Supporting our caregivers and senior citizens

Kelvin Teo

Family is the most dependable institution.

Family is the most dependable institution.

Consider the following fictitious case-study as described below:

Mrs Lin is a 65 year-old-lady with multiple chronic illnesses. She suffers from osteoporosis (bone weakness), dementia and diabetes. Lin lives with her eldest daughter, Jean, who is her primary caregiver and is responsible for her medical bills on top of providing support for her day to day living. Lin due to her dementia occasionally forgets to take her diabetic medications and when Jean is around, she would make it a point to remind her mother to take her medications.

Jean is working as a managing editor for a publishing company. She is single, and uses majority of her annual leave to care for her mother. Recently, the publishing company sent Jean overseas to cover a month long event, and has told Jean to expect such month-long assignments in future. Jean has no choice but to comply with the company’s instructions because she didn’t want to face the sack. Worried at being away for one month, Jean requests a family friend’s help to drop by her place on a regular basis to assist Mrs Lin with her daily living and ensure that she takes her medications. However, this friend also has a busy work schedule and can only drop by Mrs Lin’s place occasionally. Jean also reports feeling stressful in her role as primary caregiver.

Whilst Jean was away and during the times when the family friend couldn’t visit Mrs Lin, she did indeed forget to take her diabetic medications. Due to her high blood sugars, Mrs Lin began to suffer from complications associated with her diabetes. One day, she presented to the emergency department of Singapore General Hospital due to a fracture from a fall she suffered as a result of the deterioration of her vision, brought on by her uncontrolled diabetes.

Just recently, there has been debate going around in our public sphere about supporting our caregivers, which in usual cases, are responsible for the care of an aging relative or spouse whom are suffering from debilitating condition (s). There are two types of caregivers – primary and secondary caregivers. In the fictitious scenario above, Jean is the primary caregiver as she would be the one providing financial, emotional and practical (with daily living) for Mrs Lin, whilst the family friend will be the secondary caregiver because the latter is providing care in Jean’s absence as a result of work commitments.

Why is the caregiver issue gaining greater prominence as ever that led to the focus on the role and support of caregivers in recent days? In a powerpoint presentation prepared by Associate Professor Kalyani Mehta of the Social Work department, National University of Singapore and a former Nominated Member of Parliament, she highlighted the changing demographical landscape of Singapore which would make the role of caregivers crucial. According to Mehta, the baby boomer generation born after the second world war that forms the middle of the population pyramid enjoy better health, wealth and education and are likely to live beyond 65 years of age. Another piece of sobering statistic is that the percentage of people in Singapore above 65 years will increase from 8.4% in 2005 to 18.7% in 2030. In terms of absolute numbers, that would translate into an increase from about 296,000 in June 2005 to 873, 300 in 2030.

Thus, with an increasing aging demographic, there is an increasing need for caregivers. The situation is exacerbated by the fact that Singapore is experiencing declining birth rates, with the total fertility rate at 1.23 in 2009, which is far below the cut-off of 2.1 required for population renewal. Hence, the scenario will be an increase in aged population with a dearth of caregivers who are in their 30s to 40s.

Why do caregivers play such a crucial role? One rarely discussed reason is the important link that caregivers play in preventive medicine. If properly trained and done appropriately with regularity (meaning being able to care for a relative at regular intervals), caregivers can provide the level of care that will keep current illness (s) under control and at the same time prevent further complications from developing. The role of caregivers in the health of patients cannot be under-estimated, which is why when a patient presents to the doctor with a complaint, inputs from the caregiver are just as crucial. And in the home care and support of the patients, the caregivers’ collaboration with health professionals in terms of being educated on the diseases that their loved ones are suffering from, learning how to care and actually caring for and managing them, are all essential.

