Singapore nursing staff overworks for very little pay: study

Newbies are only paid as little as $350 monthly.

The lack of suitable staff for nursing homes is a big impediment to quality care, says a new report by the Lien Foundation and the Khoo Chwee Neo Foundation.

Citing data obtained in 2011, the latest year for which figures are publicly available, the study said that Singapore had around 12 workers per 1,000 people aged 65 and above who work in the long-term care sector, including in nursing homes, day-care and home care settings. By comparison, an average of 32 staff work in long-term care institutions in developed OECD countries.

As a result, nursing home processes are designed to maximise efficiency. Unfortunately, this can sometimes come at the cost of patient wellbeing, pointed out Dr Angel Lee, a senior consultant in palliative care who has worked with nursing home residents.

“When a patient is on diapers, the staff just need to schedule a fixed time to change it. They don’t need to take them to the toilet every time the patients call. And neither do the staff need to worry that if they miss a call, the patients may wet themselves,” said Dr. Lee.

Nurses and other staff become too task-driven – focused on feeding, serving medicines and so forth – added geriatrician Philip Yap. “You’ve got a lot of things to do and nurses want to finish their tasks so they can move on to the next one. In the process of doing their tasks, the person seems to be left out of the equation.”

So, if a nurse is serving medicines, for example, and a resident wants to go to the toilet, she will ask him to wait as she does not want to be distracted from serving the medicine.

“People prioritise the task over the person – this embodies the culture of care here. Of course, this doesn’t apply to everybody, you will always have people who are more sensitive to the needs of another human being. But in general, our culture does not really promote person-centred care; it promotes a more task-driven approach with undue emphasis on completing the task, which can sometimes be at the expense of the resident,” said Yap.

According to the study, most of the nurses are foreigners, with inexperienced newbies receiving as little as S$350 monthly salary. That excludes food and lodging. Starting pay in larger homes is around $400 to $450 on average.

Employers also have to pay the Government up to $450 per month per head in foreign worker levies for work permit-holders. The levy falls to $330 per worker per month for skilled foreign workers like nurses who are on an S-Pass.

So while a new worker can still be paid only $350 – less than most domestic workers – the cost to the employer with the worker levy and accommodation can be around $1,100 or more per worker per month, similar to the lowest-wage local workers.

The vast majority of these rank-and-file care staff in nursing homes come on two-year contracts from countries such as the Philippines, Myanmar, India, Sri Lanka and China and do mundane but essential chores such as changing diapers, showering and feeding residents and serving medicines prepared by nurses.