Commentary: Three stories from caregivers show we still undervalue caregiving
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Commentary
Commentary: Three stories from caregivers testify we still undervalue caregiving
We demand a deeper conversation on how to support caregivers and provide them with the financial and psychological support they need, says Member of Parliament Anthea Ong.
An elderly woman in a wheelchair with her caregiver. (File photo: TODAY)
31 Mar 2022 06:29AM (Updated: 02 Feb 2022 08:14PM)
SINGAPORE It'southward been said that at that place are 4 kinds of people in the earth: Those who take been caregivers, those who are currently caregivers, those who volition exist caregivers, and those who will need a caregiver.
Indeed, I was recently at a corporate event and met a most unlikely caregiver — Siti, a young professional in her twenties who became emotional when sharing her challenges caring for her three unmarried aunts in their 60s — i suffering from diabetes and depression, another from ovarian cancer and the 3rd from kidney failure.
Caregiving affects all of us yet this role is, ironically, i of the nigh undervalued in our social club.
CHALLENGES OF Breezy CAREGIVING
The psychosocial well-being of caregivers must be elevation of listen for our caregiving policies. We have non done a comprehensive national study on caregiver health (which I highly recommend we do) but segmented studies accept revealed that our caregiver population is certainly facing college mental health risks.
Caregiving is stressful and tin crusade depression. Among caregivers of stroke survivors, xl.2 per cent have depressive symptoms, according to a 2022 study by the Establish of Mental Health and National University of Singapore.
Caregivers of cancer patients are as well at greater hazard of developing depression than the general population, a study in the Singapore Medical Periodical likewise found.
READ: 'Smiling depression', depressed while appearing happy, a dangerous combination, a commentary
Wendy* is a caregiver involved in a report by the Association of Women for Activeness and Enquiry (AWARE) on the financial costs of caregiving. She is 51, single, and a caregiver to her mother who has dementia.
While she has hired a foreign domestic worker, she remains the "emotional anchor" for her mother. Caregiving has taken a toll on Wendy emotionally, physically and financially — she'due south had panic attacks and experiences high levels of anxiety.
Then at that place'southward Ivan*, in his 50s, who'south struggling to cope with the severe intendance needs of his 85-year-quondam mother with dementia. Unable to deal with his mother's mounting behaviour issues terminal twelvemonth, he had a series of anxiety attacks and ended up in hospital himself.
READ: The role reversal between parent and child, as ageing takes a price on families, a commentary
With smaller families, in that location are fewer family caregivers. Over the past few decades, however, Singaporeans have been fortunate to have an army of efficient, defended and relatively affordable strange domestic workers. They class an important office of our informal intendance workforce.
Withal, the economic touch of caregiving on Singapore is obvious. The Labour Force Survey 2022 shows that 75,800 women and xiii,000 men cite caregiving to families and relatives every bit the primary reason for beingness out of the labour force. This number does not include caregivers who accept had to calibration back on work commitments in other ways, for example, by moving to part-time or ad-hoc work.
Wendy, whom I mentioned earlier, scaled down on her working hours and now earns less than S$2,000 a month, about one-5th of what she used to earn. Ivan quit his job to wait after his mother, subsequently she repeatedly forgot to turn off the gas at abode.
READ: Dementia caregivers put on a dauntless front end – while watching loved ones fade abroad, a commentary
Some other caregiver, June*, stopped working completely when her husband was diagnosed with Parkinson's disease. She is sixty and the sole caregiver to her married man every bit they have no children. Their only monthly household income of South$ane,000 comes from renting out a room in their HDB flat.
CHALLENGES IN FORMAL CARE SERVICES
Did these caregivers lessen their caregiving burden with formal care services?
Wendy tried daycare only her mother reacted violently against information technology. She's now considering the nursing home pick but the guilt is immense and she'south been putting it off despite her own deteriorating emotional and physical health. So at that place'due south the cost of the nursing dwelling fee that she volition struggle to beget with her drastically reduced income.
June's hubby goes to daycare but is guilt-ridden because he does not like it there yet she needs that time to go to the hospital for physiotherapy. June spends around Due south$300 to S$400 on daycare (afterwards government subsidies) plus South$100 on ship to her married man's daycare a month against her S$1,000 rental income.
READ: Caregivers are getting some support simply deserve more than care, a commentary
Most of us would like to be cared for in the comfort of our own homes. However, the increasingly complex care needs of our seniors and shrinking families must be counterbalanced against the needs of the caregiver, meaning formal home-based and customs care services are disquisitional and practical necessities.
