Who cares for those who care?

By Radha Basu

SINGAPORE - Call it the silent surge. As Singapore ages, thousands of daughters, sons,
in-laws, spouses and siblings have become caregivers to sick, dependent or frail older
folk at home.
While people are living longer, many are not necessarily living well.
According to estimates derived from the latest National Health Survey made public in late
2011, Singapore may already have around 210,000 people who are looking after elderly,
sick or disabled folk at home.
Last year, researchers at the Duke-NUS Graduate Medical School released results of the
most in-depth survey done on caregivers here so far.
It polled nearly 1,200 caregivers and unearthed several startling facts. Around half the
caregivers surveyed, for instance, were employed but still spent 38 hours every week on
caregiving chores, which was like holding a second job. Only half employed a maid.
And although support services - such as home medical care or adult day care - are on
the rise, take-up rates are low. Only 3 per cent of those surveyed use day rehabilitation
services, for instance, while 4.5 per cent use home medical services.
Long at the periphery of the debate on services for the elderly, caregivers took centre
stage during the Budget debate in Parliament last month. At least five MPs - Dr Fatimah
Lateef, Mr David Ong, Dr Lily Neo, Mr Sitoh Yih Pin and Mr Low Thia Khiang - spoke
passionately about the need to ramp up home care services.
In response, Minister of State for Health Amy Khor gave an update of all government
initiatives to enable more disabled or older folk to be cared for by family members at
home rather than in nursing homes.
Moves are afoot to enhance the capacity of home care services and caregiver support,
she said. New programmes are also being initiated.
For instance, from last week, those who pass a government means test can get
subsidies from the Ministry of Health to help pay for physiotherapy sessions at home.
Patients can receive subsidies of up to $97 for home rehab. They will still need to pay
between $18 and $37 for each visit, but those who qualify can get additional subsidies
from Medifund, said a Health Ministry spokesman.
Greater subsidies
Director of Touch Home Care Kavin Seow welcomed the greater subsidies. His
organisation provides both home medical and personal care services for frail old folk at
home.
"Earlier, our staff would try and help secure subsidies from external sources like the Tote
Board," he said. But the funding was not guaranteed and had to be renewed every year.
"The new subsidies will make it easier for us to plan long term for patients who need care
for months or years."
Since 2012, home care providers have also been receiving funds to scale up services.
They can now serve 5,400 seniors needing home-based health care and 1,100 seniors
needing home-based personal care every year.
The Health Ministry also plans to switch to funding providers on a "per patient" rather
than a "per visit" basis. This will provide a fixed amount of funding per month for each
older person being cared for, based on their individual needs. "This will give providers the
flexibility to subsidise clients for services they need but can't afford," said Mr Seow.
The Interim Caregiver Service piloted last year is yet another programme to help
caregivers. It provides seniors with up to 12 hours of personal care every day, for up to
12 days over a period of two weeks right after they are discharged from hospitals.
More respite care services are also being rolled out. As part of the Nursing Home Respite
Care pilot programme, subsidised nursing home care is being provided to eligible seniors
for between a week and a month every year.
Fifteen nursing homes are on board. But only 130 people have benefited so far.
By the second half of this year, a number of eldercare centres will also begin providing
weekend respite services. Caregivers can drop off their seniors at these centres during
weekends, for a few hours, if they need to take a break or run errands.
Challenge to keep services affordable
There are around 3,000 places at more than 60 day-care centres for the elderly
islandwide. Capacity is set to double by 2020.
Still, these numbers seem low, given that Singapore is one of the fastest-ageing societies
in the world.
There are already nearly 250,000 people here aged 70 and above, a 55 per cent jump
from a decade ago.
By comparison, there are about 280,000 children aged seven and below, a number that
has stayed stable over the past decade, given that Singaporeans are having fewer
babies.
Yet, there are more than 105,000 childcare and infant-care places available in close to
1,080 centres in Singapore currently, up 60 per cent from 65,500 just six years ago.
Even as capacity is ramped up, a new one-stop call centre for caregivers will also begin
operations by the third quarter of this year.
Social service professionals like director of the Awwa Centre for Caregivers Manmohan
Singh welcomed the move to boost respite care and interim care services.
"That was a major gap in the system and it's good to see it being plugged," he said.
"However, the challenge will be to keep the services affordable."
Families living in five-room HDB flats, for instance, may not qualify for enough subsidies
and forgo the service altogether, if they have to fork out three-figure sums per session.
Full costs for respite care, for instance, can be as high as $370.
Costs are an issue
Indeed costs are an issue, say caregivers who spoke to The Straits Times. While
subsidies have increased and income ceilings have been relaxed, with the full fees of
some services stretching to $370 a day, some families may still find it tough to cough up
co-payment amounts.
Director Peh Kim Choo from the Hua Mei Centre for Successful Ageing added that more
attention should be paid to the emotional needs of caregivers.
"We're still at the basic stage of building a support infrastructure for caregivers of older
folk," said Ms Peh. "We also need to focus on the mental health of caregivers
themselves."
The problem here is that many caregivers do not even realise that they need help, said
Ms Peh, who is a trained counsellor and social worker.
Some, for instance, are reluctant to ask siblings for help. "They sometimes don't ask for
help, but feel dejected and upset when no help is forthcoming from siblings," said Ms Peh.
"Their expectations of themselves and of their siblings as caregivers need to change."
radhab@sph.com.sg