NESSA SWINN YAP and NG KOK HOE (Lee Kuan Yew School of Public Policy) explain why stronger support for informal care will help to ease pressure on public services as well as provide much needed relief to households.

Singapore is in the thick of a care crisis.

By 2050, as much as 34% of the population will be 65 years and older. As society ages, the incidence of major diseases such as cancer and stroke is increasing. Chronic conditions such as hypertension and hyperlipidaemia affect around a third of the population and are on the rise even among younger people. More invisibly, a 2024 study found that 1 in 3 young people between 15 to 35 years old experience severe symptoms of depression, anxiety or stress. These trends intensify the demand for care.

Care has steadily ascended the public policy agenda. Recent Budget measures have largely concentrated on developing the formal care sector. The capacity of services such as childcare centres, community-based eldercare centres and acute care facilities has been expanding rapidly. There have been investments to grow the care workforce and to improve service access and coordination.

Yet even with these developments, informal care eclipses the formal care sector. According to latest figures, the intermediate and long-term care sector has a workforce of about 17,000. Within acute settings, there are a total of 39,000 registered nurses.

In contrast, as many as 89,000 working-age adults reported giving up employment to be caregivers in 2023. The picture grows starker when we consider the 295,000 migrant domestic workers who provide care labour within individual homes.

Compared with investments in formal care, policy attention to informal caregivers has been lagging. Significant efforts to free up more time for care and to provide financial support for caregivers have only happened very recently. Moreover, they have been  focused on childcare among young families (with provisions expected to expand further in the upcoming Budget). Yet, young families represent only a fraction of the diverse care needs and care relations in society.

We must systematically transform our approach to informal care to tackle the care crisis.

Putting informal care first

To be sure, access to formal care services would go a long way to support caregivers in the home. But there are still barriers in the formal care system affecting take-up rates, such as costs, location, long waits and quality of service. Until these are addressed, families and migrant domestic workers will perform the lion’s share of care. Formal and informal care are also not perfect substitutes. When it comes to care, people have different preferences and needs. Those with more severe dementia, for example, may be best cared for in formal settings that provide round-the-clock care by trained professionals, while those with milder conditions can enjoy more independence and be cared for at home by loved ones. Indeed, a strong culture of filial responsibility, reinforced by policy norms, means that many people may choose to be cared for by family members rather than paid caregivers.

The Singapore government has long approached informal care as a private family matter. Like the ‘conservative’ welfare regimes[1] of Southern Europe, there are fears of the family being displaced by overly generous state support and social services. At the same time, social policy thinking here has also been dominated by a liberal ‘work-first’ ideology that is ill-equipped to recognise the contributions of non-waged household labour. Together, these instincts prevent bolder interventions in informal care, at a huge cost to individuals and families. Whereas conservative societies often experience low fertility and liberal welfare regimes are characterised by inequality, Singapore pays both penalties.

A transformative approach to informal care acknowledges that care will always be needed and provided informally, without taking for granted that people will sort out their own situations. Public policy  should minimise the economic cost and social exclusion that arise when people give and receive care within households. For families, this means more adequate and equitable access to the resources needed to provide care. Given that migrant domestic workers provide significant care labour within households, drastic improvements must be made to their working conditions, wages, and employment rights.

The authors propose a paid Carer’s Leave entitlement of twelve days. This would absorb the current six days of childcare leave, but accommodate more dependents.

Supporting familial caregivers

Time is essential to providing care. Recent policy moves have increased maternity, paternity, and childcare leave, and encouraged flexible work arrangements. But these do not help caregivers of other dependents such as older people and persons with disabilities. In addition, flexible work is not equally available to all workers; for instance, frontline service and platform workers, whose jobs are lower-paid and more precarious.

All working caregivers require time and flexibility to meet the care needs of loved ones, whether these are children, spouses, elderly parents, or even neighbours. Australia, for example, recognises this by providing paid leave of up to 10 days for employees to care for someone with illness, injury, or facing emergency. Notably, this does not have to be a family member. The care leave is designed to be flexible in terms of the nature of care required and type of care relation.

Singapore should work towards a similar Carer’s Leave of twelve days. This can absorb the current six days of childcare leave, but accommodate more dependents, including those who need care because of old age, disability, illness or injury. The policy can be implemented in phases, starting with broadening current childcare leave to other dependents before increasing the number of leave days. This new approach will build on existing efforts to legislate the right of time to provide care. It will recognise the value of all forms of caregiving and would be easier to administer than an overly targeted and fragmented leave regime. (The university where we work currently offers a whopping nine different types of care leave![2]) More importantly, in the long run, a flexible Carer’s Leave would encourage a wider distribution of care responsibilities and help to build strong communities. Given changes in our demography and family structures, we will need a more expansive view of mutual care to meet everyone’s needs.

While those with jobs struggle with finding time to care, unemployed full-time caregivers struggle with the financial costs of caregiving, including immediate income loss and foregone retirement savings. The Home Caregiving Grant (HCG) introduced in 2019 was a major step to address this concern. But for the 89,000 people who had to forego paid work to provide care, even the maximum monthly grant of S$400 is woefully inadequate.

