SINGAPORE: In the course of his work, Dr Lim Wee Shiong has seen not just sick patients, but also stressed caregivers.
“The carer will bring them (their loved one) to the ED (emergency department) and say: ‘Mum is not very well.’ ... The complaints are very vague but nothing very tangible. But when you dig deeper you find that the carer is having difficulty coping,” said Dr Lim, who is a senior consultant at Tan Tock Seng Hospital’s department of geriatric medicine.
“Even though there isn’t a really acute problem in a sense, these attendant care issues need to be looked at as well.”
This is where online tools to enhance “caregiving mastery” - the knowledge and skills needed to perform the role as a caregiver - come into play, Dr Lim told CNA.
One of these tools is TTSH’s new online physiotherapy-related resource library called 'Carers X Physios', which was launched in September.
Created especially for caregivers to refer and practise skills, it includes video demonstrations on complex care instructions, home-based workouts as well as safe caregiving management tips. The resource library also offers a platform for caregivers to tap on community services for help and join support groups.
The hospital also plans to continue to update and add more materials to the collection, including tips and information from other departments.
“The resources are great because making use of technology, at their own time, at their own pace, at their own convenience, they can look at resources, they can revise some of these things to help them enhance the caregiving mastery,” explained Dr Lim.
EXACERBATED BY THE PANDEMIC
When it comes to caregiving mastery, Dr Lim noted that the current COVID-19 pandemic has added a layer of “complexity” for caregivers. This is because they have to deal with the new situations they face daily as a result of the pandemic, on top of fulfilling their role as a caregiver.
In addition, Dr Lim noted that caregivers often face issues relating to "personal mastery" - the care for their personal well being - as they adjust to the demands of caregiving.
And some of these stressors have been “exacerbated” by the pandemic, he added.
“Because of the pandemic, they have been more ‘isolated’ socially, (are) not able to go out and meet friends, (with) more time having spent to look after loved ones,” he said.
“Often because of that, they also have poorer lifestyle habits and self care - more sedentary lifestyle, unhealthy eating habits and insufficient rest. And they also have to cope with their own stressors as well, their own uncertainty, especially some caregivers who may be affected by the pandemic themselves and also their own fears about the pandemic."
A previous study conducted by Dr Lim and his colleagues from TTSH’s Institute of Geriatrics and Active Aging also found that caregivers worry about their performance when fulfilling their role.
“In the pandemic situation, there will be more stress and more pressure,” he added. “This is a new situation, it is unknown, the sense of control is less, and (they feel like): ‘I need to get on top of things, I need to do things well.’ So much so that sometimes the caregivers forget to take care of themselves - they overlook the personal mastery part.”
Pandemic or no pandemic, adjusting to a new role as a caregiver is a common concern caregivers face, TTSH senior physiotherapist Lim Biyu told CNA.
“Usually they have a lot of skills to learn at once, on top of this understanding (of) their loved one’s medical condition. So this actually adds to the mental load. And depending on the task involved, some tasks may require many steps, and techniques. So that upon reaching home, caregivers themselves may start to forget parts of the training, and this just contributes to the existing challenges,” she explained.
“What most caregivers need is the reassurance, revision of the skills taught in the hospital when they are back at home caring for the loved one.”
This is where the resource library can come in handy, she pointed out.
“Most of the points of contact or most of the support is done within a short period of time, which is either when the patient is in the hospital, or in the post discharge. So a lot of times ... when the caregiver has to refer to some sort of resources or require further support, by then it might have already been three months or six months after discharge,” she explained.
“At their convenience, they would maybe prefer to refer to these resources that are already there, (and now) they know where to find it because it's easily accessible on the internet. The videos there are also quite comprehensive, so they do range from a variety of tasks. At the moment, it is physiotherapy related, there are plans to add more resources and materials to the website.
The “new normalcy” following Singapore’s “circuit-breaker” has also provided new opportunities for caregivers, noted Dr Lim.
“With the relaxation of certain measures, it also gives the opportunity for the caregivers to take better care of themselves - especially the personal mastery part - because now this is the time where they can actually find pockets of space to do some things they like to do," he said.
“And of course I think that new normal does mean leveraging on technology and related resources.”
Calling caregivers the “invisible workforce”, Dr Lim stressed the importance of their role in today’s society.
“They are the main ones who will be helping to look after our frail older adults with an aging society. So you can imagine that with aging population, the rate at which the population ages and thereby the rate of increase of frail older adults will outpace the ability of the healthcare system to provide,” he explained.
“It’s also been said that our caregivers, they are part of the invisible workforce that we have to care for the older adults."
And the efforts of these caregivers will allow for the “aging in place” of their loved ones, where they can live out the remainder of their days in the comfort and security of their own home, added Dr Lim.
“There are only four kinds of people in the world. Those who have been caregivers. Those who are currently caregivers. Those who will be caregivers, and those who will need a caregiver,” he added, quoting former US first lady Roselyn Carter.
“We are all inextricably linked to caregiving.”