Actions that constitute preventive care can range from reminding the loved one to take his/her medication in the case study above to administrating the medication such as those types that require injections. Even simple acts such as reminding the loved one to go for his/her screening or taking the day off to bring the latter to the clinic for screening constitutes preventive care. Besides practical care, the amount of emotional support the caregiver can provide is also crucial to their loved ones’ ability to cope with their disease. A depressed patient for instance will be at increased risk of cardiovascular disease.

Thus, the case study above highlights the quintessential part the caregiver plays in the management of a chronic disease. And because of the enforced absence of the caregivers, Mrs Lin could not manage her diabetes and developed further complications such as deterioration of vision. Furthermore, as a result of her diabetes, Lin is at risk of developing heart disease and stroke. It is conceivable that caregivers like Jean are stuck in a vicious cycle. Because of her work commitments and the irregularity of visits by the family friend, her mother could not cope with her diabetes, and as a consequence deteriorated, and suffered a fracture due to a fall brought on by poor eyesight and osteoporosis. And at the end of the day, Jean has to foot the medical bills. Consequently, it doesn’t come as a surprise that Jean reports feeling stressed. In the presentation by Mehta, women caregivers tend to feel more stressed than their male counterparts.

Hence, this led to the increasing recognition of the part that caregivers play in the health of their loved ones, and debate in the Singapore parliament threw up a few suggestions and initiatives (Sources: TODAYONLINE1, TODAYONLINE2.):

  1. The City of All Ages project which involves various key government agencies and serves to make the built environment more livable for senior citizens.

  2. Higher tax relief for caregivers – Miss Penny Low (Pasir Ris-Punggol GRC)

  3. Training support for caregivers – Nominated Member of Parliament Mr Lawrence Wee and Mr Yeo Guat Kwang (Aljunied GRC).

  4. Seed funding was provided to NTUC Eldercare and Touch Community Services to pilot the training of family caregivers and foreign domestic workers.

  5. Provision of monetary incentives to caregivers which can be credited to the Central Provident Fund – Mr Lawrence Wee

  6. Having community-based care modelled after an American programme and public education to inculcate caregiving values and skills in youths.

It is heartening to see our Members of Parliament arguing for more support in terms of infrastructure for the elderly, in addition to training and incentives for caregivers, which are intended to support and care for our caregivers. However, in a subsequent development, Mr Lim Boon Heng, who is in charge of aging issues, announced that the possibilities of financial incentives are a no go since there are schemes in place tax reliefs and maid-levy concessions. Even the requests for caregivers to be granted special leave were given a no go because according to Lim, the issue has to be taken up with the employers and unions. Requesting for granting of special leave for caregivers across the board isn’t the only viable solution. If employers are worried about productivity which could be affected, the other viable option that can be taken is to allow the employee to work from home where they could be present to care for their relative. This is known as telecommuting.

With the current focus on caregivers, medical staffing issues cannot be ignored. Due to an increasing aged population and decrease in numbers of caregivers as a result of our sub-optimal rate of population renewal, there is an increasing need for medical social workers whose responsibilities encompass the home care support of patients and assistance of the family with any concerns they may have. The other aspects of the medical social worker’s job scope is to plan the patient’s living arrangements at home and be the liaison between healthcare service provider agency and patient /and family as part of his care. To improve staffing of medical social workers’ ranks, the latter can be promoted as an attractive career option with incentives such as scholarships in return for a bond. Barriers of entry into the medical social work profession can be eased with training programmes that allow members of other profession to make a career switch.

Thus, there must be an increasing recognition of the role caregivers play in the care of their loved ones; from the medical standpoint, caregivers are an important link in preventive care. Employers with caregivers among their working staff may explore telecommuting and allow them to work from home if productivity is compromised due to granting of special leave. And given Singapore’s aging population by the time we reach 2030 compounded by the potential dearth of caregivers in their 30s to 40s, there is an increasing need to bolster the medical workforce, in particular medical social workers who would handle the day to day living arrangements of the patients at home.

Photo courtesy of Wong Jun Hao, Flickr.