Joyce Lim, 57, works from 9am to 5pm scheduling appointments for 63 doctors who see thousands of patients daily at one of Singapore's busiest hospitals.
A slip-up on the job could mean wasted time and frayed tempers, for doctors and patients alike.
At the end of her working day, she heads to her mother's Bukit Merah flat. There, she spends three hours every evening sponging, cleaning and caring for her 83-year- old mother and 66-year-old brother, who suffer from multiple illnesses.
It is past 9pm before Ms Lim, who has a grown-up daughter, begins the hour-long commute from Bukit Merah to her three-room flat in Clementi, where her own household chores need to be done.
It is often past midnight by the time she gets to bed, only to wake up five hours later and start the routine all over again.
"It's what is expected of me," she says with a sigh, at her mother's flat.
Her smile is tired. Her eyes, ringed in black, betray sleeplessness. And she weighs only 38kg. "They depend on me for everything."
There are an estimated 210,000 caregivers here and with the silver surge in Singapore, their numbers can only grow.
The first in-depth study by a team of researchers at Duke-NUS Graduate Medical School revealed some startling facts about Singapore's caregivers.
Around half the nearly 1,200 caregivers surveyed have jobs. Yet, they spend 38 hours every week on caregiving chores, which is like holding a second job. Only half employ 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.
Principal investigator Angelique Chan from the Duke-NUS school says the results show that long-term care services available are not in sync with what people need.
"The operating hours may not be suitable, costs may be high and people just don't see the value for money," she says. "This needs to change."
The survey also covered care recipients and another 800 pairs of potential caregivers and care recipients - people who are well today but could need help soon.
In the wake of the study results, made public in May, The Sunday Times interviewed dozens of caregivers, care recipients, eldercare experts and professionals to piece together a phenomenon that is inexorable, complex and challenging.
Living longer, not well
People are living longer than ever before but, for many, living longer does not mean living in the best of health. Families, meanwhile, are shrinking.
And to top it all, Singapore is one of the fastest-ageing societies in the world, with the proportion of people aged 65 set to surge from around 380,000 now to 900,000 by 2030.
There are no publicly available projections of caregiver numbers yet. But the latest National Health Survey - made public in November 2011 - collected caregiver data for the first time.
The Ministry of Health survey, which polled around 4,350 people, showed that 8.1 per cent of respondents aged between 18 and 69 - or potentially 210,000 people - were already providing regular care to sick or frail family members. Close to 40 per cent had been caregivers for more than a decade.
Data from both the Duke-NUS and Health Ministry surveys found that most caregivers are married, employed individuals in their 40s and 50s. Women outnumber men as caregivers and recipients. The Duke-NUS survey found that adult children make up nearly two-thirds of all caregivers.
But cold numbers tell only half the story. As The Sunday Times interviewed close to 20 families caring for ailing loved ones at home, the sheer physical and emotional exhaustion of caregivers was plain to see.
Elderly caregivers - particularly spouses - were especially vulnerable to stress. As Singapore ages, their ranks can only grow.
Retired cleaner Ang Hock Guan, 84, for instance, is sole caregiver to his wife, Madam Tan Kim Yer, 94, and her daughter from a previous marriage, Ms Soh Mong Chee, 64.
Both mother and daughter are nearly blind. Mr Ang cleans their two-room rental flat and does the laundry for all three of them. The couple's daughter, Ms Ang Yoke Siew, who is in her 50s, comes by to help bathe her mother once a week.
NTUC Eldercare has arranged for them to get free lunches on weekdays and provides dried food supplies to help them cook dinner.
But there is no one to meet the daily care needs.
"I do what I can and try not to think of the future," Mr Ang said in Hokkien.
Not just a silver issue
Caregiving is not just a "silver issue", says Dr Jason Cheah, chief executive of the Agency for Integrated Care (AIC), which was set up by the Government in 2009 to coordinate the care needs of thousands of frail old folk.
"It can concern everyone at some stage of their lives," he said. Anyone might end up a caregiver to parents, grandparents or an ailing spouse.
"It is important for Singaporeans to learn about eldercare and caregiving early to be better prepared for the journey, should the need arise."
So far, experts say, most people deal with caregiving in a crisis mode. Many adult children or spouses find themselves forced to give up their jobs to look after family members, putting their own financial future in serious jeopardy.
Take Mr Tan Chong Leng, 56, and Madam Azizah Mohamed Noor, 42, for example.
Mr Tan, a former painter, stopped working late last year when his mother, Madam Ong Siew Hoong, 85, fractured her hip and lost the use of her legs after a fall.
