By Radha Basu, The Straits Times, 7 Apr 2014
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.
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 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.
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.
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."
THE SINGAPORE PERSPECTIVE
Making eldercare leave mandatory
By Radha Basu, The Straits Times, 7 Apr 2014
By Radha Basu, The Straits Times, 7 Apr 2014
Herprit Kaur, 30, had to quit her job as an administrative assistant after her father, Mr Kahka Singh, 64, was seriously injured in a road accident in 2012.
The last straw came when her boss at the shipping firm where she worked foisted more work on her, when she wanted to leave early one evening as her father was undergoing a major operation.
"My mind was not on work and all I wanted was just a day off," said Ms Kaur. She spent long hours keeping a bedside vigil as her father underwent multiple operations in hospital.
Once he returned home, she had to arrange for his long-term care. He could not walk, change or use the bathroom by himself.
Despite money being tight, she hired a maid and returned to work as a travel and administration executive in a recruitment firm.
Working caregivers like her are in favour of mandatory eldercare, or parent care leave, to look after sick or aged parents.
"Even if it is just a few days a year, it will help since we won't need to feel guilty to take our parents for doctors' visits," said Ms Kaur who lives with her parents.
She has found a champion in Speaker of Parliament Halimah Yacob, who has repeatedly called for the Government to seriously consider legislating eldercare leave.
Speaking at a conference on ageing on March 26, Madam Halimah said: "Even if it's only for a few days, it will provide great relief and is a strong signal that the Government supports families in their effort to care for their elderly at home."
An NTUC survey released last year showed that 77 per cent of working caregivers do not have eldercare leave. Among the caregivers who quit work, 21 per cent did so to take care of an elderly family member full time.
The Government is reviewing again the need for eldercare leave.
It had said no to similar calls earlier, heeding employers' concerns that unlike childcare leave, which is finite, no one knows how long an elderly person will need to be cared for.
Employers are also concerned that parent care leave can add to costs and be open to abuse.
Echoing the fears of many businesses, a reader wrote to The Straits Times Forum recently to say if mandated, parent care leave will become "yet another type of compulsory leave entitlement that is difficult to police, in the same way that childcare leave has become a statutory entitlement that is being used for whatever purpose the employee chooses".
But this need not be true, shows data from the Public Service Division (PSD), which oversees policies for the civil service.
Since 2012, civil servants here have been entitled to take two days off a year to care for parents. So far, only around three in 10 have used the leave, a PSD spokesman told The Straits Times. "There are officers who do not use it as they do not have such needs now," she said.
Caregivers' advocates such as Mr Manmohan Singh from the Awwa Centre for Caregivers say that in the latest review of the issue, policymakers must consider the economic costs of people quitting work altogether when a parent's condition deteriorates.
This not only affects caregivers financially but can also undermine their re-employment prospects.
"Besides, parent care leave would also signal that Singapore is truly pro-family in substance and deed, not just in word," he said.
Countries like Britain already offer "family care leave" as opposed to childcare leave.
In fact, businesses in Britain have gone further, with some offering to even pay for caregiving packages for employees, just so that they don't quit.
An industry association called Employers for Carers has been set up specifically to guide businesses on how to retain employees who are caregivers.
More than 70 companies, including British Telecom, British Gas and the National Health Service are already on board, the BBC reported last month.
"One in nine in your workforce will be caring for someone who is ill, frail or has a disability," the organisation says on its website.
"In the current economic climate it is important to retain skilled workers rather than recruiting and retraining new staff."
This is the third of 12 primers on various current affairs issues, published in the run-up to The Straits Times-Ministry of Education National Current Affairs Quiz.
Helping to meet caregivers' needs
CAREGIVERS' needs are extremely diverse and very much a reflection of each family unit's social-economic situation ("Who cares for those who care?"; Monday). Hence, planning for caregiver support has to be configured appropriately.
The question that policymakers need to address is: Who can best help caregivers navigate the many schemes and services offered by government agencies and voluntary welfare organisations?
Unfortunately, many caregivers have to approach multiple partners to solicit advice and assistance, be it financial, medical or social. This adds to the burden of caregiving, and the social health sector should collectively adopt a "no wrong door" policy.
It is encouraging to know that home-, respite- and day-care services are gradually being increased. Even though it may seem intuitive that this is the sort of infrastructure that all caregivers need, the low take-up rate may be attributed to the mismatch of caregiver needs and available services.
We cannot overlook the complexity of caregiver dynamics within each family, and this is recognised as the silent suffering that may compound or fracture family relationships.
The caregiver's and patient's needs have to be assessed in tandem. Current health-care funding is directed towards the patient, and it may be timely to consider indirect funding for caregivers as they play a pivotal role in maintaining the patients' health.
The present gap in knowledge for caregivers and their needs assessment requires professional help. The problem is that many caregivers are unaware of what they really need, and we need to acknowledge that caregiving is a life journey that is constantly changing.
The question is: How can we string together a complete end-to-end care plan for both patient and caregiver that caters to both their health and social needs? This entails deepening partnerships between community groups and government agencies.
We need to consider developing a cohort of caregiver coordinators or case managers who can string together the many proposed new initiatives.
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