When I used to work in social services, I regularly saw caregivers coming to me who were close to burnout.
If that’s you today, I may not understand how you feel. But I hope you know that you’re not alone.
As a caregiver to your elderly parents, who may have complex conditions like dementia, you may feel averse to nursing homes. You may feel that putting your parents in a nursing home would be disloyal, and a betrayal of the love your parents showed you as you were growing up.
Others may feel that it’s too expensive to put their parents in a home, especially when weighing this against other options like domestic helpers.
This article aims to debunk some of the myths people have about nursing homes, especially the cost. But it also looks at how you can weigh this decision to place your parents in the nursing home against other options like domestic helpers.
Myth: It’s Disloyal To Put My Parents In A Nursing Home
Firstly, it’s not wrong to put your parents in a nursing home. You’ve done your best over the years caring for them, and sometimes, professional help may be wiser in the long run. As much as you love your parents, you can’t provide care like a professional, trained caregiver can.
You may say that it’s disloyal to the love your parents showed you. But if you wouldn’t attempt to treat yourself when you’re sick, why are you forcing yourself to care for your parents, when you don’t have the expertise?
But you may wonder how your decision weighs against other options. After all, if there are cheaper options, it may seem more worthwhile to try these options.
Myth: It’s More Expensive To Put My Parents In A Nursing Home, Compared To Other Home Options
You may look at options that allow your parents to be cared for at home, such as domestic helpers, and/or day-care, which occupy your parents during the day.
Let’s explore these options.
Domestic Helpers
Domestic helpers can help, if things are not too serious. They could also be less pricey than a nursing home.
As a professional, I often suggest that the helper be exclusively responsible for caring for your elderly parent, rather than overloading her with the burden of caring for your child, your housework, and your cooking.
That may be too much to bear for two parents, let alone a single individual.
But if your parent is facing difficulties with at least 2 of their Activities of Daily Living (ADLs), it may be time to consider a nursing home.
The 6 Activities of Daily Living (ADLs), as defined by the Agency for Integrated Care
Grants Whilst Your Parent Is Being Cared For At Home
The Home Caregiving Grant is a means-tested grant by the Agency of Integrated Care (AIC), that gives $200 to offset the cost of caring for your elderly parents.
To apply for this, the person you are caring for cannot be living in a nursing home.
Whilst it does seem cheaper to leave your parent at home with a domestic helper or under your family’s care, you need to ask yourself whether this is sustainable in the long-term. Caregiver burnout is real, and can severely affect your quality of life and work performance.
Whilst the financial cost can initially seem higher, weighing this against the emotional cost is also important. Many caregivers have faced conflicts with their spouse over the time they spend caring for their elderly parents. They also sometimes face children who become unhappy at the attention they do not get from their parents.
Sometimes, the frustration at having to do extremely distasteful tasks (like changing the diapers of your elderly parents), can even result in you lashing out at your loved ones.
None of this is easy.
ElderShield Or CareShield Life Payouts
According to the Ministry of Health, 1 in 2 healthy Singaporeans aged 65 and above could become severely disabled and need long-term care.
CareShield Life is a long-term care insurance scheme that provides basic financial support should Singaporeans become severely disabled, especially during old age, and need personal and medical care for a prolonged duration (i.e. long-term care).
You can find out if your parent is covered under CareShield Life under My Policy. Depending on how many premiums your parents have made, the payout will differ. But the payout starts from a minimum of $600 per month. This can go a long way towards offsetting the cost of care for your parents.
Myth: It’s Better To Put My Parents In A Nursing Home
A director of a nursing home, who declined to be named for this article, says that one misconception she often hears is that it’s better to put one’s parent in a nursing home because they will have 24/7 care there.
“A nursing home is not a hospital, and even a hospital doesn’t have a nurse sitting by the patient’s bedside 24/7. We always advise caregivers that the best place for the elderly is at home, to age-in-place.”
She further explains that nursing homes are not entirely staffed by MOH-accredited nurses and that some of the care is provided by care assistants.
Being clear about your expectations before placing your parent in a nursing home is vital. Just because you place your parent in a nursing home doesn’t mean accidents won’t happen. She shared that some caregivers are surprised that their elderly parents may still fall in nursing homes. “Falls can happen anywhere, even in hospitals.”
Knowing this, when should you consider nursing homes? Her advice is to consider 2 questions.
Firstly, is there an available caregiver at home? This means someone who can provide the bulk of care to your parent. She thus recommends that if children are not able to care for elderly parents, they should see if they can engage a domestic helper.
