By: Lynn Yuling Ng and Dr. Feng Xu
Measures taken during the pandemic and the implications for care workers
The most extensive measures the Singapore government has taken to date in response to COVID-19 include a series of “circuit-breaker” measures to enforce social distancing guidelines.[i] This comprehensive list of dos and don’ts provides specific instructions for essential and non-essential services and the community at large, most of whom were put on work-from-home arrangements. During this time, healthcare workers in residential care homes for the elderly, including nursing homes run by charitable organizations, were to remain on site or be rehoused into hotel rooms until the circuit breakers were loosened. Approximately 9000 nurses employed across 80 nursing homes were tested systematically and given isolation facilities or follow-up treatment when necessary.[ii]
In contrast to private nursing homes at Alexandra Hospital and Mount Alvernia Hospital for instance, both of which specialize in high-end geriatrics, community-run nursing homes belong disproportionately to the domain of Voluntary Welfare Organizations (VWOs) which mostly specialize in assistance with activities of daily living.[iii] Generally they do not have the capacity to deal with grave illnesses and emergency scenarios which require arrangements to transport elderly residents to hospitals. Live-in caregivers, on the other hand, are subject to escalated risks of social isolation and mental health issues, in addition to increased exposure to domestic abuse.
An already-existing form of employer tyranny, the physical confinement associated with live-in work has intensified during Covid-19. Despite hard-won legislation for weekly rest days, recurrent studies find that the state has yet to crack down on employer violations, which are prevalent and normalized. Coupled with the abolishment of rest days, FDWs were to follow the same social distancing rules as the general population or risked having their work permits revoked. Yet again, both the Ministry of Foreign Manpower and pubic media outlets called on employers to discipline and monitor their charges, even as prolonged conditions of quarantine and isolation increases the likelihood of exploitation. The Ministry of Manpower (MOM) has instructed employers to come to mutual agreements with the domestic worker and pay additional remuneration, should they forgo the rest day. Otherwise, they should not be assigned any work at home. Yet the state remains wholly dependent on the goodwill of employers to fulfill this regulation.
Unsurprisingly, the Foreign Domestic Worker Association for Social Support and Training (FAST) has reported escalating tensions between employers and MDWs, as they are receiving double the normal number of runaway cases.[iv] Employers wield disproportionate power in these employment relationships, with the unilateral right to cancel work permits without justification; in such cases, repatriation occurs, should a new employer not be found within fourteen days. Recently, amidst the escalating panic around a foreseeable shortage of maids, new laws have been made to make the termination and transfer of FDWs between households easier. This only heightens FDW vulnerability since no overarching protective body ensures due compensation, should employers default on their obligations.
As the Humanitarian Organization of Migrant Economics (HOME) says, many do not dare to voice concerns, out of fear of repatriation;[v] it is also impossible to draw a line between little favors and additional labor, which warrants compensation. The hygiene of employers no doubt benefits MDWs, but the asymmetrical power relationship in the work permit regime continues to prevail, because it operates in private homes.
The response taken by local officials in China recalls some aspects of their response during the earlier SARS outbreak. After initial official concealment or lack of transparency around Covid-19 data, effective and rapid national measures kicked in. Mass mobilization was utilized; community/shequ networks with volunteer support formed the backbone of the anti-pandemic taskforce nationwide. [vi] During the initial phase, some cases and fatalities arose in seniors’ homes, but the numbers dropped noticeably after Party General Secretary Xi Jinping ordered a top-down “war against Covid-19”.[vii] With the support of the subnational civil affairs bureaus, which are charged with eldercare policy, the Ministry of Civil Affairs issued various guidelines and orders to stop the spread of virus in seniors’ homes. [viii] Seniors’ homes were put under total lockdown: no one was allowed in and out. All community/shequ-run eldercare services provided at seniors’ homes, such as cleaning and meal planning, were halted; this included adult daycare and meals-on-wheels. Live-in eldercare givers at individual seniors’ homes had to remain indoors with their clients during the lockdowns.
