SINGAPORE: When a loved one becomes a patient at home, it can take a toll on the family, especially the primary carer.
Take, for example, Mr Richard Ashworth, who left behind a career as an office manager to take care of his adoptive father, John, nine years ago.
His father, 86, suffers from a host of age-related health issues, including dementia and colon cancer. Not only have these conditions left his elderly life in tatters, they have also taken their toll on his son’s mental health.
“I’d get so frustrated — how to handle him when he started screaming?” recounted the 65-year-old.
“I’d start arguing with him also: ‘Why are you doing this to me? Why all these things?’ That was a really hard journey for me in the beginning.”
Like anyone caring for a frail or disabled loved one, he experienced fatigue and stress. But what might push carers into a state of mental and physical exhaustion known as caregiver burnout?
Prolonged stress is one, as the programme Talking Point examines how severe the burnout can become and how to combat its effects when the pressure of being the primary caregiver of a loved one is too great. (Watch the episode here.)
It is estimated that there are over 210,000 caregivers and counting in an ageing Singapore, with some 70 per cent of them aged 40 and above.
However, there is no comprehensive national study on caregiver health, Nominated Member of Parliament Anthea Ong highlighted in a recent commentary as she called for the “psychosocial well-being of caregivers” to be “top of mind for our caregiving policies”.
“Segmented studies have revealed that our caregiver population is certainly facing higher mental health risks.”
For example, among carers of stroke survivors, 40.2 per cent have depressive symptoms, according to a 2017 study by the Institute of Mental Health and the National University of Singapore.
Carers of cancer patients are also at greater risk of developing depression than the general population, according to a Singapore Medical Journal study.
In the case of Mr Ashworth, he sought help after finding himself increasingly unable to cope with his father’s tantrums. The last straw was when a prolonged shouting match one morning left him physically and emotionally drained.
He shared with senior social worker Ng Jek Mui from the Alzheimer’s Disease Association the difficulties of being a primary caregiver, especially when his father starts screaming.
“I can’t just say I can’t be bothered. So, at that moment, it’s like — what can I do?” he sighed. “The frustration you have at that moment is really terrible.”
IT COULD LEAD TO SEVERE DEPRESSION
While there are no official statistics for the number of carers suffering from burnout, “it can be a big problem if the caregiver feels that there’s no support”, said Mr Manmohan Singh, a former director at the Asian Women’s Welfare Association.
The non-governmental organisation provides support for those with disabilities and their families, while Mr Singh himself is no stranger to caregiving: He left his job two years ago to take care of his elderly mother.
He said burnout could involve “emotional turmoil about our loved ones or our own aspirations because our career was put on hold”. It could involve financial constraints. “When it all comes together, it could lead to severe depression,” he added.
As caregiver burnout symptoms overlap with other stress-related disorders, such as anxiety, depression and physical exhaustion, they are difficult to detect.
And yet, the pressure of caregiving and anxiety about healthcare costs can be immense, as is the case with mechanical engineer Sek Mun Fai.
His wife, Bibi, suffered from complications of pregnancy four years ago and now has issues with her vision, speech and motor skills.
“Bibi’s condition is unpredictable — she may wake up in the morning feeling uncomfortable, feeling sick, so I have to attend to her,” he said. But, apart from taking care of her and their three children, he has a “dangerous” job.
“I deal with machines … and a lack of concentration will cause accidents.
He never sought professional help to cope with the pressure of being a carer, so the Talking Point team arranged for him a session with clinical psychologist Annabelle Chow, who has been helping carers with burnout for nine years now.
After the consultation, she was convinced that he was burnt out. “This isn’t just normal stress or everyday exhaustion,” she told the 41-year-old.
“One of those things about burnout is the feeling of darkness and … being disconnected from what you’re doing and everyday life. You’re feeling very inefficient.”
She recommended psychotherapy and said: “If you don’t look after yourself well, you can’t look after other people.”
FEW TAPPING RESPITE CARE
If psychotherapy sessions are not viable, there are other ways to help carers. Through respite care, for example, a professional worker steps in to provide relief for carers for a short period.
This can either be home care or centre-based services. There are 12 eldercare centres and over 40 nursing homes providing respite care, but only 2,400-plus carers have tapped these services.
More might have turned to respite care if not for the cost.
Mdm Siti Fadillah, for example, qualifies for subsidies that cover 80 per cent of respite care costs, but the single parent with no income would still need to dig into her pocket for the service.
For 16 years, she has taken care of her son, Muhammed Sayfullah — who has severe cerebral palsy — on her own.
Centre-based respite care can cost between S$3,000 and S$3,500 a month, and even the subsidies for low-income households are applicable to selected services only. So “the only setback”, said the 41-year-old mother of three, is “financial constraints”.
Households with a monthly per capita income of more than S$2,600 do not qualify for the subsidies. So for many people, hiring a foreign domestic worker seems to be a cheaper option than respite services.
Mr Ashworth, for example, had requested male domestic helpers. This was approved after a year. While the two helpers give him much-needed respite, it costs him close to S$1,200 monthly — a cost he feels he cannot do without.
“Physically it has been a relief to me. When the male helper takes (my father) to shower, I can … have a quiet time for half an hour to one hour,” he said.
Meanwhile, Mr Sek is considering enrolling his wife at the Telok Blangah ParcView Senior Care Centre and Active Aging Hub.
“Caregiving burnout is an issue that many continue to face. And as Singapore’s population gets older, it’s something more of us will experience in the future … Society is starting to slowly acknowledge this issue,” said Talking Point host Sharda Harrison.
“The key thing … is to prevent burnout before it happens, which would ultimately improve the lives of both caregivers and their loved ones."
Watch this episode of Talking Point here. New episodes on Channel 5 every Thursday at 9.30pm.