Ms Ang Bee Lian, 23 Dec 2021
Caregivers can be considered as a demographic group that has been gaining more attention over the past decade, as caregiving needs in Singapore increase (Hingorani, 2019). This “invisible workforce” has grown mainly due to our rapidly ageing population and shrinking family sizes. We now see the emergence of the “sandwich generation” - caregivers who care for both their elderly parents and children – who should be supported for their unwavering commitment to care for loved ones.
More than 210,000 caregivers in Singapore deal with the financial, physical, and psycho-social responsibilities of caring for the elderly and the young (Ministry of Health, 2010). Without doubt, caregiving is for most, a difficult journey and the pandemic has made caregiving even more demanding (Mohan, 2020). With more family members confined to their homes, caregivers now face greater obligation to care for their family and engage them for extended periods, leaving little physical and mental space for themselves (Awang, 2021). Unable to leave their houses, caregivers have also become more socially isolated from friends and their extended family (Mohan, 2020). For caregivers of dementia patients, access to care services was limited during the pandemic, as hospitals had to redirect resources to handle COVID cases. The effects of the pandemic have caused caregivers to shoulder a heavier caregiving burden, on top of their existing caregiving role (Teo, 2021). How can we then better support caregivers? How can we better understand the experiences of caregivers?
The experience of a caregiver
One way to understand the impact of caregiving on caregivers, is to understand the changes they face in taking on the role of caregiving. When caregivers take on the role of caregiving, they face a huge life transition that tends to happen unexpectedly. For instance, when a severe medical diagnosis is given to a parent that requires immediate care, the adult child has to take on the caregiving role. This new duty as a caregiver can cause stress, uncertainty, and fear, and comes with a long list of things to learn and master – hard skills such as personal care techniques, clinical skills such as tube feeding and recognising early warning signs of health conditions, and soft skills such as communication skills with a parent who has deteriorating cognition. Acquiring these skills could cause caregivers to sacrifice much time and mental energy. Caregivers may also face unrealistic expectations set by others. For caregivers of parents, the caregiver’s siblings might expect the caregiver to quit his or her job and provide 24/7 care for their parent. Caregivers may similarly set high expectations for themselves, such as ensuring that the condition of their care recipient does not deteriorate, even if it is not within their control.
As caregiving takes up a substantial amount of time, caregivers may compromise on other areas of their lives. This could in turn affect the caregiver's work performance, relationships with children, spouse and friends, as well as their personal life plans. These changes, coupled with the financial strains of caregiving, may cause caregivers to experience feelings of helplessness and isolation. These issues were further intensified during the pandemic where caregivers have to cope with their own stresses and uncertainty arising from the pandemic, on top of managing their loved ones’ needs.
The cascading responsibilities that caregivers experience can cause them to face burnout at some point. To identify caregiver burnout, it is important to watch out for signs such as anxiety, depression, irritability, impatience, constantly feeling exhausted, change in appetite, withdrawal from family and friends and more (Homage, 2021). The most serious sign is when a caregiver wishes to hurt oneself or the care recipient. Professional help should be sought if such signs of burnout occur.
1. Finding purpose in the act of caregiving. Caregiving can be difficult when the tasks are mundane and repetitive. Caregivers may also not feel prepared to care for their loved ones or may dislike caregiving tasks. It is important for a caregiver to be centred on his or her purpose of caregiving and be aware of the impact of this experience on themselves.
2. Setting aside time to self-care. Caregivers need to establish a care routine and time for themselves, even if it is just for half an hour in a day. Eating right and exercising regularly are also important for caregivers to stay physically and mentally well.
3. Managing boundaries. Caregivers tend to give in to requests, even when it goes beyond their limits. By learning to say no, caregivers will avoid overstretching themselves to meet the ever-increasing needs. Care recipients also need to realise that caregivers have boundaries.
4. Seeking out support. Caregivers should not be shy to ask for help, given the number of responsibilities that they must take on. Support could come in the form of respite care or simple tasks such as buying groceries or food. This will give caregivers more time and rest for themselves.
5. Learning to accept difficulties that come along the way. Caregivers may have to make abrupt financial arrangements due to the health conditions of care recipients. It is thus helpful for caregivers to carry out regular financial checks and plan early where possible to mitigate financial stress. Making plans such as Advance Care Planning and the Lasting Power of Attorney for care recipients may lessen future financial and care issues.
What can we do to help caregivers
As caregiving tends to be a difficult and thankless task, we should play our part in appreciating and supporting caregivers around us.
These actions may seem small, but they go a long way in valuing the work of caregivers and reducing caregiving stress.
Caregivers can check out the one-stop portal by the Agency for Integrated Care (AIC) which provides digital information and resources for caregivers and care recipients. AIC also operates eight AICare Link branches in hospitals and community hospitals to advise loved ones on getting appropriate care for seniors.
In March 2021, a new Singapore Together Alliance for Action (AfA) for Caregivers of Persons with Disabilities was formed by community partners and SG Enable to co-create solutions on issues faced by caregivers of persons with disabilities. This initiative will complement the 3rd Enabling Masterplan, which highlights the need to improve caregivers’ well-being and capabilities through peer support and informal support networks (Ministry of Social and Family Development, 2021).
Caregivers, and us
Quoting Rosalynn Carter, who once served as the first lady of the United States, she said “ There are four types of people: those who were caregivers, those who are caregivers, those who will be caregivers, and those who will need caregivers .” Knowing that caregiving responsibilities can fall on any one of us, we need to step up to care for caregivers, raise awareness of the challenges that they face and recognise the invaluable work that they do. As more Singaporeans take on caregiving, we should make it a collective effort to build up and support caregivers and make our society a more livable place for all.
Download the full letter here
MS ANG BEE LIAN
Director-General of Social Welfare