Need for more LTC workers

by | July 27, 2018

Lien Foundation’s new study finds that low pay and limited prospects, including among foreign workers, will make it hard to grow the workforce.


Lien Foundation shares its study on LTC workers. From left to right: Low Mui Lang of The Salvation Army Peacehaven Nursing Home, and Lien Foundation’s Radha Basu and Gabriel Lim.

Thirty-five-year-old Joseph Matthew came from India to Singapore in 2010 and worked for eight years as a staff nurse in one of Singapore’s largest nursing homes. Though he enjoyed his work caring for the elderly and already settled in well with the organisation, he wished that his family of two children and his wife could join him. However, he knew the difficulties in obtaining a permanent residency status in Singapore.

He decided to leave Singapore when he found a job as a registered nurse for the aged care sector in New Zealand. Even though his current salary in New Zealand is lower than what he got in Singapore, he is able to apply for permanent residency in a few months and start arrangements to bring his family over. The public health system and education available to New Zealand permanent residents were additional compelling factors for his move to the country early this year.

To keep long-term care (LTC) direct workers in Singapore, much needs to be done. According to a recently conducted Lien Foundation study of care providers and workers including foreign workers, it recommends that the country needs to grow its LTC workforce by at least 45 percent between 2017 and 2020, because of a rapidly ageing population. However, low pay, limited prospects and a constant churn in this sector may make this difficult to achieve.

According to data from the Ministry of Health (MOH) as of March 2017, there are 8,300 LTC workers in direct care roles such as nurses, therapists, doctors, nursing and therapy aides, and healthcare assistants in nursing homes, day centres for seniors and home care services. MOH hopes to attract another 3,700 direct care workers by 2020.

The Lien study estimates that direct care workers form around 75 percent of the LTC workforce, with the remaining percent working in administration, finance, human resources and other ancillary roles. This works out to around 11,000 workers in the sector for the same period.


Gaps in LTC

The Lien study evaluates Singapore’s LTC manpower needs and the pay, perks and prospects of its LTC workers in comparison with four other ageing Asia-Pacific economies – Japan, South Korea, Hong Kong and Australia. The study is based on an in-depth literature review of Government, academic and private-sector documents, interviews with around 35 care providers in the five countries, including 20 in Singapore. A face-to-face survey was also done with around 250 LTC workers and 50 hospital workers in Singapore. The survey also includes foreign workers, which has not been included in past manpower surveys.

The study found that around 70 percent of direct care workers in Singapore’s nursing homes, day-care centres and home care are foreigners. Most are coming from different regions like the Philippines, Myanmar, India, etc. This percentage is the highest in among the countries studied – 32 percent are foreigners in Australia, less than 10 percent in Japan, and five percent or less in Hong Kong and South Korea. However, Hong Kong is looking at opening its LTC sector to more foreign workers, making it another promising option for foreign LTC workers. Locals are still shying away from this sector due to it being viewed as a dirty job.

Despite concerted efforts to raise pay, redesign jobs, and improve skills and productivity, the sector seems afflicted by a constant churn and the “leaky bucket” syndrome. The Lien study found that there are short average tenures with the foreign workers – about 55 percent of workers have been working with their companies for two years or less, with an average tenure of 2.8 years. They might then leave Singapore and find work in Australia and Canada which might have promising prospects. For the local workers, the tenure is 3.4 years.

Foreign LTC workers, according to Lien Foundation, are allowed to stay in Singapore for up to 22 years. This means that if a foreign LTC worker comes to Singapore at age 25, he or she would have to leave at age 47, despite the training and work experience gained.

Pay is also a big issue for both local and foreign LTC workers, and is likely the most important factor in attracting and retaining talent. According to the survey, the median basic monthly pay for a local LTC worker (healthcare assistant) is about S$1,300, or close to 30 percent lower than what an attendant would earn in a hospital or clinic. On the other hand, the median monthly pay of a foreign LTC support worker (healthcare assistant or nursing aide) is S$850. In comparison to the other four countries, interestingly salaries of LTC workers are not differentiated based on whether they are foreign or local staff.

In addition, the median monthly pay of an LTC support worker is the lowest amongst its counterparts. For instance, the pay for a nursing aide in Singapore is S$1,350. In Australia, it is S$3,290; Japan, S$3,000; Hong Kong, S$3,751; and South Korea, S$1,830.

However, there is some good news – in Singapore as compared with the other countries with the exception of South Korea, LTC workers spent at least three times as long or an average of 75 hours in training a year compared to their counterparts. Training subsidies are also available but only for local workers.

Said Gabriel Lim, programme director, Lien Foundation, “It is just as important to look at key issues that cause dissatisfaction such as the lack of competitive compensation and attractive promotion opportunities, and long working hours. It is untenable in the long run to simply rely on the passion and dedication of these workers to their jobs.”



At The Salvation Army Peacehaven Nursing Home, besides increasing compensation to its LTC workers, its executive director Low Mui Lang is also utilising innovative practices to reduce manpower needs such as having a rehabilitation transfer sheet and a ceiling hoist transfer from chair to bed.

They have also been recruiting workers from Indonesia through its Indonesia Project, a partnership which started since 2013, and through its Micro Credit Project which started in 2014 and provides a six-month caregiver course.

Mui Lang also added a need to continue looking at the infrastructure of a nursing home. “Empower those who are wheelchair-bound and ambulant to do tasks on their own, rather than having a maid mentality,” she said, as then they will need more workers.

Lien Foundation also shared a number of recommendations as a result of its study. This includes a suggestion that the foreign worker levy could be channeled to training and wage boost, shared Radha Basu, director, Research and Advocacy, Lien Foundation. Other recommendations include a consideration on visa renewals for foreign workers; rotations between nursing homes, home care and day care centres as a means of further career progression; and a grading system to rank LTC facilities as a way to improve the sector’s quality and reputation.

Yorelle Kalika, founder and CEO, of home care services company, Active Global Specialised Caregivers, said: “I think this report highlights the strategic importance of improving the value proposition of LTC jobs in Singapore for both locals and foreigners. Given the demographic challenge at hand, Singapore’s LTC sector needs to assert its attractiveness in a big way. Competition for talent is fierce both locally (vs other industries), and internationally (many other countries are fighting to recruit the same healthcare talent).”




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