Employer's Guide to Caregiver Hiring

A live-in caregiver provides personal care and assists in the day-to-day activities of a care recipient, usually an elderly or a person with disability, at home.

This includes assisting in essential self-care activities like showering, toileting, dressing, feeding and mobility (“Basic Activities of Daily Living”).

A live-in caregiver may also assist in supporting activities like cleaning and upkeep of the house, grocery shopping, preparing meals and giving medications (“Instrumental Activities of Daily Living”).

A live-in caregiver resides and stays in at her care recipient's home. She may share a room with her care recipient so she may assist her care recipient in the night such as changing diapers, assisting in toileting or turning and positioning. This is different from a live-out caregiver who provides care from a few hours to 12 hours and does not stay there.

In the following section, we share some of our answers to commonly asked questions in live-in caregivers.

What are the skills of a live-in caregiver?

Caregiving is an area where one will require some form of training, formal or informal, to provide safe and proper care for the care recipient.

Generally, there are three groups of care skills:

• Essential care skills
• Advanced care skills
• Supporting skills

Essential care skills are focused on providing basic day-to-day care for a care recipient. These include:

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Advanced care skills are needed for specific care areas such as tube feeding, suctioning, giving injections and urinary catheter care.

These skills are usually not covered in basic caregiver training. They are usually taught by nurses in the hospital or at home when the need arises. Usually a practical-based type of training is conducted, where there will be demonstration by the nurse followed by return demonstration by the caregiver.

Beyond care skills, a live-in caregiver will need to possess supporting skills to provide holistic care to her care recipient at home. These include cooking and preparation of suitable meals and diet, basic housekeeping, as well as skills in communicating with her care recipient.

For elderly with dementia, understanding the dementia and picking up essential communication techniques will be helpful for the caregiver.

Families can tap on the Caregivers Training Grant (CTG), a subsidy of up to $200 per eligible care recipient per financial year, to train a family member or Foreign Domestic Worker to provide care for the care recipient.

LEARN: Courses under Caregivers Training Grant (CTG)

READ: What are the Grants that I can Apply for Caregiving?

What are the duties of a live-in caregiver?

Basic Activities of Daily Living

The primary care duty of a live-in caregiver is to assist in the basic activities of daily living (‘ADLs’) of the care recipient. These are:

• Showering, Sponging, Bedbath
• Toileting, Changing Diapers
• Assisted Walking, Preventing Falls
• Transferring from bed to wheelchair and vice versa
• Dressing
• Feeding
• Turning and positioning to prevent pressure injuries

Advanced Care

In addition to these basic ADLs, a live-in caregiver may also need to assist in certain areas of advanced care including but not limited to:

• Nasogastric Tube feeding (‘NG Tube feeding’)
• Oropharyngeal suctioning (‘Oral suctioning’)
• Trachea care and suctioning
• Intermittent ('in/out') catheter
• Indwelling urinary catheter care
• Oxygen Therapy
• Stoma Care
• Wound care
• Giving injections for diabetes

Instrumental Activities of Daily Living

Beyond these essential care activities, a live-in caregiver may also assist with some Instrumental Activities of Daily Living (‘IADLs’)

• Cleaning and maintaining the care recipient's dwelling
• Cooking and preparing meals
• Grocery shopping
• Giving medications and taking vital signs
• Accompanying for walks and exercises in the community
• Coordinating the care recipient’s care such as accompanying to doctors' appointments, informing family members of changes in the care recipient's physical or emotional conditions, or taking stock of the medication and consumables and informing the family members to replenish them before they run out

Who can be a live-in caregiver in Singapore?

A live-in caregiver works and resides in the home of the care recipient. This is different from an hourly-rated caregiver who takes care of a care recipient for a number of hours each time.

READ: 8 Key Differences Between a Live-in and a Live-out Caregiver and How to Decide Who to Hire

In the context of Singapore, a live-in caregiver is typically a foreigner employed on a Foreign Domestic Worker work permit.

For a foreign live-in caregiver to be employed on a Foreign Domestic Worker, she must be from one of the MOM approved source country. Common countries include Indonesia, the Philippines, Myanmar, Sri Lanka and India. The live-in caregiver must be from 23 to below 50 years old at the time of application.

The live-in caregiver can only work and reside in her employer’s registered address. Her salary is paid to her on a monthly basis. The employer must provide her with food, accommodation and medical expenses in Singapore.

Is a caregiver a maid?

A live-in caregiver is engaged on a Foreign Domestic Worker work permit, the same work permit as a domestic helper.