The Grant should be raised to a level that more realistically reflects the needs of non-working, full-time caregivers. This will of course be a significant investment. The specific amount – whether/how it is eventually based on benchmarks of basic needs, last-drawn earnings, or the dependent’s level of care needs – has to be decided through public debate. Whatever the decision, cash support should be accompanied by a CPF savings component to protect caregivers’ long-term financial security. 

Even when unpaid, care is always economically valuable. To ensure families can continue to perform valuable care work, they must be fairly compensated. We provide generous support to workers who pause employment to pursue training through the SkillsFuture Mid-Career Training Allowance, because we see their time outside the labour market as an investment in their future contributions. The unpaid care work that families perform daily are active contributions to society and the economy. They must be supported through our collective public resources, instead of having to bear the costs of caring on their own.

Sustainable migrant care labour

Within households, migrant domestic workers perform numerous caregiving functions that allow for people to be cared for at home. Yet, they are often overlooked in discussions of how we can better support informal caregivers. The only times they have featured in our national Budgets are when favourable adjustments are made to the levies imposed on employers to hire them. This is not only unjust, but also impractical. As population ageing accelerates in the wealthy economies, the global demand for migrant care workers is growing. In time, care supply will tighten as the societies that traditionally supply care workers themselves age. Amidst the international competition for care labour, we must take better care of migrant domestic workers as part of a coherent and sustainable care strategy.

Whereas working family members require the right of time to care, for domestic workers whose job is to provide care – often round-the-clock – their need is time off care. Extensive research has flagged that these workers are often overworked and receive insufficient rest, with many putting in as much as 16- to 18-hour workdays and not getting a single day off work. Recent legislation to mandate a minimum of one rest day per month is overdue and does not go far enough. Given the complex and demanding nature of caregiving, it is only reasonable that they have a weekly day off and for the full 24 hours. The migrant worker NGO, HOME, has flagged that the rest day often becomes just a few hours, because workers are required to complete chores before going out and are asked to return home in time to prepare dinner. Adequate rest is imperative for the wellbeing of the worker, and to ensure that the quality of care is not compromised because of fatigue.

Better wages will make Singapore a more competitive destination and encourage migrant domestic workers to stay. It will rehabilitate perceptions of care work – which the government has said must be better valued – and help to attract more Singaporeans to work in the care sector. Without increasing the cost to households, migrant workers’ wages can be topped up in the manner of the Workfare Income Subsidy, using the revenue generated from the Migrant Domestic Worker Levy. Between 2012 to 2016, the profit from this levy amounted to $2.62b.

At present, migrant domestic workers can be unilaterally repatriated by their employers. When this happens, the skills and experience they develop are lost. We propose giving workers the right to switch employers as well as a career pathway into the formal care sector, where skilled workers are in short supply. This simple move of introducing the possibility of job mobility will help to repair the unequal employer-employee relationship and reduce domestic workers’ vulnerability to abuse. It will be a significant step in improving the employment rights of Singapore’s single largest care workforce.

The Government has the opportunity in its next Budget, to be unveiled in Parliament this month, to make its care policies more robust and balanced, the authors argue. [Photos: Cherian George]

Conclusion

The global care crisis confronting governments and societies today is a product of decades of prioritising economic growth over the vital exigencies of care. To meet care needs, we require more than just stop-gap measures. Everyone going through life requires the care of others at some point. We must appreciate care as the axis around which society functions and is organized.

A strong formal care sector is crucial to building a new social compact centred around care. It sends the message that care is a collective responsibility. But this message will be weakened if the care provided in our homes and communities remains strictly regarded as the private exchange of individuals. A healthy care ecosystem is one where formal care supports and complements rather than stands outside of informal care. Conversely, a well-supported informal care system can help to relieve the pressure on public services. If we truly cherish families as the foundation of society, then we must help them to manage their care responsibilities.

Singapore has a proven track record of performing exceptionally through crises, as well as to make policies for the long term. In the upcoming Budget, it must apply its political will to make the robust and balanced care policies that we urgently need.

— Nessa Swinn Yap is a Research Associate at the Social Inclusion Project, Lee Kuan Yew School of Public Policy, National University of Singapore. She is currently working on a project assessing the state of care in Singapore, drawing on feminist political theory and economics.

Ng Kok Hoe is Senior Research Fellow and Head of the Social Inclusion Project and Case Insights Unit at the Lee Kuan Yew School of Public Policy. He has done research on minimum income standards, homelessness and housing policy. He currently serves as President of HOME.

This article can be freely republished, subject to conditions that you can read here.

Notes

[1] Research on social welfare distinguishes between ‘conservative’ welfare regimes that aim to preserve traditional familial responsibilities and ‘liberal’ welfare regimes which believe that social needs are best met by the free market. Both ideologies do not conceive of a major role for the state and public sector.

[2] They are Family care leave; Shared parental leave; Maternity leave; Paternity leave; Childcare leave – conditional; Childcare leave – unconditional; Adoption leave; Unpaid infant care leave; and Volunteer leave.