With Covid-19, additional burdens are piled on the already demanding roles of caregivers, such as dealing with the isolation faced by their care recipients and themselves. 

A caregiving journey is like a roller coaster ride filled with mixed emotions and psychological stress.

Take the case of Ms Tan, who took part in a case study of caregivers which I conducted.

She takes on multiple roles in her family — sole breadwinner, mother to three teenage children, wife to a husband with eyesight issues, caregiver to her late, demented father-in-law for 10 years before he passed on, and later a caregiver to her mother-in-law, who was also diagnosed with dementia.

How can we help caregivers like Ms Tan beyond providing formal training?

Mentally preparing caregivers for the anticipated life journey of the care recipient would be useful.

Ms Tan shared how draining the initial period of taking care of her demented father-in-law was, as she had to grapple with his unexpected patterns of behaviours.

Waking up at 3am to cook for him was a routine for Ms Tan, whose father-in-law would bang on her room door demanding to be fed.

While mental preparation would not change her father-in-law’s behaviour, it could prepare her and help to reduce her helplessness, confusion and anxiety.

Bite-sized video resources could be curated to provide some form of psychological inoculation for caregivers.

CAREGIVING IS LIFE-GIVING

Filial piety and the need to reciprocate the love and care received from the father-in-law prior was the main reason why Ms Tan cared for him. The micro moments of connection while taking care of him were gratifying for her and gave her a life purpose.

When her father-in-law passed on, she struggled with mixed emotions — guilt for the moments when she lamented that he was burdensome, relief to be able to relinquish her caregiver role, grief for losing a loved one as well as bitter sweetness for having the chance to demonstrate filial piety.  

A few months after her father-in-law’s passing, her mother-in-law — ­with whom Ms Tan had a difficult relationship — was also diagnosed with dementia. Ms Tan was obliged to take on the caregiver’s role.

Again, reframing her meaning and purpose of caregiving provided Ms Tan with clarity and sustained her everyday life.

HOLISTIC SUPPORT FOR CAREGIVERS

Beyond training on how to care for others, caregivers also need counselling support to cope with the psychological and emotional complexity of their role; and even coaching to help them change their perspectives of caregiving into something positive and purposeful.   

Family and social support are critical throughout the journey. Caregivers understand caregivers best, so caregiver support groups provide an essential emotional and knowledge resource.

Online counselling and support groups are useful for caregivers who find it challenging to attend physical classes or have face-to-face meet-ups with support groups.

With multiple heavy responsibilities, one might ask why Ms Tan did not send her father- or mother-in-law to a day care centre. 

Ms Tan shared that her in-laws could not adapt to the differences between the centre and home environment; and would throw tantrums when they were home.

Ms Tan felt inadequate in managing her in-laws as her way of caring for the elderly differed from the centre and this also caused confusion to her in-laws. 

The standard closing hours of the centre also made it difficult for her to pick them up on time due to her work schedule.

There are lessons to be learnt from how senior day care centres are run in Taiwan. 

The Chang Gung Dementia Centre in Taipei, for example, believes that “there is no cure for dementia but the caregiver cannot collapse”.

With a caregiver-centric philosophy, the centre gives much attention to details. 

For example, caregivers have the flexibility of sending and picking up their loved ones from the centre based on their work schedule. Such caregiver-focused service gives caregivers the respite and relief so that they can focus at work.

Caregivers are also constantly updated on the development of the clients at the day care centre to prevent a disconnect when the seniors are home at the end of the day.

In Singapore, numerous new policies and initiatives, such as the Caregiver Support Action Plan, have been implemented over the years. 

The raft of measures to help relieve the burden of caregivers include new grants, caregiver respite services and expanded capacity for aged care services.

However, more help is needed to ease the burden of this group and to help them cope with stressors exacerbated by the pandemic.

Caregivers and those they care for should be viewed as one holistic care model. 

Understanding the psychological, social and emotional struggles of caregivers would allow us to appreciate the support needed in the context of a rapidly ageing society and for the care recipients to age in place — a term to mean growing old comfortably in places one is familiar with.    

Digital platforms would certainly play a useful role to bridge the care at the centre and home to strengthen the care integration. 

One area that holds some potential is to use virtual reality (VR) technology to create an immersive experience for both caregivers and their charges at home.

For example, when the senior citizen is home, he/she could continue to feel as if he/she remains in the environment of the centre by looking at a three-dimensional computer-generated simulation using electronic devices such as laptops, mobile phones, and goggles with screen or gloves with sensors. 

The same could be done for a senior citizen at the centre — he/she could log into the VR image of his/her home.

With Singapore’s ageing population, it is now more critical to care for and better equip the caregivers who are part of our invisible workforce.

ABOUT THE AUTHOR: 

Sng Hock Lin is pursuing a PhD in gerontology at the Singapore University of Social Sciences. He completed his master's degree in gerontology at SUSS, where he received the Alice Lim Memorial Fund gold award for topping his cohort. His research interests include active ageing, leadership, organisational transformation and citizen-centric service.