Secondly, is the elderly capable of most of the ADLs? If your parent is struggling with at least 2 of the ADLs, it might be time to consider a nursing home.
These two questions can help you think through your decision about applying for a nursing home.
Do This Before Applying For Nursing Homes
After considering these options, you may still wish to go ahead with a nursing home. Here are some helpful guidelines.
Always Talk To A Social Worker
If you are planning to place your parent in a nursing home, ask to speak to the hospital’s medical social work team or go to the nearest Family Service Centre (similar to a GP for social services) to seek advice.
The social worker can advise you on subsidies and grants available. In special cases, they may also write letters called ‘Social Reports’ that detail the situation your family is facing. This can sometimes speed up the process of your parent’s nursing home stay.
Start The Consultation Early
As you can see from the graph below, demand far outstrips supply. The pandemic also exacerbated the demand due to the delays in the construction of new nursing homes, and the growing burnout of caregivers, who were now facing their aged parents daily as they worked from home.
Source: Lien Foundation and Oliver Wyman’s research in 2016
The wait for a nursing home can take months or even years. It is best to begin this conversation early. However, the director of the nursing home was quick to add a caveat. “In Singapore, you cannot pre-queue for a nursing home. The application will only be placed when professionals assess that there’s a need for it.”
The Nursing Home Landscape
But who are the providers of nursing homes in Singapore? There are two primary types – namely, privately-run nursing homes as for-profit entities; and the next being nursing homes run by non-profits.
The Cost Of A Nursing Home Stay
Whilst we don’t wish to be evasive with the concrete numbers, the exact cost would come down to your family’s financial situation. Our source agreed. “When you ask me how much the nursing home costs, it really depends on each person’s situation. Depending on means-testing, it could still cost between $300 to $2,500 per month.”
Your family’s situation will determine how much subsidies you can get if you are applying for a nursing home operated by a charity.
Based on the latest research study by Lien Foundation and Oliver Wyman in 2016, their survey of 5 nursing homes found an average cost of $106 per day.
That amounts to roughly $3,180 per month.
The table below, from the Ministry of Health, details the amount of subsidies you may receive.
The subsidies available for a nursing home stay
You may be wondering if these subsidies apply to privately run nursing homes. It’s not a straightforward yes or no answer. Instead, there are some private nursing homes that do qualify for subsidies if the patient has been referred by AIC.
But What Exactly Are You Paying For?
$3000 per month for your parent’s nursing home stay sounds pricey. What exactly are you paying for? Oliver Wyman’s insightful analysis details more about the breakdown in cost.
Essentially, the bulk of the cost (almost half) goes towards the direct care of your elderly parent. The cost of round-the-clock personal social and medical care, organising of programmes to engage the elderly, and the use of nursing supplies, is expensive.
Figure 1 – A breakdown of costs, according to Oliver Wyman’s research in 2016
You are also paying for the cost of the room. In most nursing homes in Singapore, you will still see dormitory-style layouts. As you can see below, the average floor area your parent will live in is not large, compared to other nations.
Figure 2 – Oliver Wyman’s survey of 5 nursing homes found the average space per person to be about 6 square meters
Knowing this, you may feel even more sceptical about placing your parent in a nursing home. It’s expensive, cramped, and can seem isolating.
Perhaps You Are Paying For This
When I used to conduct the Advance Care Plan (a conversation that talks about how they would like their end-of-life care to look like) for the elderly, they would tell me that they didn’t wish to be a ‘burden’ to their loved ones when they were no longer able to take care of themselves.
They wanted their loved ones to be happy.
If you’re struggling with the care of your elderly parent today, there’s no shame in admitting that it is difficult, and that you’re slowly coming to the point of giving up.
You may think of the times your parent lies alone in the nursing home, whilst you’re at home with your loved ones. You may wonder about the times when your parent interacts with strangers, whilst you spend time with your family. You may think that you’re being selfish.
But maybe it’s also equally painful for your parent to see you struggling, venting your frustration on your children, and reaching burnout.
Don’t just look at the downside of ‘abandoning’ your parents in a nursing home. Today, with activities, programmes and professionals caring for them, they may find a second spring in their last days.
There is help available if you’re willing to reach out.
You don’t have to struggle alone.
The post How to Offset and Rethink the Costs of Putting Your Parent In A Nursing Home In Singapore appeared first on DollarsAndSense.sg.
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