement Ratio funding scheme, said the report. While this is useful, some homes say they cannot always make use of the funds, since they cannot find enough local workers to begin with.
The nursing home operators told researchers that the job scope and work hours were also problematic as most Singaporeans wanted normal office hours and weekends off. Some applicants even made unreasonable demands, said the report.
“I’ve had applicants tell me that their husbands said they cannot touch men!” said Dr Lina Ma, deputy executive director of Lions Home for Elders.
According to statistics from the Ministry of Manpower, in 2015, positions for local healthcare assistants were among the top 10 job vacancies for clerical, sales and service jobs, with nearly 60 per cent of positions remaining vacant for six months or more. Unattractive pay, shift work and the job’s physically strenuous nature were listed as key reasons the vacancies were hard to fill.
And despite moves by the Government to improve nurses’ salaries, the number of them graduating from local institutes has fallen in recent years from 1,744 in 2012 to 1,479 in 2015, according to the report. Majority of the current care staff are foreigners.
“Foreign workers may not continue to come here forever, so it’s essential for us to start harnessing local workers,” said Mdm Low.
The report suggested that nursing home staff salaries be increased, the staffing ratios reviewed, and efforts made to attract locals to do the job - especially when by 2030, a quarter of Singapore's population will be made up of seniors who are 65 and older. The number of elderly people living alone is also set to increase from about 40,000 now to more than 92,000 in 15 years' time.
(Chart: Lien Foundation and Khoo Chwee Neo Foundation)
This means there will be more people who will need long-term care out of their homes, but while the number of beds in nursing homes has been increasing, the system needs improving.
"I think what we see in the nursing home sector is tantamount to a market failure, where archaic models continue to dominate the field," said Mr Lee Poh Wah, CEO of Lien Foundation.
The report highlighted that most nursing home residents live in hospital-like settings, but with more than 20 people sharing a room and 15 to a toilet. There is also a lack of focus on seniors' social and emotional needs.
"Most of the nursing homes in Singapore are preoccupied with minimising risk, facilitating staff routine, rather than creating a home-like environment to enhance the well-being of the elderly,” said Mr Lee. “As a result, there is an institutionalised absence of life and joy, a state of homelessness in nursing homes."
Responding to the study, the people running Villa Francis said all it needs is a human touch.
"How do you speak to a sick person? How do you address a person's human spirit? I think that's important,” said Sister Maria Sim, executive director of Villa Francis Home for the Aged. “What are the programmes that will help this person in that relationship we build?"
They also said that cutting down the number of beds per room to give seniors more privacy would raise costs.
"We are coming down from eight to six to maybe four beds. One or two (beds) may come, but will it be affordable? And most importantly, sustainable? I would think it would be double the cost to go down to one or two beds, because you will need more staff," said Mr Thomas Tan, chairman of the board of governors from the Catholic Welfare Services.
(Chart: Lien Foundation and Khoo Chwee Neo Foundation)
Another issue highlighted in the report is the lack of housing options, besides nursing homes. The report recommended having more “assisted living facilities” - popular in countries like Australia and the US - where seniors get to live more independently, in home-like environments.
"The best way to save manpower and to enhance productivity is to get the elderly to do things for themselves,” said Mr Lee. “So instead of being an object where the staff serves you, the elderly are empowered - if you're thirsty, you go to the pantry to serve yourself."