A Personal Reflection
At 20, I became my mother’s primary caregiver. Her battle with depression and recovery from cancer didn’t manifest in ways that traditional support systems recognize. She was prone to falls, struggled with eating and sleeping, and often missed her medications. These challenges didn’t fit neatly into the criteria of Activities of Daily Living (ADLs), yet they demanded constant vigilance and care. I found myself rushing home from work, coordinating medical appointments, and providing emotional support – all without formal recognition or assistance. (It is also the reason why SG Assist was started based on our SG Assist App (Appstore / Playstore) to support caregivers and social services to find community volunteers on a real-time manner to support them on simple tasks and bringing care recipients to medical appointments)
This experience isn’t unique. Many caregivers begin their journey long before their loved ones reach a state of physical dependency. Yet, our current support models often activate only when a care recipient’s needs align with specific, measurable criteria.
1. The Reality of Singapore’s Ageing Population
Singapore is ageing at an unprecedented rate. According to data presented by Prof. John Wong at the Impact Beyond Summit hosted by DBS Foundation, Singapore’s population aged 65 and above is projected to increase from 7% to 21% in just 28 years – a pace much faster than countries like France, which took 115 years for the same demographic shift.
This rapid demographic shift means that caregiving will soon become a common and inevitable part of many Singaporean households. As families grow smaller and seniors live longer, more individuals – spouses, children, siblings -will find themselves stepping into caregiving roles, often without formal preparation or support.
We are becoming a nation of caregivers, whether by choice or by circumstance. Yet, if our systems of support continue to only respond at the stage of severe dependency, we risk overwhelming families who are already juggling employment, caregiving, and personal responsibilities. Strengthening caregiver support is not merely a social welfare issue; it is a national resilience strategy that we can no longer afford to overlook.
2. Longer Life Doesn’t Equate to Healthier Life
While Singapore boasts one of the highest life expectancies globally, the gap between life expectancy (LE) and healthy life expectancy (HALE) remains significant. According to the Global Burden of Disease Study 2019 findings published by the Ministry of Health, Singapore’s LE at birth increased from 75.6 years in 1990 to 84.9 years in 2019, ranking first globally. Likewise, Singapore’s HALE improved from 66.6 years in 1990 to 73.9 years in 2019, also the highest globally (MOH, 2022).
Yet, this still leaves approximately a decade where Singaporeans are expected to live with chronic illnesses or disabilities. During these years, individuals may not be fully dependent in the sense of needing help with basic self-care, but they require significant daily support – medication management, emotional encouragement, nutritional care, physical supervision to prevent falls, and transportation for medical follow-ups.
This period often defines the core of caregiving, where the load is heavy but largely invisible to current policy frameworks. Recognising and addressing this reality is critical if we are serious about supporting ageing in place and sustainable caregiving.
3. The Invisible Load of Caregiving
Caregiving extends beyond assisting with ADLs. It encompasses:
- Instrumental Activities of Daily Living (IADLs): Managing finances, transportation, medication adherence, meal preparation, shopping for essentials, housekeeping, communication support (e.g., making phone calls, managing appointments), and ensuring safety at home.
- Emotional Support: Providing companionship, mental health support, and navigating behavioral changes associated with conditions like dementia.
Research shows that IADL impairments often occur earlier than ADL impairments, particularly in conditions such as early-stage dementia, cancer recovery, and mental health decline. Caregivers are frequently engaged long before physical dependence manifests, managing complex needs that are not currently prioritised in many eligibility criteria (SpringerLink, 2023).
Further reinforcing this, Wayne Freeman Chong, PhD – Keynote Speaker, Social Scientist, Caregiver, in his doctoral research on long-term care and caregiver well-being in Singapore, highlights that international definitions by WHO and the US Department of Health and Human Services recognise that long-term care extends beyond basic ADLs to include IADLs and health maintenance activities to preserve quality of life (Chong, 2020). His research further shows that while Singapore had 31,738 older persons with at least one ADL limitation in 2010, this is projected to rise to 82,968 by 2030 – yet the unseen burden of IADL and emotional support remains much larger and often unmeasured.
For a practical breakdown, a helpful reference from A Place for Mom outlines common IADLs, which include preparing meals, housework, shopping, managing medications, handling finances, communication, and transportation (A Place for Mom, 2024).
If we are to future-proof our caregiving policies, recognising and supporting IADL caregiving must be part of the conversation.
4. The Limitations of Current Support Models
Singapore’s caregiving support is predominantly means-tested and heavily reliant on ADL assessments. This approach often excludes caregivers like myself, who provide substantial support that doesn’t meet these specific criteria.
Moreover, the concept of “state familism” – as described in academic research such as “State Familism in Action: Aging Policy and Intergenerational Support in Singapore” (SpringerLink, 2023) – emphasizes the family’s role as the first line of support for older persons, with the community and state stepping in only as a last resort. Singapore’s policy landscape actively strengthens the family unit through mechanisms like housing policies, CPF savings schemes, taxation benefits, and eldercare subsidies.
While such a structure reinforces familial responsibility, it also places immense pressure on families, particularly when caregiving needs arise long before formal support kicks in. If family is expected to be the first line of care, it is only fair and pragmatic that we prioritise strengthening families’ caregiving capacity early and comprehensively.
5. Rethinking Caregiving Support: A Proactive Approach
To better support caregivers:
- Broaden Assessment Criteria: Include IADLs and emotional support in caregiving assessments.
- Provide Early Intervention: Offer resources and support before a care recipient reaches full dependency.
- Strengthen Family Support: Recognize and bolster the family’s role in caregiving through policies and programs that provide tangible assistance.
As Singapore continues to promote the narrative of “family as the first line of support,” it’s imperative to ensure that families are equipped and supported in this role.
Conclusion: A Call to Action
Caregiving often begins in the shadows, long before formal systems acknowledge its presence. By expanding our understanding and support of caregiving to include the full spectrum of responsibilities, we can create a more inclusive and compassionate society.
I invite you to reflect on your experiences and share your thoughts:
- Have you faced challenges in caregiving that weren’t recognized by existing support systems?
- What changes would you like to see in Singapore’s approach to caregiving?
Let’s work together to advocate for a system that truly supports caregivers at every stage of their journey.
This article was written by Adrian Tan and originally posted on LinkedIn on April 29, 2025.
