Nurse helping disabled lady with walker, horizontal

Hastings Center News

Envisioning “Good Care at Home” for Older Adults in an Aging Society

How should we think about the ethics of everyday interpersonal relationships focused on giving and receiving care? When home is also a care setting, how can family members and other caregivers best provide care to older adults? What protections are needed for migrant workers who provide care in the home? These questions are among those explored in “Good Care at Home for Older People in Singapore,” a report and recommendations co-authored by Hastings Center research scholars Nancy Berlinger and Michael Gusmano.

Berlinger and Gusmano were in Singapore in August for an event to launch the report, which is a product of a five-year collaboration between the Centre for Biomedical Ethics at the Yong Loo Lin School of Medicine at the National University of Singapore, The Ethox Centre at the University of Oxford, and The Hastings Center. The collaboration, supported by the Lien Foundation,  has also produced the Singapore Bioethics Casebook, first published in 2014, and a second edition, Caring for Older People in an Ageing Society, published in 2017.

As a companion to the second edition, the report considers how to balance the interests of older people and caregivers in the home and the wider community, focusing on the challenges faced by Singapore. The city-state is a rapidly aging society and relies significantly on foreign domestic workers – women from other Asian nations, recruited and employed on contracts — to provide live-in care to older adults, especially those with dementia. The report includes recommendations on how to support and protect these caregivers, and also how to prevent undue burdens from being shifted from health care professionals to unpaid family caregivers, who are usually women. While some recommendations, particularly those concerning foreign domestic workers, are specific to Singapore, many others are also applicable to the U.S. and other aging societies with advanced health care systems and a reliance on family caregivers and on global care migration.