Unlike in larger families where caregiving load can be spread out, an only child faces immense stress and is more likely to suffer burnout
By Elizabeth Law, Correspondent, The Straits Times, 28 Sep 2024
On a Tuesday afternoon at a coffee shop in Ang Mo Kio, Mr Glenn Poh returns to his waiting mother with two drinks: one hot and one iced. She picks the iced lemon tea.
“All my life she never used to drink cold drinks but now, she always wants something iced. It’s like she’s a small kid again,” he says of his 74-year-old mother, Madam Tan Sow Meng, who has Alzheimer’s disease.
As the only son, Mr Poh took it upon himself to look after her, personally navigating the twists and turns of caring for an ailing parent.
“Whatever needs to be done needs to be done. It’s because I was raised like this,” he says. Having seen how his mother cared for his late father after a stroke, he knew he wanted to do the same for her.
In Singapore, with its rapidly ageing population and cultural norms of filial piety, many adult children find themselves thrust into the role of caregivers.
Life can be put on hold when mum or dad falls ill, and those without siblings or other home help can find themselves shouldering the whole load.
Data shows there were at least 128,800 only children with mothers above the age of 50 in 2023, more than triple the 39,800 in 2003.
In a population of 5.92 million, 1.36 million people have mothers above the age of 50. While the number of only children is just a fraction of that total, researchers and social workers warn that unlike in larger families where the caregiving load can be spread out, only children face immense stress. Among other health challenges, they are more likely to experience burnout.
A stout man with a buzz cut dressed casually in a polo shirt, shorts and sliders, Mr Poh, 44, is unfailingly polite. He says “thank you” or “pai seh” (Hokkien for “sorry to bother”) to anyone he interacts with, and thanks The Straits Times team profusely at each of our three interviews.
He talks about his days in a methodical way, ticking off each activity as if going down a list. He says drawing up lists and “standard operating procedures” helps him find structure amid the uncertainty and constantly evolving nature of his mother’s condition.
But ask him about challenging moments, and his upper lip quivers.
The week before, rather than take her shower at the usual time, his mother fussed around with throwing away rubbish and lighting the oil lamp at the family altar.
“I shouted at her, and I asked her to go and take a bath, which she did. By the time she came out of the bathroom, I apologised but she didn’t remember. I regret it when I lose my temper with her because she cannot remember,” he says, tearing up.
“So it’s not a good feeling. Because you did something wrong, but you’re not able to make up for it.”
He admits this often happened in the initial stages, especially when he had unrealistic expectations about his mother’s condition, and became frustrated that he could not do more to help her.
Like Mr Poh, human resource executive Gail Lim found it hard to come to terms with her mother’s condition. The older woman had a massive heart attack while on holiday in December 2023, leaving her unable to walk or use the bathroom without assistance.
Although the family has a domestic helper to help with her care, Ms Lim, 33, was worried the latter might become burnt out and quit.
“I got even more stressed and kept pushing (my mother) to do more to regain strength and mobility. It was only when my mother said I should let her recover at her own pace that I realised I was imposing my own thoughts and timelines on her,” she says.
Her mother, who is in her 60s, is still undergoing occupational and physical therapy, but is unlikely to fully regain her independence.
Ms Lim admits being “not in a good headspace” then, consumed by the fact that her mother, a retiree who lives with her husband, could no longer be as social or active as before.
“The hardest part was seeing my mother losing her independence. So emotionally and psychologically, it’s been very, very hard for me… there was a point where I felt like I was crying all the time,” she says, adding that she stopped seeing friends for nearly five months. The situation also strained her marriage.
Although her employer, a multinational energy company, was accommodating and offered her flexible work arrangements, work took a back seat. It had become difficult to concentrate on her job when she was constantly worrying about what was happening at home.
It was only after a psychologist advised her to carve out a specific time every day to check in with her mum that she was able to better compartmentalise her time and emotions, she says.
“I’ve thought that if this didn’t happen, I would’ve been so much better at my job. I would definitely have put in extra hours to adapt to my new team. But because of the way things panned out, your priorities get realigned because I do want to help out and take care of my mother,” she adds.
Asian expectations about caring for one’s parents are long-held. For example, those who put their parents in nursing homes may be seen as “unfilial”. While this is gradually changing, many still see caregiving as an obligation rather than a choice, and a lack of family support can leave caregivers feeling stressed and disappointed.
