Symposium on Caregiving 2018

Registration closes on Friday, 17 August 2018.
Seating is limited and on a first-come, first-served basis. All are welcome.

For enquiries, please contact Ms Jess Tan

Panel 1: Ethical Responsibilities at the Intersection of Health and Social Care
Presenters: Dr Jacqueline Chin, Dr Nancy Berlinger, Mr Michael K. Gusmano and Dr Michael Dunn

Abstract:
In ageing societies, attention has focused on ‘the intersection of health and social care’, that is, socially-based interventions that better meet health and healthcare needs than purely healthcare interventions, including: care through community organisations and family arrangements, and care services related to social work or social care. As societies grapple with issues arising at this ‘intersection’ (appropriate provision, integration, accessibility), what ethical frameworks are being developed for health and social care systems that aim at justice for professional and non-professional stakeholders, and paid and unpaid informal caregivers as they embrace change and shoulder expanded care responsibilities? At the practice level, how can clinical ethics offer needed clarity regarding the roles and responsibilities of professionals and non-professionals, amid the fundamental complexity of ‘negotiated responsibility’ within health and social care settings? These questions are considered in the light of two recent projects funded by the Lien Foundation: an online bioethics casebook, ‘Caring for Older People in an Ageing Society’, and a report entitled, ‘Good Care at Home for Older People in Singapore’ by a team from the Centre for Biomedical Ethics, National University of Singapore, The Hastings Center and the Oxford University Ethox Center.

Panel 2: Enabling Singaporeans to Age Well in Place
Presenters: Associate Professor Elaine Lynn-Ee Ho and Associate Professor Shirlena Huang

Abstract:
The number of Singapore residents aged 65 and above crossed the half a million mark in 2017. By 2030, the number of seniors will climb to nearly a million. These numbers have enormous implications for the elderly and their families, as well as the eldercare industry, welfare sector, and policymakers. Drawing on focus group discussions and in-depth interviews with 29 non-profit and 21 private care providers, this presentation focuses on four aspects of enabling Singaporeans to age well in place: organisation of the overall eldercare landscape, including the demand and supply of services; financing; human resource capabilities; and governance. The research is also informed by supplementary interviews with family caregivers, government ministries and affiliated agencies, and other stakeholders in eldercare. The presentation highlights the strengths of Singapore’s eldercare landscape, but also draws out concerns that providers and caregivers expressed towards navigating a complex eldercare sector; out-of-pocket expenses and insurance for long-term care, and the fund-raising burden that charitable organisations face; the need to enhance the attractiveness of careers in the long-term care sector and for standardised training in home care; and the importance of establishing a regulatory framework for eldercare to ensure care quality.

Panel 3: Long Term Care Manpower Study
Presenters: Ms Radha Basu

Abstract:
Singapore needs to grow its pool of long-term care (LTC) workers by at least 45 per cent between 2017 and 2020, as more nursing homes, day centres for seniors and home care services are developed to cater to a rapidly ageing population. But low pay, limited prospects and a continuing churn in the sector may make it hard to meet this target, shows a new study commissioned by the Lien Foundation, which polled both providers and workers. The study also found that Singapore’s LTC sector is far more reliant on foreign workers compared to other fast-ageing APAC economies such as Australia, Hong Kong, Japan and South Korea. Average tenures among workers are low in LTC compared to hospitals. Around 55% of foreign LTC workers, for instance, have worked in their current company for under two years. Despite the second highest median wages nationally, salaries of both local and foreign LTC workers are lowest here, compared with post-tax salaries of peers in the four territories surveyed. For instance, a local nursing aide in Singapore earns around $1,350 and a foreigner around $850 per month, compared to a post-tax salary of $1,830 in Korea, $3,000 in JP, $3,750 in Hong Kong and $3,290 in Australia. Hong Kong and Japan plan to open its LTC sector to more foreign workers, which could hurt supply in Singapore. (See here for details)

Presenter’s profile:

