Caring is Complicated

PEOPLE MOVE ON

Professor Elaine Ho is a member of the NUS Department of Geography and the Asia Research Institute. Themes in her research agenda include immigration and citizenship, diaspora engagement and emotional geographies. While much of this research is centred on mainland China, she has also studied migration trends in Singapore, including its intersection with ageing. 
     

The Republic of Singapore will turn 65 in 2030, and every fourth person you encounter then at your kopitiam will be that age, or older. In eight years’ time, the country will thus enter the ranks of ‘super-aged societies’, according to a Duke-NUS study acknowledged by state officials. While that might conjure images of people in retirement homes, Professor Elaine Ho suggests otherwise. “The ‘young old’, like the Merdeka Generation, are very active (physically as well as socially) and have really embraced the government’s call for active ageing,” she says. “One senior in my research project had accumulated more than 20 certificates from using her Skills Future credits!” This, in her view, is a group of people who are clearly ready or preparing to take charge of their own destinies.  

Currently, Prof Ho is engaged in no fewer than five research projects, mostly centred on ageing. Why is a geographer looking so intently at this issue? Prof Ho points out that ‘ageing in place’ — the formal term for living out our golden years in our own homes and neighbourhoods — is fundamentally about place; and ‘place’, of course, is something geographers specialise in. 

Ageing, Migration and Long-Term Care

While studying migration, Prof Ho’s project on the confluence between migration and ageing led her to dive deeper into the topic of ageing in Singapore. “In order to understand how our seniors experience ageing in Singapore as a migration hub, I needed a better grasp of long-term care and ageing policies in the country,” she explains. The project began in 2017, with the Lien Foundation coming onboard to ask for a review of the long-term care policy framework in Singapore. The resulting Care Where You Are report became part of a CNA documentary.

Singapore’s position as a migration hub allows Prof Ho to explore a multitude of subjects, including ageing. The topic of ageing did however, bring up questions about migration and how that ties in with long-term care in Singapore. Her research (Transnational Relations, Ageing and Care Ethics or TRACE) also revealed that seniors in Singapore were ageing alongside seniors from other countries, largely elderly from China acting as caregivers for their grandchildren here. “Many of these grandparenting migrants are on short-term visas, but they attend neighbourhood activities alongside Singaporean seniors,” says Prof Ho. In some cases, they are not short-term visitors, as Prof Ho discovered while observing senior catwalk classes. The instructor was a former model from China who was taking care of her grandchildren, and had lived in Singapore for decades. 

Practical Implications

Stories like this are more than merely colourful because they also illustrate some practical issues. For the grandparenting migrants in TRACE, their efforts can be considered social reproductive work, which allow the parents to continue working and contributing to the economic development of Singapore. Despite this, these grandparenting migrants are unable to access all the benefits Singapore offers to senior citizens, because they are neither citizens nor residents. Prof Ho also notes that these seniors are exposing themselves to some risk, because they space out their healthcare appointments in their countries of origin. When asked, they say this is primarily due to cost issues, and is also the reason that these seniors often bring a large stockpile of medicines with them. 

Of course, cost is also an issue that impacts local seniors, and Prof Ho’s Care Where You Are report illustrates this in stark terms. She keenly points out that long-term care is separate from healthcare, and there are challenges inherent in trying to understand these costs. It is also challenging to understand the subsidies in place to alleviate some of these costs.

Agency for the Elderly

For the elderly who are frail and who live by themselves, Prof Ho advocates getting family members to be more involved when it comes to disseminating the wealth of information on programmes and options available. Workplaces, too, can play a part, principally in leave benefits to care for elderly family members. “Volunteers from Social Service Organisations are strapped for time and cannot do everything, so we have to mobilise all of society to help,” she says.

On the subject of how the elderly view their own prospects, Prof Ho’s work generally shows that they have more agency and more opportunities than ever before. “In a different generation, the elderly might have just sat at home and waited for their children to return or to visit — and that would be the highlight of their day. Today, the elderly do not just age in place, but form networks across their neighbourhoods, and across multiple neighbourhoods, as they travel for classes or to meet their friends.” This actually forms the basis of one of Prof Ho’s current research projects, Ageing and Social Networks: Mapping the Life-worlds of Older Singaporeans.

The subject of community care brings up the issue of caregivers once again, and it is an area that Prof Ho has done significant work in. She highlights a critical pay gap between care providers who deal with acute healthcare and those in the long-term care profession. While acknowledging the point that these are indeed two separate areas, Prof Ho notes that long-term care providers get the short end of the stick. The work is dirty and difficult, and the pay does not stack up. 

Solving a first-world problem

Given that Singapore requires caregivers such as nursing aides, this is clearly a problem. Prof Ho also notes that it is indicative of a future problem, because some children quit their jobs to take care of their parents. They might burn through their own savings to such an extent that they will no longer be able to support themselves in old age. The solution might seem like migrant labour, but it is complicated. “As part of the TRACE project, we also went to Myanmar to interview trainees in the area of caring for the aged. They told us that Singapore is not their first choice as a migration destination; Japan and Hong Kong pay better. Canada allows them to eventually apply for permanent residency. So we’re competing globally, and the best may not choose to come (to Singapore).”

Community care is thus an option, although it is not without its own issues. “Increasingly, there’s this recognition that this is probably the better model, as domestic workers will not be able to provide that level of professional care.” ‘Community care’ is not another term for nursing homes. “What we are referring to is day care, rehabilitation and dementia care. These are daytime facilities rather than nursing homes where seniors stay in,” says Prof Ho. “Families are now more open towards community care.” She adds that this model allows the elderly to benefit from professional care while still being able to live with family. Nevertheless, funding issues remain.

In the report Care Where You Are, Prof Ho concludes that while Singapore has “a world-class acute care system and provides universal healthcare, the long-term care system remains relatively underdeveloped and underfunded.” Now that a few years have passed since the report’s release in 2018, Prof Ho is optimistic about new grants and schemes, and better training options for caregivers. “We advocate an all-of-society approach — and this is where the geographer in me speaks.” She adds that exploring the topic of ageing in the school curriculum, in Social Studies classes for example, could equip children with information that may be relevant to their grandparents.