While this may be even more heightened for only children, there has not been much research into the issue, because of their small numbers, says Dr Jeremy Lim-Soh from the Centre for Ageing Research and Education (Care) at Duke-NUS Medical School.
In a 2023 survey of older adults receiving care as well as their caregivers, those who were only children reported higher levels of perceived stress and depressive symptoms than those with siblings. However, the sample size of seven only children – as compared with 178 respondents with siblings – was too small for any statistically significant conclusions, he adds.
The main question is how much support a caregiver has.
“Personally, my hunch is that having siblings does not matter as much as whether those siblings are supportive or not… Someone may not be an ‘only child’, but one can still be an ‘only caregiver’ if siblings are unable or unwilling to pitch in,” says Dr Lim-Soh.
He points out that in families where there is only one child, there is no “option” of sharing the load, and the burden of care naturally lands on the only child.
“Caregiving is both labour-intensive and financially burdensome, and the worry is that children who spend the prime of their life caring for ageing parents will not have sufficient savings and/or CPF for their own old age,” he says.
“This problem could be compounded if they do not have siblings who can at least lend financial support even if they are unable to physically help with caregiving.”
Children who are caregivers may also experience disruptions to their careers. Ms Michelle Tan, 44, a global product manager at a medical device company, had to cancel two work trips this year because her mother was hospitalised six times. Madam Mary Tong, 78, has high cholesterol, high blood pressure, osteoarthritis, diabetes and diverticulitis, or inflammation of the large intestine lining.
“It’s not as intense as cancer but it takes an emotional toll,” says Ms Tan. “If you say that this isn’t causing me stress, I would be lying.”
Calling herself “independent and a bit rebellious”, she lets on that she would have taken the chance to work overseas if she had siblings to “keep an eye” on her mother, especially after her father died.
“I’ve held myself back by not relocating overseas,” she says.
Others, like tax consultant Heron Khalid Goh, 56, end up leaving careers and lives abroad to return home.
In January 2021, his then 86-year-old father was admitted to the intensive care unit after a serious bout of pneumonia. His mother, unable to find her way home, was later diagnosed with dementia.
Then based in Kuala Lumpur, Mr Heron knew he had to move back after nearly three decades away, but flew right into Singapore’s strict pandemic-control policies.
“Those 14 days in hotel quarantine were the longest two weeks of my life, knowing my father was fighting for his life, my mother wasn’t well too, but not being able to do anything,” he says.
His jet-setting life gave way to one that largely revolved around cooking, cleaning, and taking his parents to medical appointments.
Earlier this year, his father, Mr Khalid Goh Abdullah, had a violent outburst during a regular appointment at Changi General Hospital, yelling at nurses, doctors and even security. As they were leaving the clinic, his mother suffered a fall and had to be hospitalised.
During the three days she was in hospital, her husband refused to leave her bedside.
“That’s when the medical staff asked if my father had dementia,” Mr Heron recalls.
“How could it be? He has been so independent and able to do everything himself. But in hindsight, I missed the signs. You don’t see what you don’t want to see.”
Help from the community
At the TouchPoint active ageing centre in Ang Mo Kio, Madam Tan is getting distracted. It is 2.15pm and she has been at “Happy Exercise” for nearly 45 minutes, but her son is nowhere to be seen. A popular weekly activity at the centre, the hour-long session combines simple movements with basic cognitive exercises like counting backwards – a workout for mind and body.
That hour is also when Mr Poh goes to run errands like buying groceries, doing the laundry, or catching up on cleaning.
At 2.20pm, he appears, and her face visibly relaxes.
He helps put away the chairs, thanking each staff member by name for watching his mother while he was gone.
Then it is off to AMK Hub, a 15-minute walk away in the blistering heat.
Mr Poh used to take his mother out to a variety of places, but now she becomes anxious when faced with the unfamiliar, so they stick to their neighbourhood mall.
He holds her hand as they walk, his bulky backpack and a sling bag – filled with what he calls “caregiving essentials” like medicine, a windbreaker and a change of clothes – swinging against his sweaty back.
Several carabiners hang on the shoulder straps. For food or groceries, he says, so his hands are free to hold Madam Tan or catch her if she trips.
