A local study conducted by SingHealth Polyclinics (SHP) shows less than 50 per cent of the foreign domestic caregivers who are caring for seniors with chronic diseases, such as diabetes mellitus, hypertension and dyslipidaemia, have the confidence & skills to support the healthcare needs of the elderly. Among the recruited caregivers, 45.5 per cent and 40 per cent of those who were required to perform blood pressure and blood glucose monitoring respectively, lacked the confidence to perform them. In addition, 36 per cent of those who were involved in medication supervision, were apprehensive to do so. 

The pilot study carried out at four SingHealth Polyclinics – Bedok, Bukit Merah, Outram and Tampines, aimed to determine the proportions, level of knowledge, anxiety and confidence of foreign domestic workers (FDWs) supporting chronic disease patients aged 60 years and older. Majority of the caregivers were from Indonesia, the Philippines and Myanmar, with most of them in their 30s. The average age of care-recipients was 81 years old.

FDWs are hired as additional family caregivers in many families in Singapore. Almost half of the families hire FDWs for the purpose of looking after the older family members, aside from managing other household chores.1,2,3 The duties of looking after an older adult can be divided into cleaning, cooking and caring.4 The boundary between care work and domestic tasks is usually blurred, with most FDWs involved in looking after the older adults in the household. However, over half of them do not have geriatric care experience or formal training.5,6 Families hire FDWs despite concerns that the latter lack proper training in caring for frail older adults.7

The selection of FDWs often relies solely on their profiles provided by commercial hiring agencies, including nationality, age and previous working experience. This is followed by brief assessment over short telephonic interviews or conversation over social media platforms. Evaluation of FDWs’ competency in providing geriatric care is lacking in the hiring process.8

Patients with chronic diseases require regular monitoring of disease status, such as blood pressure, capillary glucose for those with diabetes mellitus, medication adherence, diet and physical activity supervision.9 Poorly managed diseases can lead to complications and morbidity. 

“In my 19 years of work in the polyclinic, close to 30 per cent of my patients, are accompanied by at least one foreign domestic caregiver, when visiting the polyclinic,” said Ang Kim Wai, Nurse Clinician, SHP-Tampines. Kim Wai is also the main author of this research paper.

Kim Wai added that although the FDWs in this study appeared to be aware of healthy lifestyle practices, such as cutting down the consumption of salt and oil, using whole grains during meal preparation, as well as benefits of exercising, most of them would require specific training in performing health-related tasks, such as medication supervision, types of exercises, and in particularly monitoring the blood pressure and blood glucose of the elderly.

“The study revealed that almost half of them were unfamiliar with the use of measurement devices, possibly due to the lack of related training. In addition, the more knowledgeable the FDWs were, the more they are confident in accomplishing the healthcare-related tasks, which will ultimately benefit the patient,” said Kim Wai.

“Poorly managed chronic diseases can lead to complications and morbidity. In order to prevent that and to deliver competent eldercare in a rapidly ageing population, such as those in Singapore, the need to implement basic healthcare related training to empower the FDWs with the necessary skills is essential,” said Clinical Associate Professor Tan Ngiap Chuan, Director of Research, SHP and Vice-chair, Research, SingHealth-Duke NUS Family Medicine Academic Clinical Programme (FM ACP).

“The findings gave conclusion on this potentially vulnerable population that require specific training. Although our polyclinic nurses are already training patients and their families in managing their elderly who have chronic diseases, there is a need to tailor workshops catered to the FDWs. With this, the team has ultimately developed a polyclinic-based training workshop, which will empower the FDWs with knowledge and skills to perform geriatric care tasks. The training workshop for the FDW will be piloted around late 2023 to early 2024, and its effectiveness to improve their care of the senior people will be evaluated in a subsequent study,” added Prof. Tan.

1 Ministry of Manpower. Employment rules for migrant domestic workers (MDWs). Singapore: Ministry of Manpower, 2021. https://www.mom.gov.sg/passes-and-permits/work-permit-for-foreigndomestic-worker-worker/employers-guide
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7 Abu Baker J. Hiring untrained MAIDS to take care of frail sick elderly may not be safe or sustainable: experts. channel news Asia, 2019. Available: https;//www.channelnewasia.com/news/Singapore/hiringuntrained-maids-to-take-care-of-frail-sick-elderly-risks-11415562 [Accessed 2 Nov 2020].
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