Nancy Berlinger is a research scholar at The Hastings Center whose scholarship focuses on ethical challenges in health care work and on related health and social policy challenges in the United States and internationally. Her special interests include societal challenges arising from population aging; treatment decision-making and care for seriously ill people and near the end of life; health care access and social integration for migrants; and the ethics of managing safety and harm in health care systems. She co-directs a grant-funded process to develop a social ethics framework for population aging that can guide future work in bioethics. Her recent projects include a collaboration with the Society of Hospital Medicine (SHM) and the American Association of Critical-Care Nurses (AACN) that created a new primary palliative care process and practice standard for frontline hospital clinicians to improve communication about serious illness. This translational project built on her leadership of the 2013 edition of the landmark Hastings Center Guidelines on treatment decision-making and care near the end of life. With colleagues at the National University of Singapore, The Ethox Centre of the University of Oxford, and The Hastings Center, she co-edited the Singapore Bioethics Casebook, which has become a tool for professional and public learning in Singapore and other Asian societies. Berlinger is the author of After Harm: Medical Error and the Ethics of Forgiveness (Johns Hopkins, 2005); The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life (with Bruce Jennings and Susan M. Wolf, Oxford, 2013); and Are Workarounds Ethical? Managing Moral Problems in Health Care Systems (Oxford, 2016). She is currently working on a book project about the membership of migrants in urban societies. Berlinger co-founded and co-directs The Hastings Center’s Undocumented Patients project and directs The Hastings Center’s Visiting Scholar program. She serves on the Bioethics Committee at Montefiore Medical Center (Bronx, NY) and is a frequent participant in Montefiore’s Ethics Review Committee process for hospice access for patients alone at the end of life. She teaches an interdisciplinary course on migration at Lehman College, City University of New York (CUNY) and serves on the editorial committee of the Hastings Center Report. She is a graduate of Smith College and earned a Ph.D. in English literature from the University of Glasgow. She also received a M.Div., with a focus on ethics, from Union Theological Seminary. She was a resident at the Bellagio Center of the Rockefeller Foundation in 2018.

Jacqueline Chin is currently a full time caregiver. She was Associate Professor at the Centre for Biomedical Ethics (CBmE), Yong Loo Lin School of Medicine, National University of Singapore until June 2018. Trained as a moral philosopher at the University of Oxford, her research of the past nine years addresses national and globally-relevant capacity-building in biomedical ethics. She has conceptualized and led key projects such as CENTRES (since 2009), commissioned by the Ministry of Health for networking and supporting clinical ethics committees in Singapore’s restructured and private hospitals; What Doctors Say About Care of the Dying, an empirical ethics study of doctors’ perspectives on end-of-life decisions (2010–2011) aimed at informing professional stakeholders, policymakers and the public; Making Difficult Decisions with Patients and Families (2014), an online casebook (www.bioethicscasebook.sg) which recently featured in a 2015 Hastings Center Report’s special collection of papers on Bioethics Education by the US Presidential Commission for the Study of Bioethical Issues; and Vol 2 of the online casebook, Caring for Older People in an Ageing Society (2017), which engages with ethical challenges of eldercare among health workers in community care settings.

She volunteers time as a member of the hospital ethics committees of the National University Hospital, a member of the National Transplant Ethics Panel of Laypersons (since 2009), and Vice-Chair of the Ethics and Regulatory Workgroup of the Precision Medicine Steering Committee (2016-2019).