“She’s very ‘sticky’ with me. At the early stage (of her disease), I tried to have other family members watch her while I went out, but she got very upset, and anxious, so it’s better that I’m with her,” he says. These days, an aunt helps out once a week, accompanying Madam Tan to Buddhism classes at a Geylang temple, and giving Mr Poh two hours to himself.
Social service agency Touch has also been a source of support.
It runs a wide range of programmes and centres, including an active ageing centre at Block 433, Ang Mo Kio Avenue 10, a stone’s throw from Mr Poh’s home.
Finding the right community support can be a lifeline for solo caregivers.
Mr Poh has registered his mother for activities every weekday, ranging from exercises to board games, to keep her physically and mentally engaged. A social worker helps to coordinate their assistance or care programmes, including counselling support for Mr Poh.
In 2022, the centre started Carers Circle, a caregiver support group, which Mr Poh repeatedly refers to as a light shining through the fog.
Through monthly sessions, he was connected to other caregivers within the neighbourhood, including those with years of experience under their belt like Ms Carol Neo, 61, whom he refers to as a “mentor”.
The adjunct trainer who cares for a 91-year-old mother with advanced dementia, says: “Single children like Glenn have a lot to carry, especially since he’s still very young and a man trying to care for his mother, so we try to help wherever we can, be it simple tips on how to handle situations, or what to expect when the disease progresses.
“It might be small things like incontinence, urinary tract infections, or your parents’ inability to dress themselves, but it can be very traumatic.”
For instance, when Mr Poh’s mother started losing control of her bladder, Ms Neo was the first person he texted asking what to do.
Others, like 46-year-old Robin Teo, turn to day care and home nursing services to help with his elderly parents.
His father, Mr Teo Chin Hye, 86, has several chronic illnesses, a fractured hip, and breast cancer. His mother, Madam Eng Ah Nio, 85, has dementia and has to use a wheelchair to get around.
Each morning, Mr Teo and his parents wait at the void deck of their three-room flat in Bedok for two different transport services. One takes his father to St Luke’s ElderCare in Marine Parade, and the other, his mother to Tembusu Eldercare Centre in Eunos.
With his parents looked after, he can go to work in his IT support role for ValueMax, a Singapore firm with interests in moneylending, pawnbroking and jewellery stores. His parents are also dropped off at home in the evening and he brings them dinner.
On the weekend, a care aide comes to bathe his mother.
But things don’t always go according to plan.
“Sometimes we’re just a little bit late in the mornings because you know how old people are. Then the transport will leave without us, which means I have to try to find a way to get my father to day care, or he will have to stay at home.
“Other times, the aide may not come on weekends, and I have to shower my mother myself.
“It can be a bit difficult dealing with my mother because she can’t remember, or doesn’t want to take her medicine, or shower, but I have to tell myself it’s okay, she has done it for me before so I should help her,” he says, choking up.
Finding emotional support
Mr Poh remembers the exact moment he knew his life would change for good: 3.30pm on Oct 25, 2021. Down with a cold, he was unable to take his mother to her polyclinic appointment following a series of tests for dementia.
He was told about his mother’s dementia diagnosis over the phone, while he was standing outside Ang Mo Kio Polyclinic.
“The doctor continued to speak but I couldn’t take in the details already. Throughout the rest of the day I tried to act as normal as possible. That evening, I did a lot of Googling, then I knew it was a lost cause.”
He has since come to terms with his mother’s condition, he says.
“I don’t think that I’ve got over it. It’s just that you just have to live with it.
“I know this is a war that I will lose eventually, but the small wins like making my mother more comfortable, dealing with a situation better, those small daily wins, I take them.”
Studies have shown that the emotional burden of caring for an older person, especially a parent, is a heavy one. According to the research brief on caring for the elderly published by Care at Duke-NUS in 2023, nearly one-third of caregivers in the survey exhibited depressive symptoms.
“Further attention is needed on family caregivers’ own physical and mental health, given that the prevalence of depressive symptoms among them is much higher than the national average,” the researchers wrote in their concluding remarks.
It is a problem that social service agencies are aware of, with many conducting sessions on emotional well-being during training programmes. Research has shown that those with strong support networks through family, friends or support groups exhibit less stress and have more positive experiences as a caregiver.
