Forum: Help hired helpers looking after those with dementia at home
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Hiring a live-in helper is often seen as the ultimate solution for ageing in place (As seniors age at home, untrained helpers are figuring out dementia care alone, Aug 10).
However, as both a healthcare professional who has managed hundreds of home-based patients living with dementia, and a daughter who journeyed through 10 years of caregiving with my mother, I have realised that general eldercare experience does not equal dementia care competency.
Many families, hit by severe caregiver burnout, parachute hired live-in helpers into homes just as a loved one’s condition deteriorates. Overnight, these helpers are expected to manage complex, multi-faceted caregiving roles. They become responsible for heavy lifting, preparing diets, managing bedsores, and handling unpredictable behaviour or emotional outbursts.
This is an immense, unfair burden for those often hired based only on general housekeeping skills or basic overseas nursing certifications.
General eldercare experience does not prepare a live-in helper for the reality of “sundowning” – where patients experience day-night confusion and may have frequent night wakings. It also does not train helpers to handle near-choking incidents or navigate language barriers when a patient regresses to an unfamiliar dialect.
When exhaustion sets in, safety compromises may follow. I have seen helpers unwittingly force-feed or roughly handle patients just to tick items off relentless daily checklists. In my family’s case, before we transitioned my mother to a nursing home for her safety, I watched helplessly via home cameras as the exhausted, half-awake helper repeatedly shoved my wandering mother back into bed like a rag doll.
Conversely, I have also met dedicated helpers who treat their care recipients like their own parents. The critical difference between failure and success comes down to ongoing, practical, on-site guidance from a real person (not helplines or handouts).
Many dementia care courses exist, but they remain out of reach. Families face steep cost concerns, lack of awareness, and competing priorities. Once a helper is immersed in pressing daily duties, there is no time or mental headspace for new learning. Existing home caregiving grants are also barely enough to cover a helper’s monthly salary, leaving nothing left for specialised courses.
To let those with dementia age at home safely and with dignity, care support in Singapore must evolve to include:
Mandatory basic “dementia care” training within the standard pre-deployment package for live-in helpers.
Proactive check-ins by healthcare professionals, hospital discharge teams and grassroots organisations on the well-being of both the patient and the helper.
Accessible resources, perhaps by assigning the helpers a person in the immediate neighbourhood from a social service agency or active ageing centre who can guide them through changing care needs.
If Singapore continues to rely on hired helpers to support its ageing population and those living with dementia, it must help them fulfil the role. True dignity in ageing requires the protection of not just the vulnerable patient, but also the caregiver beside him.
Lim Hwee San
