Should Singapore legislate eldercare leave?

SINGAPORE - Lung disease, high blood pressure, prostate problems, difficulty walking. These are the health problems of just one man, aged 89.

It means he has to go to the hospital many times to see multiple doctors: cardiologist, lung specialist, kidney specialist, a urology and diabetes specialist.

And who takes him? His dutiful daughter-in-law.

And at home, who cares for him? She does, too. She is the main person tending to his needs, preventing him from falling, cooking for him and making sure he takes his medicine.

National University Hospital geriatrician Reshma Merchant, citing the example, says: "It is almost like a full-time job."

This is not an untypical prospect for many children in rapidly greying Singapore, who will end up caring for an elderly parent or family member - all the while juggling this with going out and earning a living too.

It is against this backdrop that Speaker of Parliament Halimah Yacob called for eldercare leave to be made compulsory by law two weeks ago.

But is Singapore ready for such legislation? And will it help caregivers?

Mounting pressures

Singapore hit a demographic turning point last year when the first baby-boomers crossed into old age. The proportion of those older than 65 is expected to grow from 9 per cent in 2010 to 20 per cent by 2030 - the fastest-growing age group.

But who will look after them? As Madam Halimah points out: "(Caregivers) struggle daily to balance their work and their family needs. Some also have other responsibilities such as childcare, and their struggle is worse."

In an NTUC survey of people who provide care to family members, 27 per cent of those polled had multiple dependants.

Longer life expectancy

Longer life expectancy

Yet, today's smaller families have reduced the support network of siblings whom caregivers of elderly parents can call on.

"Families now have less capacity to provide care," says Dr Mary Ann Tsao, chairman of the Tsao Foundation, which provides eldercare services and which advocates ageing well.

Longer life expectancy complicates the problem.

Although improved medical care has allowed older people to live longer, it is "not a disability-free life", says Dr Tsao.

By 2030, many of the 900,000 baby-boomers will have turned 80, putting them at higher risk of falls and chronic diseases such as diabetes, kidney failure and stroke.

Worse, these conditions can predispose them to dementia.

Today, about 28,000 people here above 60 suffer from the brain disorder that robs them of their memory, intellect and personality.

Dr Merchant has seen it take its toll on adult children of patients. "They work full-time during the day, and at night, they care for their loved ones who wander around and shout."

The Organisation for Economic Cooperation and Development, in a 2011 report about long-term care, found that caregivers across its member countries were 20 per cent more likely than non-caregivers to suffer mental illnesses. They often also endure overall health deterioration.

Here, the situation is no different, says Madam Halimah. These caregivers can end up having to quit their jobs. Mandating eldercare leave will provide workers with much-needed flexibility to manage these family demands, she adds.

Will it work?

Employers, understandably, are wary. Singapore National Employers Federation (SNEF) executive director Koh Juan Kiat asks: If such leave is legislated, how many days will be enough?

His union of employers polled 270 firms and found that most of those with eldercare leave capped it at two days a year.

This is unlikely to help those with sickly parents who require constant care and frequent hospital visits, says Mr Koh.

Eldercare leave could also disadvantage the very people it aims to support, by not giving them a fair chance at employment, says Mr Chan Chong Beng, president of the Association of Small and Medium Enterprises (Asme).

"It would affect an employer's decision, for sure. Comparing somebody who doesn't take any of this leave and somebody who takes it 10 times, how would you assess it?" he says.

But the main concern of business owners and employers is that more statutory leave will increase costs.

The Ministry of Manpower is aware of this. Responding to Madam Halimah's call, a spokesman said: "We are mindful of the need to strike a balance between supporting workers in taking care of family members and not to impose too many obligations on employers that ultimately affect workers' employability."

Already, companies have had to contend with newly legislated family leave benefits - adoption, maternity and paternity leave - announced earlier this year as part of the Government's push to encourage people to start families.

It has resulted in lost work days at some firms, says Mr Koh.

There are other complexities too, say legislation opponents.

