Have a question about MSF? Chat with our new virtual assistant Ask MSF for information relating to MSF.
MSF website may undergo scheduled maintenance on Thursday, 7 December, 6pm to 11.59pm and on Saturday, 16 December 10pm to Sunday, 17 December, 6am. During these maintenance period, users may experience intermittent access issues or downtime when accessing the website. We apologise for any inconvenience caused.

Caregiving for Elderly

  • Practice issues
  • Vulnerable Persons
  • Children and Family

Ang Bee LianMs Ang Bee Lian, 16 May 2018

Dear Social Service Practitioners,

Many of you would have handled cases with elderly clients who rely heavily on caregivers for assistance in their activities of daily living and for psycho-emotional support. Often times, these caregivers come from the sandwiched generation and also have their own families and children to care for. All these responsibilities often lead to caregiver stress and burnout. What can we as practitioners do to better support the caregivers in our midst?

Understanding the Factors that Lead to Burnout

As practitioners who work with caregivers, it is important to understand the factors that leads a caregiver to experience burnout and to provide timely referrals or assistance before the situation deteriorates. Caregivers who are new to the role may not go in expecting to face stress, depression, loneliness or hopelessness. This is where practitioners can intervene early when working with new caregivers to ensure that they are prepared and to direct them to the support and help they need.

So why is caregiving such a difficult role and what factors contribute to burnout and stress?

1. Changes in roles: the dynamics of the relationship between a child and parent or between a husband and wife would change significantly upon taking on the role of a caregiver. Such changes can cause strains and stresses to the relationship, especially when expectations are unmet and when new responsibilities are taken up. It takes time for caregivers to adjust to the new role and the new dynamics of their relationships.

2. Failed Expectations: caregivers may expect their caregiving to effect positive change in the health and psycho-emotional well-being of their loved ones. However, this may not always be the case especially with the presence of progressive diseases such as dementia or Parkinson’s.

3. Little alone time: the schedule of the caregiver centers now around the person being cared for rather than themselves. They often have a long list of caregiving duties and have little time for themselves to recuperate or rest.

4. Fear and uncertainty: taking on the role of caregiver often requires learning new knowledge and skills such as information about the illness, household chores and helping with daily activities of living. Caregivers can be overwhelmed with fear and uncertainty over their own capabilities for this new role, and are unsure what to expect for their loved ones in the future.

(Scott, 2018)
(Cleveland Clinic, n.d.)

Dilemmas and Difficulties that Caregivers face

The main dilemma that most caregivers have is about trade-offs. The choice is often between safety and autonomy and independence. The elderly are often motivated by autonomy and are reluctant to accept help. They interpret accepting help as a loss of autonomy and independence when in fact by accepting the correct form of help, they can better keep their independence. Having the conversation and negotiation is an important start although it is fraught with difficulty because it is filled with emotions.

Any conversation about supporting the senior can be emotional as the senior will naturally be anxious if there is a loss of independence and a signal about moving into a nursing home no matter how distant the idea may be. The goal of the negotiation should therefore be how to enable the senior to live safely with the appropriate help.

Signs and Symptoms to Look Out for

When working with caregivers, some red flags that practitioners can look out for in clients include:

  • Overwhelming fatigue or sleep problems (sleeping too much or too little)
  • Changes in eating habits, excessive weight gain or loss
  • Feelings of hopelessness or depression
  • Withdrawing from or losing enjoyment in activities they once enjoyed
  • Feeling overwhelmed
  • Being unusually impatient or argumentative with others or the person being cared for

(Vitas Health, n.d.)

These symptoms are usually signs that the caregiver is facing stress or burnout and should not be ignored.

Practitioner’s role in supporting caregivers

Practitioners should not only help caregivers who reach out for help but be on the lookout for those who do not ask for help but are in need of help. Practitioners can intervene by providing information on services and programmes that provide respite care for caregivers, organising family meetings to discuss caregiving responsibilities and stresses, connecting caregivers to support groups or other caregivers and providing resources for financial management and planning, as well as financial assistance (Nguyen, 2012). These interventions should be done in a timely and sensitive manner so that caregivers do not feel even more overwhelmed.

When working with new caregivers, it is helpful for practitioners to inform them of the common struggles faced by caregivers as well as the resources or support that are available. This would help them to be mentally prepared before they plunge into the role and to be aware of the help resources available to support themselves and their families.

Starting a Critical Conversation

It may not cross a caregiver’s mind to engage the elderly they are caring for on a conversation about ageing. However, this is important as it helps caregivers to understand the needs and wants of the loved ones they are caring for. While we think that speaking with a senior about ageing is like any other conversation, it is perhaps not quite so. Practitioners can coach caregivers how to carry out these conversation starters. Examples of starters can include topics such as safety, freedom, peace of mind, social connection, and being able to make choices.

Practitioners can walk caregivers through the process. Encourage them to write an outline to organize their thoughts so that they won’t forget important points. Emphasize that there are no right or wrong options or ideas and to keep an open mind. Encourage them to be respectful and considerate and to be a good listener. It sounds odd but it is useful to do a practice run so that one will be less nervous about the conversation.

It is usually natural to start with casual conversations to plant ideas. The caregiver can then build on these to lead to the more decision focused conversations later. Some possible ice-breaker questions are as follows: “I’ve noticed some things take more energy these days. What are the important things you really want to do? or “What are your priorities? Is there a way we can make it easier for you to do these things?” Caregivers can also use an event in the news or a story about an ageing family member or friend to link the conversation. For example: “We never talk about these things. I don’t want to pry, but it would give me a peace of mind to know there’s a plan if we need it.”

Ensuring Caregiver Support

With our ageing population, the number of caregivers will be on the rise in the years to come. They are an important source of care and help for the elderly and should not be overlooked. It is important that they are also supported by state and community resources. Practitioners need to be increasingly prepared on how to work with caregivers and to ensure that they get the support they need.


    Scott, E. (2018, March 9). Common Causes of Caregiver Stress. Retrieved from verywell mind.

    Cleveland Clinic. (n.d.). Caregiving: Recognizing Burnout . Retrieved from Cleveland Clinic.

    Vitas Health. (n.d.). Signs of Caregiver Burnout and How to Prevent It. Retrieved from Vitas Health.

    Nguyen, A. (2012, October 31). Working With Family Caregivers. Retrieved from Social Work License Map.

Download the full letter here

Ang Bee Lian

Director-General of Social Welfare
Ministry of Social and Family Development