SINGAPORE - Having been a full-time caregiver to her 87-year-old mother who has dementia for eight years, Ms Kris Foo's constant companion has been stress - emotional, mental and financial.

The self-employed designer suffered from caregiver burnout in 2015, when bouts of depression, anxiety and tantrums were a daily recurrence.

"I woke up one day and I just started crying. But looking back now, there were telltale signs - I was getting increasingly irritable, lost my focus on everything else besides caregiving. I simply had no respite for three years, which took a mental toll on me," said Ms Foo, 53, who is single and has an older sister.

The issue of caregiver stress is in the spotlight recently, with a number of tragic cases, including a murder-suicide ruled by the coroner last week. A depressed mother strangled her five-year-old son, who was autistic and had attention deficit hyperactivity disorder, before fatally stabbing herself.

In 2018, Ms Foo began sending her mother to daycare - which gave her five extra hours each day to catch up on her work and sleep.

Seeing a counsellor has also helped her to better identify and cope with stress, though she now finds herself grappling with the larger issue of self-care.

For instance, uncertainty over her future and retirement plans has weighed on her.

During a visit to the geriatrician in July, she was told that it was time to "care for the caregiver", as the doctor could tell she was heading towards another burnout.

Applications were made to send her mum to a nursing home and they are awaiting the outcome.

Although Ms Foo knew that such a decision would be crucial for her mental well-being, it is one that she made while ridden with guilt.

"There's always that sense of abandonment tied to nursing homes. It has not been easy warming her up to the idea of moving someplace else that isn't her own home, and for her to understand that I can't look after her alone anymore," she said.

While she yearns to restart her own life, the feeling of guilt is not easy to deal with.

"The shift in reality and embracing a lifestyle of not living with my mother will be a huge adjustment for me, but counselling and social support will be important as I make these transitions in life," she added.

This caregiver guilt is a familiar feeling for many, as the deeply entrenched values of filial piety and duty often come at the expense of self-care, said experts here.

Dr Annabelle Chow, principal clinical psychologist at Annabelle Psychology, noted that as society's view of familial caregivers is centred around duty and obligation, those who need help are worried of being shut down or invalidated.

In addition, many tend to under-report feelings of stress because of the guilt that they face.

"Caregivers are often used to a constant routine of caring, and when they are not, they feel guilty for being away, and that they are not doing their job well or fulfilling their duty."

"This worsens if they decide to take time off to recuperate, where they may feel 'selfish' for doing so," she added.

Dr Chow also noted that there are very few caregivers seeking help for themselves at her clinic. Rather, they would often be accompanying those whom they are taking care of. During the consultation, the caregivers would then share their difficulties with the psychologists in passing.

Social entrepreneur and former Nominated MP Anthea Ong noted that many caregivers de-prioritise their emotional needs out of guilt.

"Some may also think that it is their responsibility as a family member, and that asking for support is too difficult. But it is not mutually exclusive to be filial and still look after our own well-being, so caregiver education is paramount in making sense of these ideas and feelings," she said.

Assistance and resources for caregivers could be made available and more visible at all general practitioner and other clinics, along with caregiver support offices at polyclinics, said Ms Ong.

Peer support training and caregiving classes could also be held at community centres, she added.

The Ministry of Social and Family Development (MSF) said that SG Enable, a disability service and support organisation, has worked with social service agencies and the community to organise peer-to-peer mentor training for caregivers of persons with disabilities (PWDs).

According to five agencies and support groups whom The Straits Times spoke to, caregiving stress has been on the rise during the Covid-19 pandemic, a result of work-from-home arrangements, the lack of caregiving reprieve, and financial stress arising from lesser income and the loss of jobs.

Caregivers can tap the annual $200 Caregivers Training Grant administered by the Agency for Integrated Care to offset the cost of caregiving training courses. Such courses could help them build their capabilities and reduce the level of stress that they face.

Caregivers of PWDs may also be eligible for levy concessions, if they wish to hire a foreign domestic worker (FDW), and the Home Caregiving Grant, a $200 monthly cash payout to defray the costs of caregiving. It can also be used for hiring an FDW, said the MSF.

But a survey by the Association of Women for Action and Research (Aware) last year showed that caregivers of elderly patients who employ FDWs spent an average of almost $1,300 monthly, whereas the monthly expenses without an FDW was around $380.

However, Aware noted that FDWs themselves suffer stress and burnout "due to inaccurate matching to and inadequate training for eldercare jobs, and lack of access to caregiving-specific information and emotional support".

Agreeing, Ms Foo said that some of her FDWs quit as they felt they lacked training and were not equipped to provide eldercare.

She added that the $200 Home Caregiving Grant covers only a fraction of expenses, and does not acknowledge the value of family caregivers and the medical expenses for care recipients.

Respite care services should also be more affordable and accessible, she noted. For instance, she has considered night respite care for her mum, who regularly wakes up six to eight times a night. But the cost of around $100 to $150 each night, is prohibitive in the long term.

Ms Ong also noted that these services must be "made more affordable to serve its well-meaning intent of giving caregivers a respite".

A possible solution would be to allow the payment of these services through Medisave or Medifund, she added.

Ms Shailey Hingorani, Aware's head of research and advocacy, said that a caregiver support grant, offering additional financial support from the Government, could be helpful.