1. Family Caregiving for Older Persons in Singapore Prof. Kalyani K.Mehta Dept of Social Work National University of Singapore

2. Importance of the issue Cultural (filial piety) Government policy “Family is the first line of support” The ageing population profile of Singapore - increasing life expectancy - lower fertility rate

3. Some statistics The percentage of people above 65 years will increase from 8.4% in 2005 to 18.7% in 2030 In absolute numbers there will be an increase from about 296,000 in June 2005 to 873, 300 in 2030 (Committee on Ageing Issues Report,2006)

4. Baby Boomer generation Born after the Second World War They form the middle section of the Population Pyramid Most will be healthier, wealthier and better educated than the current cohorts of people above 65 years in Singapore

5. So what does it mean?

6. Life events As people age, even if they have resources, they still need care A physically able person may be struck with stroke An active senior may have some eyesight problems An accident or fall may render a person incapacitated for a temporary period of time

7. Statistics on caregivers So far no national survey has been done so we do not know the exact figures Estimated that there are about 210,800 caregivers in S’pore looking after seniors, disabled children, physically and mentally ill people (Straits Times 12/4/04)

8. National Survey of Senior Citizens 1995 It showed that about 60% of family caregivers were not working and 43.4% were working 2005 5% of senior citizens are dependent and require family care (14,845 seniors)

9. NUS Research A survey (2006) done on 323 family caregivers showed that 54% were working and 40% were housewives or retirees Stressors faced by the working caregivers can be different from the non-working Age of caregivers is important eg. a wife who is 70 years looking after her husband compared to a 45 year old daughter looking after her 80 year old mother

10. Older Persons living alone 2005 1995 ( Source: CAI Report, 2006, p.6) Total65 & aboveTotal65 & above Living alone 5.67.33.13.4 With spouse only 11.012.65.26.3 With Family 76.472.986.284.4 Other6.97.35.65.9

11. More Singles In 2004, 14-16% of resident males and females at age 40-44 years remained single as compared to 11% in 1994 In 20 years time what will be the challenges faced by these singles? More community-based services will be required to help them if they lack social and practical support

12. Needs of seniors in family setting vs needs of seniors living alone What are the needs and issues faced by seniors living with family members (in same household) What are the needs and issues faced by seniors living alone? What are the needs and issues of seniors living ‘with strangers’?

13. 2 main types of caregivers The family caregivers (since the majority of seniors live with family) The professional caregivers (eg. nurses and doctors, social workers, counsellors, physiotherapists, occupational therapists,nurse aides, healthcare attendants and so on)

14. The family caregivers Spouses Adult children Grandchildren, nieces, nephews Foreign maids (employed caregiver in home setting) Siblings Adopted children, “step-children” (remarriage after divorce/widowhood)

15. Primary and Secondary caregivers Primary caregiver: the one providing major part of the practical, emotional, and financial support Secondary: the one helping out when the primary caregivers needs a break, or is unavailable (at work, or attending to other commitments)

16. Challenges faced by Primary caregivers I HAVE NO TIME! I HAVE TO JUGGLE WORK AND HOME!

17. Feeling tired and exhausted There comes a time when being filial is associated with mental and physical stress, despite the satisfaction that you know you are helping a loved one

18. Financial pressure The middle-generation have to face an “economic squeeze” because they have to bear the financial expenses of not only parents and parents-in-law but also their growing children (as well as household and maid expenses) On top of this, the higher expenses related to medical costs and inflation

19. Emotional and relationship issues Depending on the prior relationship between the caregiver and senior receiving care, and their current personalities the dynamics of the caregiving can be either co-operative or CONFLICTUAL If conflictual, there can be much emotional hurt, pain leading to depression or elder abuse/neglect

20. Worries about work & family At work, boss may not be understanding and threatens to sack employee for asking too much leave (senior may be ill) or arriving late too often (senior may be suffering from dementia and has a crisis)

21. Link between stress and physical dependency of senior The higher the level of physical dependency or mental incapacity of the senior the greater the stress of the family caregivers Research on 61 homebound seniors and the caregivers

22. Females have more stress than males Usually female caregivers (and majority of family caregivers in the world are females!) are more emotionally and mentally stressed Why? Possible they take their role very seriously, or they have more responsibilities in taking care of their own children, or they have more household chores to juggle)

23. Family carers may feel helpless This can be due to lack of training in looking after certain types of patients eg. dementia patients who need a lot of supervision and special handling Particular skills such as transferring from bed to chair, or feeding someone who recently had a stroke, or bathing a heavy person have to be learnt

24. Appreciation for family caregivers My research has indicated that many caregivers feel unappreciated (or taken for granted) Resentment of other siblings who do not help or only criticize but are not helpful Even the senior care recipient may not say anything positive to recognise the sacrifices of the caregiver

25. Family caregivers have difficulties with the “system” Stress may be compounded when the family members cannot communicate with the other societal systems eg. hospital staff, agencies handling financial assistance, legal system, other case managers and service providers Especially the illiterate and those who do not speak English or Mandarin

26. Some policy recommendations Integration of policies for caregivers Family leave in lieu of childcare leave Flexibility on the part of employers Innovative ideas for caregiver recognition eg. waiver of fees for training, free movie tickets For the low income families, tax reliefs are not applicable, so some NTUC and transport vouchers should be given annually Support groups for family caregivers free of charge at all FSCs Caregiver centres to do more outreach

27. At Hospitals and Clinics New CAI report has emphasised the role of family physicians to provide holistic care Suggest that at the point of discharge from all hospitals, there should be educational counselling provided at all geriatric wards to help the families, as well reduce re- admission in the long run All Polyclinics should hire medical social workers as more families need help

28. Caregivers Week Held in April every year It should be an ongoing exercise throughout the year for more effective reach to family caregivers esp. the ageing spousal caregivers A more service-oriented attitude be adopted by administrators towards caregivers of elderly because they need this to continue caring!!

29. THANK YOU I salute all family caregivers of elderly!!