While the Government has been busy increasing capacity in contempo years, more needs to be done to amend the affordability and quality of these services.
The ElderShield Review Committee report estimated that, including send, consumables and formal dwelling care services, it could cost caregivers every bit much every bit Due south$3,100 per month to look later on a severely disabled senior at domicile, well to a higher place the S$2,400 median monthly fee for looking afterward severely-disabled residents in VWO-run nursing homes.
The Care Where You Are study past Lien Foundation notes that co-payment of care fees remains a key concern for families, although means-tested Government subsidies for long-term intendance accept been increased to embrace up to ii-thirds of Singaporean households since 2012.
Even for those who are non severely disabled, daycare and dwelling intendance services can price S$900 to Southward$2,200 per month before subsidies, excluding transportation costs. Families eligible for subsidies must co-pay between twenty per cent and 70 per cent. Those with a per capita monthly household income of more than than Due south$2,600 do not qualify for subsidies at all.
Costs may therefore deter even middle-income families from using formal long-term care services, especially since many find it cheaper to hire a foreign domestic worker instead.
Still, foreign domestic workers — and fifty-fifty family unit caregivers themselves — may not exist trained to handle complex intendance needs and, sometimes, could end up compromising the well-being and health of vulnerable seniors, leading to unnecessary infirmary stays.
Heed: Why foreign domestic workers are borrowing money, an episode on The Pulse podcast
Home care is expensive too and appears underfunded with charity dollars, even later on accounting for government subsidies and payouts from CareShield Life insurance — a scheme that may be useful but limited in its impact, given the strict qualifying weather for payout and seeing that the scheme is optional for older cohorts who need long-term care now.
Even every bit nosotros piece of work out ways to improve affordability, emphasis must be made on quality and outcomes. In recent years, many sophisticated new care models - such as the Integrated Home and Daycare Programme - accept sprung up.
Anecdotal evidence propose these schemes fulfill some intendance gaps though programme outcomes need to be tracked and made public to convince skeptical caregivers of their effectiveness.
SHIFT HEALTHCARE SPENDING TOWARDS LONG-TERM AGED Intendance
Singapore is ageing from a position of relative strength. We take a largely good for you population and in that location is a sharper focus in recent years on harnessing the potential benefits of longevity. Nevertheless we must do more than.
While the importance of enabling seniors to age at home is widely acknowledged, the Lien report besides noted that Regime spending on home-based and centre-based care — at S$240 1000000 in 2022 — accounted for only ii.5 per cent of the overall Southward$9.eight billion healthcare budget for the year.
The Authorities should consider recalibrating the healthcare upkeep to enable seniors to age and exist cared for at home. More than subsidies can be targeted at seniors who are non severely disabled — and therefore do not qualify for ElderShield or CareShield Life — but likely to benefit from professional rehabilitative care before their conditions deteriorate farther.
Heed: What life in your 60s should look like, an episode on The Pulse podcast
To better support caregivers' psychosocial well-being needs, the Government could consider giving seniors flexible care packages, whether for daycare, dwelling care, respite care services, transport fees and consumables, or to pay a family unit member or friend for elder-sitting. Respite care should be enhanced to include counselling and self-care training services every bit well.
Some other way forrard is to accord the long overdue recognition and appreciation to family caregivers with an assart or payment, in both cash and CPF credits. This also ensures some level of financial security for them.
The recent announcement of the Southward$200 home caregiving grant that replaces the Due south$120 foreign domestic worker grant is a stride in the right direction but it is arguable whether the amount is sufficient.
Perchance, the payment should vary past the number of Activities of Daily Living the care recipient requires assistance with.
To enable caregivers to continue working while providing care, the Authorities should consider converting paid childcare leave into a longer quantum of family unit care leave of at least 10 days and allow it to be used for the intendance of any family members, including older relatives. Employers should be partners in this try to provide flexible work arrangements on request by employees.
Higher up all, we should collectively cover caregiving — not as the brunt of a few, but a responsibility of all.
There is an urgent need for more than informed collective conversations amongst Singaporeans about what kind of care arrangement we want for our grandparents, parents — and eventually ourselves — and how much we are willing to pay for information technology, whether through premiums or taxes, for those who can afford it and to back up those who cannot.
Because to care for those who once cared for u.s. is one of life's greatest honours.
Anthea Ong is Nominated Member of Parliament, Hush Teabar founder and writer of fifty Shades of Honey who advocates for mental health, variety and inclusion of vulnerable communities, volunteerism and environmental issues.
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