SINGAPORE - Workers who take care of the elderly in nursing homes, daycare centres and at home are paid significantly less than their peers in other ageing countries, as well as those in other jobs here requiring similar educational qualifications - including receptionists and sales assistants.
This, coupled with the high turnover rate in the sector, could make it difficult for Singapore to meet its target of growing the long-term care workforce by at least 45 per cent between 2017 and 2020, said a report by philanthropic organisation Lien Foundation that was released on Thursday (July 26).
"Despite concerted efforts to raise pay, redesign jobs and improve skills and productivity, the sector seems afflicted by constant churn and the 'leaky bucket' syndrome," the report added, referring to how constant attrition poses obstacles to meeting manpower needs.
By 2030, almost one in three Singaporeans is forecast to need some form of eldercare service. One in four Singaporeans will be aged 65 and above.
Lien Foundation, which commissioned an international management consultancy to conduct research and surveys, sought the views of 20 industry practitioners in Singapore and polled more than 250 workers in the long-term care sector here between January and June.
The study focused on direct care workers, referring to those who take care of the elderly, rather than those in administrative roles.
Less than half of the workers surveyed found their salaries competitive for the work that they do.
It also compared findings from Singapore against research and data in four advanced, fast-ageing economies in Asia-Pacific - Australia, Hong Kong, Japan and South Korea - and interviewed 15 industry practitioners across these markets.
Among the five economies, Singapore ranks at the bottom on wages for long-term care workers - even though it ranks second, after Australia, for wages across all occupations.
A local nursing aide here earns an average of $1,350 a month, compared with $3,750 in Hong Kong and $3,290 in Australia, after tax adjustments.
Median salaries of long-term care workers here, across local and foreign workers, also lagged behind other jobs requiring similar qualifications.
For instance, receptionists here earn $1,000 more per month than nursing aides, who help the elderly with activities such as eating and bathing.
In contrast, Hong Kong's nursing aides are paid at least $1,400 more than office clerks and receptionists on average.
Lower wages could be behind the higher turnover rates in the sector here - which are double the rates in hospitals, the report found, with long-term care workers staying with their companies for an average of 3.4 years.
Higher salaries offered in other countries could be drawing foreign talent away from Singapore, it said. This could increasingly be a problem, since Hong Kong and Japan both have plans to open the long-term care sector up to more foreigners.
Of the five economies studied, Singapore is the most reliant on foreign workers. They make up about 70 per cent of direct care workers here, compared with about 32 per cent in Australia and less than 10 per cent in Japan, Hong Kong and South Korea.
Singapore needs to prioritise attracting more locals into the sector, said Ms Radha Basu, director of research and advocacy at Lien Foundation. At the same time, more can be done to attract and retain skilled foreign workers, she added.
“We need more clarity on retention rates of locals and whether enough of them are joining the sector,” said Ms Basu. “And even as we build up the local core, we cannot afford to continue to treat foreign workers as dispensable. They will simply move to countries where they are equally needed and valued more – and Singapore will be poorer for it.”
As of March 2017, there were an estimated 11,000 workers in the sector, of whom about 8,300 were direct care workers looking after the elderly. The Ministry of Health (MOH) hopes to attract another 3,700 direct care workers to the sector between 2017 and 2020.
One way to raise salaries could be to introduce a Progressive Wage Model (PWM) for the sector, Ms Basu suggested.
A PWM is a wage ladder that specifies wages at various rungs according to skill and experience levels so that workers can get higher pay as they upgrade their skills. The Government has made PWM compulsory for the cleaning, security and landscaping sectors.
Public spending could also go up further, said Ms Basu.
While spending on long-term care went up to $800 million in the financial year 2016 from $600 million the year before, Singapore still has relatively low government spending on long-term care, compared with other benchmarked economies, said Ms Basu.
It spent 0.19 per cent of its gross domestic product in FY2016, compared with 0.9 per cent in South Korea.
These figures indicate that there is room for the Government to further subsidise the long-term care sector, to relieve the load of manpower costs, which make up the largest chunk of operators' expenses, Ms Basu said.
Daycare centres are mostly run by public operators and voluntary welfare organisations, while private operators run 30 per cent of home-based care services and 40 per cent of nursing homes.
"We do not have to go the way of other countries that are spending in an unsustainable manner. But right now, we are at the other end of the spectrum," Ms Basu said.
Ms Yuliana Muhamad Yusoff, 36, used to earn $1,300 a month as a healthcare assistant in a nursing home, where she organised group activities for elderly patients with dementia.
But she quit her job in 2016 after two years, and took up a position as a reservations officer in a hotel instead. This pays her at least $500 more than her previous job.
"Working in a nursing home is not easy. You have to get to know the patients well and put up with their moods. Some even spit in your face if they are angry. Even though I enjoyed the job, it didn't pay enough for me to provide for my family."