While there is no official definition on what qualifies an FDW as a caregiver, generally, an FDW can be employed as a live-in caregiver if she:

• Has prior experience in caring for a person with care needs in a private home setting or a nursing home, usually substantiated with documents; or
• Holds a caregiving qualification, such as a nursing degree or a certificate in caregiving.

READ: Maid vs Caregiver - 4 Key Differences and 4 Hiring Considerations You Need to Know

READ: Who is a Certified Caregiver? Types of Qualifications and Things to Look Out for

What are the things a live-in caregiver can or cannot do?

Does a live-in caregiver do housework?

Other than caregiving, a live-in caregiver may or may not assist with household chores such as the cleaning and maintenance of the house, cooking, washing and ironing.

For some agencies, the live-in caregiver may only cleaning the care recipient’s room, do the laundry or cook for the care recipient. For other agencies, the caregiver may be able to assist in some housework for other members in the house, for example, cooking and preparing meals for one or two other family members who also reside there. It is important to clarify with each agency on this before you confirm that you want to employ a particular caregiver to prevent any misunderstanding with the caregiver.

Can a live-in caregiver communicate with my parent?

As live-in caregivers come from abroad, they may or may not be familiar with the languages that are commonly used in Singapore. Employers typically will have concerns if a caregiver may be able to communicate with their elderly parents.

For caregivers from the Philippines, they are typically more conversant in English. For caregivers from Indonesia, they will not have issues with communicating with elderly who speak Malay.

For first-time caregivers, they will typically have undergone some basic English training before flying to Singapore. Also, higher education levels attained, such as college degrees or the completion of senior high school, can also indicate a higher level of competency in English.

If language is an important factor for families, they should seek out caregivers with experience working in Singapore, Hong Kong or Taiwan. Generally, caregivers who have worked in Singapore are conversant in English.

For families with elderly who speak Mandarin, caregivers with experience in Taiwan can be able to converse fluently in Mandarin. In fact, Mandarin-speaking caregivers is an area that our agency specialises in.

Does a live-in caregiver get a weekly rest day?

As live-in caregivers are engaged on a FDW work permit, they are entitled to a weekly rest day under the regulations. The employer and the FDW must mutually agree upon which day of the week to be her rest day. In the context of Singapore, the rest day is typically agreed to be Sunday. Other days of the week may also as long as both the FDW and employer agree to it.

With regards to FDWs providing caregiving help, it is common for the employers to need their live-in caregivers to work on her rest days. If the live-in caregiver agrees to work on her rest day, the employer must compensate her with either at least 1 day’s salary in addition to her monthly basic salary or a replacement rest day. The calculation for 1 day’s salary can be derived by dividing her monthly salary by 26 working days.

TOOL: FDW Rest Day Pay Calculator

Does a live-in caregiver get breaks during the day?

As family members, we will like our live-in caregiver to provide the best care for our loved one. Providing a live-in caregiver with sufficient rest at night and sufficient breaks in the day will support her in performing her caregiving duties.

Typically, an elderly care recipient will wake up a few times at night. This may be to go to the toilet or to drink some water. Difficulties in sleeping and sleep disturbances are also common in elderly.

For bedridden elderly, the caregiver needs to wake up to turn and position the elderly to prevent pressure injuries, change diapers and perform suctioning (if required).

An elderly with dementia may confuse day and night, being active at night and resting in the day.

Employers should discuss with the live-in caregiver to make sleep or rest arrangements such as allowing time for the caregiver to sleep in the day when she is required to wake up at night.

How long do we need to engage a live-in caregiver for?

The employment contract for a live-in caregiver typically states that it is for a period specified in her work permit. The work permit, excluding renewals, is usually valid for 2 years as the security bond purchased is for about 2 years.

During the contractual period, if live-in care is no longer needed, the employer can choose to terminate the contract before the expiry of her work permit.

This is common for caregiving. Sometimes the care recipient has recovered fully following months of rehabilitation. At other times. a care recipient with advanced cancer has passed on after a few months of palliative care.

When the employer or the caregiver seeks to end the employment before her work permit expires, the termination clause would apply.

The standard employment contract typically states for a notice period to be served or for pay-in-lieu. The notice period typically ranges from a few days to 1 month.

The employer can allow the caregiver to be transferred to another employer in Singapore or repatriate her. The employer must ensure proper upkeep of the caregiver until her transfer or repatriation. The costs of repatriation are borne by the employer.