In Southeast Asia, family members are traditionally the primary providers of long-term care to family older adults, due to enduring cultural values such as filial piety, as well as long-term care systems and policies that promote informal care by family members.
However, with population ageing, family caregivers are not only getting older, but will have to take on greater responsibility due to shrinking family sizes, fewer family caregivers, and rising cost of living. Exploring ways for community members and care systems can be set up to provide care, alongside family members is therefore important.
- Subsidize costs for family caregivers or others who administer care to older adults with to attend training, gain skills, knowledge, and psychoeducation on caregiving. Beyond physical skills for day-to-day care, topics such as understanding ageing, communication skills as well as self-care will be useful, see Case Study 2.3a.
- Assist caregivers to access respite care either at centers, or from help of professional caregivers so that they can make time to attend such trainings.
In Singapore, the government subsidizes training program for caregivers, both family caregivers and Foreign Domestic Worker to learn how to care for seniors and manage their daily activities of life. Training is offered in bite-sized format and tailored according to different requirements of caregivers, based on the mobility and care needs of their care recipients.
Access to livelihood opportunities and financial security increase the ability of older persons to cope with unexpected emergencies. It also provides them an avenue to be active and contribute their skills.
- Recruit community members to serve as volunteer caregivers (i.e., care volunteers) to older persons in their homes, working with healthcare teams in community and hospital settings to integrate these volunteer networks with services. Care volunteers can carry out home visits to monitor cases with more stable conditions, and be supervised by nurse care managers who do more formal needs assessment and care planning, see Case Study 2.3b of the community-based long-term care system in Thailand.
- Develop pathways in which these care volunteers could progress through gaining proficiencies to deliver higher levels of care (e.g., para-nurse or para-counsellor) that translate into potential job opportunities in the eldercare sector.
The long-term care system in Thailand systematically trains and activates local volunteers in each subdistrict to support families in caring for older persons after they are discharged from the hospital. Decentralization and management of the system is at the subdistrict level, where the local government recruits, develops and pays care volunteers through national funding that is matched by the local government. Care volunteers undergo 70 hours of training that focus on biopsychosocial health and knowledge of the care system but can go on to undertake more complex nursing roles and advise on medication through further 420 hours of training. A capitated funding model is used where budget is set aside for every older person based on their needs. These care volunteers report and are supervised by healthcare professionals using social networking services like Line application.
- Recruit former or retired professional caregivers to sign up as care volunteers through various channels such as alumni networks, newspaper, social media and so on.
- Adopt suitable technological platforms which can match caregivers to care recipients in the community on demand. Such technologies develop algorithms to assess the care needs and health conditions of the older adults and match them to caregivers with the relevant care skills and experiences. Final assignments are made by staff at the backend of these technologies. By coordinating demand and supply more efficiently, such platforms could offer more choice, flexibility, and on-demand access for caregivers to long-term care, see Case Study 2.3c.
Pairing of medical and nursing students in Don Keow University to older adults in the community as part of their curriculum. Students and faculty members periodically visit older persons to conduct routine health checks. During these visits, students/faculty members would teach older persons to assess their own health using self-assessment toolkits.
A robust long-term care system is required in ageing communities to ensure that older person can age in place with dignity and be cared for. Local community members who are trained and certified can help in many aspects of long-term care. Raising awareness and development pathways for the caregiving profession would encourage more community members to join the pool of trained care volunteers that can strengthen Non-familial Support (IC13)
Moreover, tapping on former caregivers is a good way to utilize their former skillsets and provide them with flexible employment options. When the duty of caregiving is shared amongst many, it will become a lighter load for all in terms of Family Roles and Responsibilities (IC15), allowing caregivers more time for self-care, opportunities to fulfil work and social roles for better Mental Health (IC11) and resilience.
- A code of conduct can be established for care volunteers to ensure quality of care. A framework for supervision and monitoring should also be set in place to prevent potential abuse or neglect of the older person in their homes.
- Beyond training, the role and work of these volunteers should be integrated with the services of hospitals and community organizations that provide more formal care. This would enable the care these volunteers provide to compliment as well as be better supported by these formal services, see Good Practice 2.4 for more details
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