The wizened old woman with a warm smile is fully dependent on her son for her day-to-day needs, including bathing and changing of diapers.
Sitting in their one-room rental flat in Lengkok Bahru, Mr Tan says: "She can't even walk, so it's impossible for me to leave her alone at home and work."
Madam Azizah, who lives nearby, quit her part-time job as a cleaner in a bank to look after her widowed mother, Madam Fatimah Hadir, 69, ever since the older woman collapsed suddenly one morning in May this year. She has kidney disease, diabetes and knee problems on top of a pre-existing speech impairment.
A divorced mother of four, Madam Azizah used to leave her youngest child, three-year-old Siti Nurjannah, in her mother's care while she went to work. So caregiver has turned care recipient overnight. She needs to be fed, bathed and changed and needs a wheelchair to get around.
When her mother's condition stabilised, Madam Azizah recently returned to work for two hours a day. "I just pray that nothing happens to them when I work," she says, of leaving her invalid mother and young child at home alone.
Although the poor are hardest hit, caregiving woes strike better-off families too.
Single mother Hayati Suaidi, 42, spent the entire day in hospital recently with her mother, Madam Haisah Satni, 76, who has leukaemia, before returning to her five-room Bedok flat and her father. Retired driver Suaidi Said, 80, has a slipped disc and severe mobility problems.
Madam Hayati, a diploma holder, quit her full-time job after one-too-many hospital emergencies. A former employee of Outward Bound Singapore, she recently started her own small business running outdoor activities for schools and other interested groups.
"My own company is uncharted territory for me, but at least it allows me more flexibility," she says. When she takes short business trips to Malaysia, her 15-year-old son helps tend to his grandparents.
Madam Hayati, the only child from her father's second marriage, has not yet sought any state support as she believes there are "many more who need it more". But her future is fraught with worry.
Ask about care arrangements as her parents get older and she breaks down in tears. "I just leave it to God," she says simply.
Help on the ground, meanwhile, is on the rise. According to AIC, there are more than 20 programmes that either directly or indirectly help caregivers and most were initiated in recent years.
The trouble is, many do not know the help exists.
Touch Caregivers Support, which runs a helpline, received more than 3,000 calls last year, a 70 per cent rise since 2010, when the line was set up.
Its director Kavin Seow points out that one of the most common queries is about "elder-sitting", where someone will stay with an elderly person at home while the caregiver tends to other chores or simply needs a break.
The cost for such a service, at more than $20 per hour, is high even though there are some subsidies for poor families.
"In order to manage costs, caregivers may engage this service sparingly, denying the most appropriate care necessary for the older person," says Mr Seow.
Where services do reach caregivers, they are accepted with gratitude.
The Aged Care Transition (Action) Programme is one of the more popular schemes under which AIC care coordinators help connect families of patients recently discharged from hospital to various community support services.
Ms Joyce Lim, who is a hospital administration clerk, has been a beneficiary of the programme since her mother, Madam Soon Kim Pian, 83, who has gout, rheumatoid arthritis and osteoarthritis among other conditions, was discharged from hospital more than a year ago.
Since 2011, Madam Soon has been getting subsidised meals delivered to her doorstep.
AIC case manager Dawn Low drops in fortnightly. "It's good to have someone to talk to - it eases my stress," says Ms Lim, the youngest of five children.
But still, her day-to-day burdens remain unrelieved.
She tried putting her mother in a nursing home but, at the last minute, the feisty old woman refused to go to what she described as a place with "rows of beds and nothing else".
Day-care centres for the elderly are not an option either as Madam Soon needs to lie down frequently, a service most such centres do not provide.
One of Ms Lim's sisters used to help, but reduced her commitment once she had to start tending to four grandchildren. The other sister, she says, is uncontactable.
Both her brothers are ill. The elder one works odd jobs and has knee problems. The second, who lives with Madam Soon, has been treated for mental illness since he was 19.
Ms Lim says she tries her best to be a filial child but her mother can be hard to please and does not care for the subsidised meals delivered to the house.
So she often ends up buying food she cuts into bite-size pieces for her mother.
"She raised five children as a single mother working as a washerwoman," says Ms Lim. "She just can't understand why I find it hard to care for just two of them."
This is the first of a two-part series on caregiving in Singapore. To share in the journeys of love, loyalty and sacrifice, log on to www.razortv.com.sg. The second part will appear next Sunday.
This story was first published in The Straits Times on Sept 22, 2013
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