Unlike childcare leave, which cuts off at age seven, eldercare leave would be needed for an uncertain period, so deciding on limits and criteria would be tough and, at best, arbitrary.

Former Cabinet minister Lim Boon Heng, who headed the Ministerial Committee for Ageing before retiring in 2011, often cited this reason in Parliament to urge patience on the issue of leave.

Then there is the possibility of abuse of the leave benefit, note SNEF's Mr Koh and Asme's Mr Chan. Without a fixed system, like medical certificates for sick leave, employers would be none the wiser if an employee went to a movie instead.

Inaction also costly

But safeguards can be put in place such as requiring a note from doctors, says the director of the Asian Women's Welfare Association (Awwa) Centre for Caregivers, Mr Manmohan Singh.

Also, by not doing enough to help caregivers achieve work-life balance, companies could face stiffer competition for workers.

The NTUC survey found that among caregivers who stopped working, 21 per cent had quit to take on the duty of caring for an elderly family member full-time.

As it is, the proportion of working adults is falling - so losing more of them to become caregivers does not bode well.

Offering eldercare leave, therefore, could turn out to be a good human resource strategy.

Dr Tsao says: "It would make companies more competitive in recruiting and retaining staff, and grow their reputation as forward-thinking, family-friendly (and) socially responsible. A grateful employee (also) will be more loyal, work harder and be more likely to have the company's best interest in mind."

Going by a yearly MOM survey, the trend is catching on, even without legislation: As of last year, one in six companies provided such benefits, up from one in 16 in 2008.

Singapore's largest employer, the civil service, has formalised eldercare leave. Starting last year, employees can use two out of 14 days of unrecorded leave towards eldercare.

Other companies will be pressured to follow suit, says health economist Phua Kai Hong of the Lee Kuan Yew School of Public Policy: "We're basically competing for scarce labour. It's all about the market and competition."

Other ways

His suggestion is first to educate employers, failing which the Government can try engineering the system through providing economic incentives and disincentives.

To that end, MOM introduced the Work-Life Grant in April this year to help defray the costs of implementing flexible work arrangements, said the ministry's spokesman.

In fact, many companies already have unofficial flexible work arrangements which allow employees to take time off to care for ailing family members, contend Asme and SNEF.

Says Mr Chan: "SME employers are sympathetic. They have family members who are old, too."

Holding off on legislation allows companies to work out benefits that suit their staff profile, adds Mr Koh.

For the group of caregivers who are most stretched, he adds, flexibility probably works better.

Others say more should be done to help caregivers, such as building more community hospitals and senior day-care centres.

Nearly 250,000 people here are over 70, but there are only 3,000 places available at 60 eldercare centres islandwide.

Mr Choo Jin Kiat, executive director of O'Joy Care Services which provides counselling and health services to the elderly, says the bigger issue is helping caregivers emotionally and helping them find jobs once they are ready to work again.

Wider message

The Government has long objected to paying allowances for family caregivers. Mr Lim had warned it could "unwittingly monetise family obligations".

Indeed, Mr Choo says passing laws on eldercare leave could end up looking like the Government is legislating filial piety. "Caregivers should look at their annual leave of 21 days and see how they can use that," he says.

Awwa's Mr Singh counters that caregivers also need respite.

"Most of us just accept and carry on, but when it comes to the crunch, some people lose it even with their own mum," he says.

Plus, says Dr Tsao, helping families cope this way will not have the unintended impact of cash support: "Eldercare is simply asking companies to share some of the collective responsibility (of caring for the elderly), that's all."

Proponents say legislation will also take away the stigma caregivers may feel when asking for unofficial time off work.

But more important than the show of support for caregivers, it also helps throw the Government's weight behind, and garners society's support for, the concept of "ageing in place".

Says Madam Halimah, who re-ignited the debate with her call: "I see eldercare leave as part of the holistic effort to support ageing in place, so our frail elderly do not end up in nursing homes, which is not good for them, as well as (straining) resources as more nursing homes will have to be built."

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