Michael Dunn is a Lecturer in Health and Social Care Ethics at the Ethox Centre, University of Oxford. In this role, he also directs undergraduate medical ethics and law education in Oxford University’s Clinical School, and the Ethox Centre’s graduate research training programme within the Nuffield Department of Population Health. Dr Dunn’s academic research interests span a range of issues in healthcare ethics, social care ethics, and health law. The predominant focus of his current work seeks to address ethical questions presented by the development and expansion of community-based and long-term care practice, law and policy – both in the UK and internationally. He is the author of over 50 peer reviewed journal articles and book chapters on these topic areas. Two co-edited books have recently been published, including Empirical Bioethics: Theoretical and Practical Perspectives (CUP, 2016), and a further book, Medical Ethics: A Very Short Introduction, 2nd ed, co-authored with Tony Hope, will be published shortly (OUP, 2018). Dr Dunn holds undergraduate and postgraduate degrees from the University of Cambridge, and he has held visiting positions at the National University of Singapore, the University of Tokyo, the University of Oslo, the VU University Amsterdam, the University of Bradford, and the Hastings Center, New York. He is a Senior Fellow of the Higher Education Academy, an Associate Editor of the Journal of Medical Ethics, the Book Reviews Editor of Ethics and Social Welfare, and a member of both clinical and research ethics committees.

Michael K. Gusmano, an Associate Professor of Health Policy, is the Interim Chair of the Department of Health Policy and Behavioral Science and Director of the Concentration on Health Systems and Policy at the Rutgers University School of Public Health. He is also a research scholar at the Hastings Center and a visiting fellow at the Nelson A. Rockefeller Institute of Government of the State University of New York. His research examines the politics of health and social policy. He co-directs the World Cities Project, which compares large city health systems across the world. He is the author of Debating Modern Medical Technologies: The Politics of Safety, Effectiveness and Patient Access(with Karen J. Maschke; ABC-CLIO/Praeger, 2018), Health Care in World Cities: New York, London and Paris (with Victor G. Rodwin and Daniel Weisz; Johns Hopkins University Press 2010), Healthy Voices/Unhealthy Silence (with Colleen Grogan; Georgetown University Press 2007), Growing Older in World Cities (with Victor G. Rodwin; Vanderbilt University Press, 2006) and more than 100 scholarly articles. He is also the co-editor and co-author of Making Difficult Decisions with Patients and Families and Caring for People in an Ageing Society published online by the National University of Singapore, The Hastings Center and Ethox Centre at Oxford University. In 1995-1997 he was a Robert Wood Johnson Scholar in Health Policy Research at Yale University. He serves as the International Editor of the Journal of Aging and Social Policy, Associate Editor for Health Economics, Policy and Law, and is on the board of editors of the Journal of Health Politics, Policy and Law and the editorial committee of the Hastings Center Report. Gusmano received his doctorate in political science from the University of Maryland College Park in 1995.

Elaine Lynn-Ee Ho is Associate Professor at the Department of Geography and Senior Research Fellow at the Asia Research Institute, National University of Singapore. She is Principal Investigator of a Lien Foundation funded project on “Community and Home-based Care for Older Adults in Singapore”, and of a Ministry of Education funded project on “Transnational Relations, Ageing and Care Ethics” (TRACE) which traces the care circulations between Singapore, China and Myanmar. The TRACE project also sets Singapore in comparative perspective with Australia. As a social geographer, her current research focuses transnational ageing and care; and on immigration, diaspora engagement and citizenship within the Asia-Pacific region.

Shirlena Huang is Associate Professor at the Department of Geography, National University of Singapore. She is Co-Principal Investigator of a Lien Foundation funded project on “Community and Home-based Care for Older Adults in Singapore” as well as a Ministry of Education funded project on “Transnational Relations, Ageing and Care Ethics” (TRACE). A social geographer, Shirlena’s research and publications have focused on issues at the intersection of transnational migration, gender and family, with particular interests in the themes of care labour and transnational families within the Asia-Pacific region.

Radha Basu is Director, Research and Advocacy, at the Lien Foundation, a Singapore-based philanthropic organisation which seeks to inspire social change in the fields of eldercare and early childhood development. In 2016, she authored Safe but Soulless, an in-depth report commissioned by the Foundation on Singapore’s nursing home sector. Prior to that, she spent nearly 15 years with The Straits Times, where she wrote on issues like ageing, income inequality and human trafficking. A two-time winner of international journalism awards given out by the Society of Publishers in Asia, she has also won the Aware Heroine award for promoting gender equality.