Hiring untrained maids to take care of frail, sick elderly may not be safe or sustainable: Experts

SINGAPORE: Ms Ruth Thia’s mother suffers from late-stage Parkinson’s disease and requires constant attention. The degenerative disease makes the 68-year-old prone to falls, her hands tremble, and breathing is a struggle.

Last year, she fell four times while under the not-so watchful eyes of maids charged with taking care of her, and as a result suffered bruises and even needed stitches.  She uses a wheelchair when outside, but walks around the home using a walking stick.

“She forgets to use her stick and I have reminded the maids that my mother should never walk without it,” Ms Thia told CNA. Her mother’s disease, which mainly affects the motor system, will only get worse, and she will have to look for other solutions, Ms Thia added.

Yet, like many Singaporeans, Ms Thia feels she does not have a choice but to employ maids to help for her frail mother, as the arrangement works out to be the most affordable and convenient for her.

If she could afford it, she would rather engage a professional caregiver for her mother, given the amount of attention she needs, Ms Thia said.

However, when she was considering it, her research showed that such help would set her back by at least double the S$1,000 she pays for a foreign domestic worker, including costs like her salary and daily necessities.

The fact that that the professional would not be able to perform any other household chores like cooking and cleaning was also a factor, as she would have to pay for other services like laundry and food delivery to compensate that.

Caregivers have been in the spotlight recently, as the Government works to address some concerns. As part of a Caregiver Support Action Plan, a new Home Caregiving Grant will be introduced by the end of this year, replacing the Foreign Domestic Worker grant. 

The change will allow caregivers to use the grant on other things, like home and community-based services, as opposed to solely on a maid. This is an important move to enhance flexibility as maid-assisted care may not be the right choice for everyone, experts told CNA. 

EXPERTS WARN AGAINST MAIDS TAKING CARE OF FRAIL ELDERLY

In fact, experts have gone as far as to warn about the potential risks of maids taking care of the frail or sick elderly, a trend that they have observed to be becoming more common.

Founder of private care provider Homage, Ms Gillian Tee, said she and her staff have seen the negative consequences of this happening first-hand.

In her firm’s experience, bed sores have been the most common problem arising from maids taking care of immobile elderly people. Bed sores happen when a person is not turned frequently enough. These sores also get infected and lead to hospital stays, Ms Tee said.

Even seemingly simple tasks like transferring a bedridden senior to a wheelchair could prove painful.

“They (the maids) will need to do a manual transfer, and because they don’t know how to transfer the legs, the seniors are filled with bruises. When you don’t know how to do it properly, the seniors’ legs are just getting knocked from place to place. They are not doing it safely,” she said.

While there is no breakdown on how many foreign domestic workers take care of the elderly in Singapore, as at December last year, there were 253,800 domestic workers with permits here.

According to a survey commissioned by the then Ministry of Community, Youth and Sports involving 1,190 pairs of elderly persons and their caregivers in 2012, almost half of the families polled said they hired foreign domestic workers to care for frail elderly relatives. 

That survey also found that nearly half the helpers lacked experience or training to perform eldercare duties.

This figure was quoted by philanthropic organisation Lien Foundation in its report in August last year. The foundation flagged the trend of untrained maids being caregivers to sick elderly. 

Employers often expect these helpers to perform nursing functions such as managing medication, tube feeding, handling insulin injections, carrying out blood tests and the like, the report noted.

This could prove unsafe for the care recipient, family physician from Healthway Medical Dr Vincent Chong said. He pointed out that maids may have difficulty understanding instructions on complex tasks involving medical care. 

READ: Caregivers, professionals welcome additional support for those looking after their loved ones

“They may not be able to pick up early signs or symptoms of clinical deterioration when the elderly are not doing well,” he added. 

He also said that other potential risks include them getting burnt out and not being able to communicate their concerns about the elderly under their care, and therefore being unable to get appropriate help.

A spokesperson for Tsao Foundation, which advocates active ageing, also highlighted some challenges, including administering the prescribed medicine according to dosage and frequency, knowing how to transfer the elderly from a bed to a chair properly, especially in the case of stroke victims which limits mobility in the older person, and knowing what can constitute a fall risk in the home.

"For instance, showering in the toilet when the floor is wet. Without training, the maids will not always know what was considered safe or unsafe,” she said.  

Still, families, some families choose this arrangement primarily due to costs, which are higher if one engages live-in caregivers or professional help, she added.

HIRING MAIDS NOT A SUSTAINABLE PRACTICE

However, Associate Professor of Economics at the Singapore University of Social Sciences Walter Theseira pointed to another potential problem - the sustainability of having maids perform this role.

In the longer run, Singapore has to recognise that this situation of having FDWs in many middle-class households is not sustainable, he said.

“They come from poorer regional countries that are not going to be poorer forever. They’re rapidly developing their economies, and it will become less and less attractive for women from these countries to come here to work,” he said.

He warned that the cost of hiring them will also go up.

“We should not encourage a situation in the long run where we continue to rely on this. Because it may not be available,” he said.

He also said that another consequence of hiring maids as all-in-one solutions is the crippling of the professional sector that provides similar services, like Ms Tee’s firm.

“In other countries, they have the same needs as us, but many of these needs are met by professional services like home nurses and eldercare facilities, and in Singapore we don’t have that kind of services sector because every household’s response is 'I’m going to hire a maid'.” he said.

Associate Professor at the National University of Singapore’s Department of Geography Elaine Ho, who is conducting ongoing academic research project on the care relations between foreign domestic workers and their elderly employers, echoed the same sentiment.

Singapore could gradually become a less attractive working destination, she said.

SOLUTIONS AND WHEN TO GET PROFESSIONAL HELP

Dr Chong advised families to get professional help when maids are new and not confident of looking after the sick and frail elderly, or when there's a significant deterioration in the elderly's health, or when family members have little time or ability to supervise and monitor.

In addition, elderly people with mild to moderate disabilities or multiple medical conditions that require round-the-clock medical care should have trained nursing care. He highlighted dementia and strokes as two such conditions.

Elderly who need frequent blood sugar monitoring, injections, feeding tube changes, wound dressings, vital signs monitoring, as well as management of multiple oral medications, would also benefit from trained nursing care, he said. 

Senior consultant geriatrician at The Geriatric Practice at Mount Elizabeth Novena Hospital Dr Chong Mei Sian suggested getting professional help when the older adult is fairly functionally impaired and requires a lot of physical help beyond a single paid caregiver.

She also said that it is important to ensure that the paid caregiver has enough rest and is able to cope with the physical and emotional demands.

“This is important as caregiving is a tiring physical and mental process,” she said.

Assoc Prof Ho, who was involved in researching and writing the Lien Foundation’s report, was quoted in it saying that eldercare training should be made mandatory for maids who care for seniors, preferably before they are assigned to employers. She added that maids should be seen as complementary carers, not solely responsible for the care of seniors, particularly those who live alone.

Tsao Foundation echoed this view and said it can be mentally exhausting for the untrained maid which could result in the maid losing her temper and risk venting it on the older person.

The spokesperson also said that training ensures that maids are mentally prepared on what to expect in caring for an older person.

“There are soft skills required when communicating to the older person who is unwell and coupled with frailty, the care demands constant attention,” she said.