Because the pandemic circumstances unfolded over the Chinese New Year period, some workers went home for the holiday. When lockdowns were enforced, those who went home were unable to return to work for months, while those who remained had to work overtime, due to labor shortages and an increased workload. Furthermore, seniors who had traveled home to celebrate with their families could not return to seniors’ homes either, adding care burdens to their children. According to the Ministry of Civil Affairs guidelines, returning workers had to go through a 14-day isolation period in a hotel. Lockdowns had adverse impacts on the earnings and overall mental state of eldercare workers. Eldercare workers are not considered healthcare workers in the government’s eyes, in contrast to frontline healthcare workers (doctors, nurses, lab technicians and so on). The Central Government sent the latter to outbreak epicenters; they were entitled to paid subsidies, workplace injury compensation and a one-time merit-based pay increase. [ix] Eldercare workers enjoyed no paid holidays when returning home and during their isolation period, nor were they given workplace injury compensation, though they were paid for overtime work.[x] Reports circulated widely that private seniors’ homes saw revenues fall at least 20% due to the pandemic: the reasons included the increased cost of regular disinfection, mask and glove purchases, and the income lost to zero client-turnover policies and non-returning clients during the lockdowns. However, these reports did not mention eldercare workers’ welfare, except to recommend psychological counselling for those who remained at work.[xi]
Some more shocking reports have generally been treated as outlier cases with few implications for policy. For instance, a recent scandal in a privately owned but publicly funded facility concerned one senior whose body was covered with maggots due to neglect. The publicity of this case led to the local bureau of civil affairs taking over the running of the facility, firing the worker in charge of the senior, and starting a criminal investigation.[xii] However, no national debate has arisen about the desirability of an ongoing profit-making model of eldercare.
This silence around the profit-making philosophy of eldercare, and social welfare more broadly, is all the more pertinent in Singapore, whose state has negligible public investments in eldercare facilities. What state investment exists is overwhelmingly in the form of acute care and bed space in public and private hospitals,[xiii] both of which have been intensively medicalized. The more rudimentary yet critical tasks of assistance with daily activities of living for the frail elderly has not been normalized. The latter domain of eldercare is in highest demand, yet operates as a shadow industry. The Chinese state’s 9:7:3 model likewise indicates that public investment is of a minor scale, yet this clearly overshadows the Singapore state whose intervention in the everyday upkeep of the elderly is virtually non-existent. While live-in FDWs-cum-caregivers are the most vulnerable workers in this sector, eldercare caregivers who are non-live-in benefit from public social distancing rules. While eldercare workers in homes and public care homes in China are not considered eldercare workers, in Singapore it is only live-in FDWs who are not considered public sector employees. The status of nursing homes as VWOs notwithstanding, eldercare workers working in non-domestic settings are covered under national labor laws. These signs suggest that in China, the exclusion of eldercare workers is about occupational type more than public or private settings, while in Singapore it is the live-in condition of employment that is of primary significance.
Ultimately six Singaporean nursing homes have seen Covid-19 cases, which at the time of writing have all been controlled. In late March, when the first confirmed case emerged in Singapore, transfer protocols were set up to allow nursing homes to refer all residents with fever and respiratory symptoms to acute care hospitals for isolation and testing.[xiv] There was no total lockdown of care facilities as essential healthcare workers, many of whom are foreign workers on work permits, were still required to report in and out of work and to take leave if unwell.
Conclusion
The Singapore state retains a neoliberal spirit of eldercare responsibilities which stresses the prominent role of individual, family and community help with state institutions as the last resort. The Chinese state is increasingly letting private companies and buyer-driven demands to take the rein in allocating eldercare services, which risks worsening situations of an inverse care law where services are given based on paying power rather than needs. Still, the Singapore state exhibits a much heavier devolvement of eldercare obligations compared to the Chinese state whose local-level governments have significant intermediary roles. Nonetheless, in conventional accounts of labor, eldercare work is doubly devalued firstly due to its classification in the reproductive schema, and secondly due to a perception of eldercare activity as extra-nonproductive since resources are invested into the decaying body without replenishment.