Yet asking for help in a group setting can be difficult for some like 37-year-old Ernie Zheng.
After his father’s sudden death in 2022, Mr Zheng, who lived with his grandmother, was now responsible for his mother, who lived in a neighbouring block.
It took the accounts specialist in the tech industry a year of struggling to manage his mother’s schizophrenia before he walked into a Family Service Centre in his neighbourhood for help.
A social worker suggested he attend a 12-week training programme at Caregivers Alliance Limited (CAL), a non-profit organisation specialising in supporting caregivers to those with mental health conditions.
“I was initially sceptical about how much it’d help, but after a few weeks, I learnt not to react to things my mother was saying or doing.
“Getting to see people from all walks of life coming together and sharing all kinds of challenges, it made me feel like I wasn’t alone,” he says.
Much like the support group at Touch, CAL’s classes are aimed at equipping caregivers with practical and soft skills like creative problem-solving, and making time for self-care when looking after another person, says Mr Louis Lee, an ebullient CAL programme executive who runs the training sessions.
“Importantly, it’s not us the facilitators who matter in this, it’s about forming a network of fellow caregivers who can support each other in the long run.
“Whenever I see in these chat groups that people are organising meetups, or answering each other’s requests for help, it makes me very happy because I know my job here is done,” he says.
Anticipating future needs and wishes
In 2011, Singapore introduced its national advance care planning (ACP) programme so individuals can set down their healthcare wishes before they lose their mental capacity to do so. With more Singaporeans encouraged to age in place, ACPs offer a blueprint for caregivers to follow in hopes of reducing the stress of decision-making in difficult moments, even though they are not legally binding.
According to the Agency for Integrated Care, some 36,600 Singaporeans had ACPs by May 2023. In a speech in August 2024, Minister of State for Digital Development and Information and Health Rahayu Mahzam said another 10,000 ACPs were completed between July 2023 and August this year.
Ms Tan, the medical device executive, was spurred into drawing up an ACP after an anaphylactic episode in 2020. She feared that the tables would be turned and that her mother might end up having to look after her instead.
“While it is stressful for my mother to have to deal with the situation, at least there’s a plan,” she says.
It also prompted conversations between her and Madam Tong about what the older woman wanted if things took a turn. A former canteen operator, Madam Tong said she would leave things in the hands of her “more educated” daughter.
“She wants to be in a quiet environment, and wants to be at home if possible,” Ms Tan says.
“But of course if it’s something serious, then we’ll have to decide what is the best care possible for her in that situation.”
Some parents are also making plans so that their only children are not left with the heavy job of looking after them.
Former BMW marketing executive Mary Lim has ensured she has enough after retirement so there is no financial burden on her only daughter Yvonne, 46, a general manager at a private lifestyle club.
The active 73-year-old still regularly meets old colleagues and friends for lunch, volunteers at church and attends the “occasional” Pilates class, in between looking after her granddaughters Lauren, 12, and Nicole, 10, who live just a block away.
“If I get sick, I hope to have my daughter take care of me, of course. But I won’t mind going to a good nursing home either,” she says, perched on a sofa in her daughter’s flat as her lively granddaughters clamour for her attention.
“She knows it, we’ve spoken about it, so I think by having the finances in place, it at least takes away one stressor when I’m incapacitated,” she says.
Nursing an iced fruit tea at the Coffee Bean & Tea Leaf in AMK Hub, Madam Tan watches the mid-afternoon crowd of students and shoppers cruising through the mall as her son sits across the table fiddling with his laptop.
The lull allows him to catch up on work while his mother relaxes in the air-conditioning.
For a graduate with a computer science degree, working on IT support for a local company is not challenging, but it pays the bills. At night, Mr Poh stays up till the wee hours, working on a tracking app for those with dementia, or simply watching anime.
He knows the caregiving has exacted a price on his health, but he just has to keep going. And he knows that as his mother’s condition worsens, she will need greater care. He plans to have her live at home until he can no longer care for her. He doesn’t want to think about where she would go if something were to happen to him.
“I worry that if a day comes when I’m not around and can’t take care of her any more, she will forget me, or think I abandoned her,” Mr Poh says.
“It’s my greatest nightmare.”
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