SINGAPORE: Sheila Ofalia came to Singapore from the Philippines to work five years ago, but unlike many of her countrywomen, Ms Ofalia is not a domestic worker. She is a live-in caregiver.
For the past three years, the 30-year-old has been taking care of a 93-year-old woman she fondly calls “mama”. Ms Ofalia’s main job is to take care of the elderly woman, who she alone shares a home with.
It is what she was trained to do, having graduated from a nursing aide course in her home country. She then worked as a live-in caregiver in the Philippines for more than a year to gain experience before applying to come to Singapore.
However, as she did not know that live-in caregiver jobs were available, she applied to be a domestic worker and worked as one for two years before changing jobs, after seeing an advertisement on Facebook.
Ms Ofalia is one of 1,600 live-in caregivers currently employed in Singapore, said Mr Teo Koon Cho, chief executive of Active Global Specialised Caregivers, an agencywhich provides this service. This number is more than double the 700 caregivers employed in 2018.
“We have seen a steady increase in demand for specialised care for the elderly,” said Mr Teo.
On the reasons for the increase in demand, Mr Teo said: “We have been educating the public and building awareness about the importance of professional care for elderly.”
He added that a Manpower Ministry scheme - the Advance Placement Scheme - allows his agency to bring in caregivers before they have found employers, which makes it possible to provide help to clients quickly. This makes hiring a live-in caregiver a more attractive option, he said.
Live-in caregivers are brought into Singapore under work permit passes like foreign domestic workers.
HIRING A LIVE-IN CAREGIVER
Ms Jade Tang, 62, hired Ms Ofalia for her mother after the 93-year-old had a minor stroke. The elderly woman cannot walk.
“Mum has multiple issues - she has colon cancer, she had a minor stroke three or so years back, kidney stones, urinary tract infection (UTI), you name it, but she is stable, just that once or twice a year she ends up in hospital for the UTI,” Ms Tang told CNA.
“Because of all these conditions, you need someone who has at least some nursing background who can look at the symptoms, or the warning signs. A domestic worker is not trained for that.”
While Ms Tang’s mother can sit up, she needs someone with the ability to help her move to places like the bathroom.
“A domestic worker can normally manage these daily tasks like bathing and feeding, but why I would prefer a caregiver like her is the nursing and medical aspect, because she looks out for symptoms. She’s careful my mum doesn’t get bed sores, and also the warning signs for UTI, she can tell,” Ms Tang said.
Ms Ofalia also cooks and does a bit of cleaning as part of her job scope.
DIFFERENCE BETWEEN LIVE-IN CAREGIVERS AND DOMESTIC WORKERS
Mr Teo said that it is important to hire a trained person to take care of the elderly if they have specific conditions that need attention, and have particular needs.
This includes assistance with activities of daily living, specialised care for specific conditions and exercise routines, he said.
“While there are certain ‘lighter’ caregiving tasks that may be carried out by foreign domestic workers under careful supervision, when it comes to caring for someone with a medical condition, it is imperative that the caregiver has proper training, as they will know the right course of action in times of emergencies,” he said.
He added that maids often find themselves juggling multiple tasks.
“To expect them to shoulder the responsibility of caring for a person with a medical condition properly can be quite a liability because they are not able to provide focused care and attention required,” he said.
Live-in caregivers are "qualified, professional caregivers who focus on providing quality patient care", he said.
He gave a few reasons why elderly people with medical conditions should be taken care of by live-in caregivers instead of maids. Among them are the need for constant monitoring, for example, for dementia patients with wandering tendencies and knowing what to do when symptoms like depression and aggressiveness might be observed.
He added that stimulating and pushing patients to comply with exercise routines, and encouraging them to become more independent is “always a challenge for a helper or a family member”, he said.
“Unlike a domestic helper, caregivers have the training and authority to know how to ‘push’ the patients the extra mile, which helps them recover faster. This is a fine balance between caring and stimulating, that only someone with many years of nurses training will know how to do,” he said.
Active Global recruits and trains foreign nurses and nursing aides from Myanmar, Sri Lanka, India, Philippines and Indonesia to take up roles as live-in caregivers here, he said.
Caregivers under the agency are people who have obtained their degrees, diplomas and certificates in nursing or caregiving in their home countries and have been selected after undergoing “rigourous interview processes” by our nurse recruiters, Mr Teo said.
“Only caregivers with the right nursing skills, attitude and passion for the job have been hired,” he said.
Live-in caregivers have a contract directly with their employers for two years, and command between S$600 and S$1,200 monthly based on how skilled they are.
Other agencies that provide round-the-clock caregiving services through 12-hour shifts like Homage and Caregiver Asia have also seen an increase in demand.
These agencies hire freelance Singaporeans and permanent residents for caregiving and other services such as care companionship and therapy. Clients can select the type of services they need, and the duration they need them for.
Caregiver Asia said that about 20 to 25 per cent of nursing requests are for round-the-clock services currently, up from 10 to 15 per centthree years ago.
Among the reasons for the increase in demand are increased awareness about caregiver burnout and options available, an ageing population with family caregivers getting older and unable to keep up with caring for an elderly parent, and difficulty in hiring new foreign domestic workers due to the pandemic, a spokesperson said.
Chief executive of Homage Gillian Tee said that from 2018 to present, “we have observed a 10 times growth in demand for homecare in general”.
“On average, two of 10 care recipients engage Homage’s care services round the clock,” she said.
In tandem with the ageing population, she said that there is a rise in chronic conditions.
“With more seniors in the community, there is a greater demand for care support due to the higher incidence rates of chronic disease among older adults,” she said, citing statistics that show that the number of older adults in Singapore with three or more chronic diseases has doubled from 2009 to 2017.
“This results in a sharp growth of seniors requiring long-term care assistance with their daily living activities and beyond that holistic services that meet both non-medical and medical needs,” she said.
She added that more home support is needed amid the pandemic as the more vulnerable communities are encouraged to stay at home and care recipients are homebound for long periods of time.
At Homage, round-the-clock care services cost from S$19 hourly, depending on the complexity of the type of care needed, while at Caregiver Asia, a 24-hour service typically costs at least S$576.
Ms Jenny Tiew, head of Caregivers Support at non-profit organisation Fei Yue Community Services, said that dedicated caregivers can give more attention to the needs of the elderly instead of having to juggle them with other duties.
"Depending on the health condition of the elderly, some will require more and longer care and attention from the caregivers to support recovery as well as manage chronic, advanced conditions," she said. Services they may require include nursing care, medication management and cognitive stimulation activities, she said.
She added that communication with foreign domestic helpers can be challenging for families and care recipients.
"The language barrier in communication could be minimised when families can engage a suitable professional caregiver who can converse in the similar language as the care recipient," she said.
Ms Tang said hiring Ms Ofalia costs a "few hundred (dollars) more" than hiring a domestic worker, but that the expense is worth it.
“She’s smart and she is responsible, and that is important because it gives me peace of mind, because I don’t live with my mum,” she said.
Editor's note: This article has been updated to reflect the fact that Active Global is not the only agency providing live-in caregivers recruited from overseas. We apologise for the error.