Caring for those who provide care

Mr Goh Swee Ann, 78, has several health problems. A stroke patient, he also has diabetes and is incontinent.

He needs round-the-clock care and a wheelchair to get around. His wife, Madam Tan Lung Hiang, 72, also has serious heart problems. She is frequently out of breath and is in no position to look after him.

Their only child, Jason, 30, who lives with them, needs to work.

A few years ago, the family would have had no choice but to put Mr Goh in a nursing home.

But these days, there are better eldercare options. Thanks to the Singapore Programme for Integrated Care for the Elderly, the retired gardener can get nursing care in a day-care centre and return home to his family at night.

After subsidies, it costs $350 a month, cheaper than having a maid. "With my dad well taken care of for the whole day, I can go to work in peace," said his son, a polytechnic graduate.

As Singapore ages, the Agency for Integrated Care (AIC), an organisation set up by the Government to coordinate eldercare services, has been making a concerted effort to crank out new support services.

There are more than 20 such services that directly or indirectly benefit caregivers. Most were started after the agency was set up in 2009.

Some, like the Aged Care Action Programme, help frail old folk make a smooth transition from hospital to community care. More than 30,000 families have benefited since the programme was initiated in 2008.

Others, like the caregiver training grant, seek to equip caregivers with skills to take better care of ailing loved ones at home. Yet others provide respite care, information and referral services and financial assistance.

New programmes are being regularly launched - and there have been two in recent months. The Caring Assistance from Neighbours (CAN) programme enables frail elderly people to be looked after by their neighbours in return for a fee of $80 a month for each person they care for.

Bukit Batok housewife Rahimah Nirin, 36, for instance, keeps an eye out for Madam P. Lakshmi Govinasami, 85, who has heart disease, asthma, diabetes, high cholesterol and high blood pressure. Madam Lakshmi, who must take 10 pills every day, lives with a hearing-impaired son who is an odd-job worker.

Madam Rahimah, who lives in the opposite block, drops by every morning to ensure that she has taken her medicine, check on her health and to make sure that she turns up for medical appointments.

Despite their age difference, the pair have been friends for 10 years. "She is like a grandmother to my daughter," said Madam Rahimah, mother to a nine year old. "I have been visiting her regularly for years. Now I just come every day."

There are 41 carers looking after 237 older folk as part of the CAN programme.

Despite an increasing number of programmes, studies suggest that take-up rates of community care services are low.

Associate Professor Angelique Chan from the Duke-NUS Graduate Medical School, who led a large research study on informal caregivers here, found that take-up rates were less than 5 per cent each for services such as day-care centres, home medical, home nursing and caregiver support services.

The study found that participants said they did not need services. But there could be other reasons, said AIC chief executive Jason Cheah. For instance, many caregivers may not have sufficient information to decide what kind of care is required for their loved ones. "This is where AIC and its partners are working together to better reach out to and educate our caregivers," he said.

There are others who may believe they can cope, said Dr Cheah. "Caregiver burnout can be a real phenomenon, however, and we need to help caregivers recognise when they need to take a break."

Professor Chan and eldercare expert Mary Ann Tsao believe that the small number of people using eldercare support services could be the result of a mismatch between demand and supply, and the low overall capacity.

"If you're working, you might need a day-care centre that's open from 7am to 7pm," said Prof Chan. "Having one that operates from nine to five will be of no use at all."

Similarly, a transport service to ferry wheelchair-bound folk to a day-care centre may be of little use if it operates "kerb to kerb" rather than door to door, said Dr Tsao, who chairs the Tsao Foundation, which provides direct services and does research training and advocacy work on ageing well.

Short-term respite options, like when maids go on home or compassionate leave, is also in demand, said Centre for Caregivers director Manmohan Singh.

"This is an area which private nursing homes are not sufficiently incentivised to address," he said. "They favour longer-staying patients."

Support for caregiving employees must also be "emphasised and embraced by society", especially by employers, said Mr Singh.

Caregiver leave - while quietly adopted by the public sector and a growing number of social and health-care agencies - must be embraced by private companies too, he said.

Many family caregivers say that taking leave for caregiving is frowned upon by employers and even human resource professionals. "Some caregiver employees have told us that they were pressured into resigning," said Mr Singh. "This must change."

His centre, which has reached about 33,000 past, present and future caregivers through outreach and education programmes, is trying to do more.

A programme where former caregivers provide emotional support to current ones, for example, is being ramped up. Caregivers are likely to open up more to those who have walked the long, hard road before. "We believe this service has great potential," he said.