Overall, the Covid-19 pandemic has shown that both cases arguably need urgent reform in the direction of public resources and funding for eldercare provision. The domain of eldercare work is plagued not just by economic but also by socio-cultural devaluation. Even as COVID-19 has forestalled the ease of physical mobility, an uneasy tension exists between an insatiable demand for care workers and society’s unwillingness to see them as part of the community. The indefinite period of social distancing is perhaps a chance to work on this fractured relationship.
Lynn Yuling Ng and Dr. Feng Xu are both with the Department of Political Science, UVic.
[i] Clara Chong, “Covid-19 circuit breaker measures: what you can and cannot do until May 4”, 2020, https://www.straitstimes.com/singapore/a-new-normal.
[ii] Linette Lai, “All staff, residents at homes for the elderly to be tested for Covid-19”, 2020, https://www.straitstimes.com/singapore/all-staff-and-residents-at-nursing-homes-to-be-tested-for-covid-19-starting-with-those-who.
[iii] Teo, Peggy, Kalyani Mehta, Leng Leng Thang, and Angelique Chan. Ageing in Singapore. Routledge, 2006.
[iv] Wang Yang, “Coronavirus: more maids running away during circuit breaker, say advocacy groups”, 2020, https://www.straitstimes.com/singapore/coronavirus-more-maids-running-away-during-circuit-breaker-say-advocacy-groups.
[v] Wong Yang, “Maids, employers in conflict over rest days, home leave amid Covid-19”, 2020, https://www.straitstimes.com/singapore/maids-employers-in-conflict-over-rest-days-home-leave-amid-covid-19.
[vi] For more details on community policing during the pandemic, see Feng Xu and Qian Liu, “China: Community Policing, High-Tech Surveillance, and Authoritarian Durability,” in Covid-19 in Asia: Law and Policy Contexts, ed., Victor Ramraj (New York: Oxford University Press, forthcoming 2020).
[vii] Caixi Net, “There Were Many Suspected Covid-19 Cases in Seniors’ Homes in Wuhan,” 2020, http://china.caixin.com/2020-02-20/101517853.html.
[viii] Ministry of Civil Affairs (Minzhengbu), “Guidelines on the Prevention and Control of Covid-19 Virus at Seniors’ Homes (Yanglaojigou Xinguanzhuangbingduganran de Feiyan Yiqing Fangkon Zhinan),” 2020, http://www.gov.cn/zhengce/zhengceku/2020-02/07/content_5475906.htm.
[ix] P.R. China government net (Zhongguo zhenfuwang), “Announcement Regarding Fully Implementing Measures on Protecting and Caring for Health Care Workers,” 2020, http://www.gov.cn/gongbao/content/2020/content_5488912.htm; P.R. China government net (Zhongguo zhenfuwang), “Questions and Answers on Fiscal Support Policies during Covid-19,” 2020, http://www.gov.cn/fuwu/2020-03/21/content_5493863.htm.
[x] There might be exceptional cases depending on local government policies. See, for instance, Bandao News, “Staff at Qingdao Seniors’ Homes Were Paid 300 Yuan per Month during the Pandemic (Yiqingfangkon Qijian Zaigang Gongzuorenyuan Meiyue Zengfa 300 Yuan),” 2020, http://news.bandao.cn/a/355849.html. However, the subsidy in the case of Qingdao was 300 yuan per month, while frontline healthcare workers were paid 200-300 yuan per day. The former came out of local budget, the latter the central government budget.
[xi] Xinhua net (xinhua wang), “Taking Care of ‘Fragile’ Seniors’ Homes,” 2020, http://www.xinhuanet.com/local/2020-05/09/c_1125960384.htm.
[xii] Beijing News, “One Elderly Resident in a Seniors’ Home in Hebei Province Suffered from Neglect,” 2020, http://www.bjnews.com.cn/news/2020/06/18/739653.html.
[xiii] Ministry of Health (MOH), “Beds in Inpatient facilities and Places in non-residential long-term care facilities”, 2020, https://www.moh.gov.sg/resources-statistics/singapore-health-facts/beds-in-inpatient-facilities-and-places-in-non-residential-long-term-care-facilities.
[xiv] Tan, Li Feng, and Santhosh Kumar Seetharaman. “COVID-19 outbreak in nursing homes in Singapore.” Journal of Microbiology, Immunology, and Infection (2020).