February 2nd, 2015

Who cares for the caregivers? Recommendations for the national Budget

budget 2015On 29 January, AWARE submitted its fifth annual set of recommendations for the national Budget through the public consultation portal REACH. This year, AWARE urges the Government to develop a caregiving infrastructure that provides adequate care of the elderly, children and disabled people, rather than expect women to provide care by leaving the workforce. Initiatives to encourage women to return to the workforce are largely in the form of skills training or upgrading. These do not address the key question of whether there are alternatives that adequately replace the care provided by women as unpaid family caregivers.

“We cannot leave caregiving as a problem for individual families to solve by making personal sacrifices,” said Dr. Vivienne Wee, Research & Advocacy Director of AWARE. “Care should be a public good available to all in need. This will enable women caregivers who have left paid employment to return to the workforce, assured that family members are well cared for by professional caregivers without the family becoming financially stressed. Women who leave paid employment become dependents themselves, with insufficient funds for their health care or old age.”

According to the Ministry of Manpower’s Labour Force in Singapore 2013, almost half of the 690,000 women who are outside the labour force stated that they had dropped out of the formal workforce because of family responsibilities, including caregiving. The financial vulnerability of these unpaid caregivers is a serious concern.

Care of the elderly

Our current dependency ratio of 6.3 working-age citizens supporting each citizen aged 65 and above will shrink to 2.1 by 2030. To prepare for this situation, our key recommendations are:

  • Review Eldershield. The current programme is too limited in terms of the payout (typically less than half of monthly hospital bills) and period of coverage (72 months, which does not allow for long-term care). In 2013, the Ministry of Health announced an intention to review Eldershield, but this has not yet taken place.
  • Increase subsidies to meet the full cost of care. At the moment, co-payment is always required, which renders care too expensive for many to access.
  • Provide “person-centric” funding independent of the identity of the care provider. A caregivers’ allowance should be provided, including to a caregiver based in the home of the person being cared for. This can come in tandem with quality and training standards.
  • Legislate eldercare leave. Public bodies, such as the Health Promotion Board, have provided employees with eldercare leave since 2014. Legislation is needed to ensure that every employee have eldercare leave to care for family members.
  • Provide a basic pension. CPF is relevant only for those who are employed. Women who have left paid employment due to caregiving responsibilities will have insufficient savings. The spouse who is the sole source of financial support for a family is unlikely to have enough retirement savings for the couple. This is particularly so since only 48.7% of active CPF members are able to meet the minimum sum, and that includes people whose property has been pledged to meet this sum.

Care of children

  • Childcare should be publicly funded and available to all children equally. Caregiving must be supported to enable mothers who drop out of paid employment to re-enter the workforce.
  • Give every child an equal chance. Unmarried mothers and married mothers who are not in paid employment should have access to child and infant care subsidies. Without these subsidies, their children are disadvantaged from the earliest possible age.
  • Abolish subsidies given as tax relief. As only one-third of wage earners pay income tax, the majority of parents are excluded from subsidies given in the form of income tax relief.
  • Invest in childcare and early childhood education, not subsidies for births.
  • Fully support childcare as a shared responsibility between parents. Paternity leave and childcare subsidies for caregiving fathers should be increased.

Care of disabled people

There are very limited subsidies for disabled people. The Interim Disability Assistance Programme for the Elderly (IDAPE), for instance, is not available to those below 65, and is limited only to a maximum of $250 a month for 72 months. This does not meet the needs of disabled people.

Means testing

Means testing should be applied only to individual applicants for public assistance, not the entire household where the applicant lives. The Legal Aid Bureau of the Ministry of Law is already using a fairer method of means testing only individual applicants, taking into consideration some disposable income and disposable capital. In contrast, vulnerable people in need of assistance are means tested by MSF and MOH in terms of gross household income, prior to deductions and fixed expenses of household members – a method which leads to having higher incomes stated that often exceeds the threshold for financial assistance schemes. This method excludes many who need assistance.

Exclusion is further exacerbated by the assumption that simply by residing in a household where per capita household income is above $2600 or where the Annual Value of the residence exceeds $13,000, a vulnerable person would be adequately cared for, with no investigation of whether other members of household are contributing to the care of the individual applicant or whether the Annual Value of the residence is used to provide financial support for caregiving.

Read the full text of AWARE’s Budget 2015 Recommendations here. AWARE has made recommendations to Singapore’s National Budgets since 2011, advocating for equitable allocation of resources to meet the needs of vulnerable groups. Our recommendations for Budget 2014 are here

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