Nursing homes need locals to step up

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The elder care profession is currently facing a severe imbalance in the number of local staff versus foreign workers.

Lynn Chow is the CEO of CSM Academy International, a private education provider of healthcare training programmes in Singapore. She estimates that the ratio of foreign to local caregivers in nursing homes is 9 to 1 at the moment, and is keen to see more local students trained, especially given the current manpower shortage nursing homes face.

“We always get email from nursing homes – when is your next batch of students coming out?

“They are ready to snap them up. But unfortunately a lot of Singaporeans are too affluent to take up this job.”

This imbalance is something that nursing homes are keen to see redressed, according to Chow. A representative of Orange Valley Nursing Home also acknowledged in a quick chat, “We prefer locals; these foreigners do not stay long.”

Yet at the end of the day it is the foreign nationals who are the most keen to take up training courses and seek employment in the eldercare sector. May Than Htaik, a lecturer with CSM Academy International, explained that, “For them to take up [aged care profession], it is a stepping stone to work in a developed country”.

Work shortages at home are also a potential push factor for foreign caregivers. Dr Kalyani Mehta, head of SIM University’s Gerontology Programme, points out that challenges to professional caregiving are universal, but “perhaps in underdeveloped countries it may be less challenging as jobs are harder to secure.”

What measures can be taken in order to right the balance and incentivise more locals to enter the eldercare sector?

Lynn Chow thinks that the industry faces an image problem.

“Glamorise the image of the caregiver more – the perception is that as caregiver you are doing a dirty job and you clean bums.”

“MOH (Ministry of Health) should have a campaign… the perception needs to be fixed.”

According to Chow, maintaining a nursing home incurs high costs, and the nature of the role means that it is hard to increase productivity.

Staff-to-resident ratios are fixed according to four different categories, and can range from a ratio of 1 staff member to 30 residents for Category 1 patients (who require less attention) to a ratio of 1 staff member for every two residents for Category 4 patients who often suffer from mental disorders and require total assistance and supervision.

The Ministry of Health’s new set of Enhanced Nursing Home Standards (ENHS), due to take effect in 2015, highlights the need to boost psychological competence among caregivers.

“All trained staff should be able to recognise signs and symptoms of psychosocial/mental health conditions, and changes in such conditions.”

Chow adds, “When you are in the nursing home you cannot be productive using technology. It is labour intensive.

“We are not at the stage where we have robots that can do that.”

From Chow’s response, it is clear there is no substitute for meticulous, highly trained person-to-person care in nursing homes.

The solution is not as straightforward as simply driving up foreign caregiver numbers. Chow points out that because foreigners are not eligible for funding, training courses are expensive.

“We don’t have any Myanmar students yet because they are from the lower income group and they cannot afford this course.”

Another problem with over-reliance on foreign caregivers is that of the language barrier.

“A lot of older folk use dialects, not everyone knows English or Mandarin.

“The Chinese from China won’t be able to communicate with them – a communication problem is the main issue.”

Not only is language adjustment a major issue; there is a further problem of cultural adjustment too, as Chow stresses.

“[For example] cleanliness – to us, we are very particular. When MOH comes to check even though it is very clean they would still go ‘tsk tsk.’ But maybe to a foreign caregiver a thin layer of dust – what’s wrong?”

“There are a lot of small things that we do differently.”