17 steps to consider when you’re a caregiver.

For some people, the word “retirement” evokes images of dancing seniors on cruise ships. For me (and increasingly more and more people), retirement has always meant a period of time when you have a drastic reduction of income either purposely due to choice, or unexpectedly due to unforeseen circumstances. By this definition, retirement can occur at any age. My past experiences have convinced me that at any moment, we can be “forced” into retirement. This is why I’ve spent my entire life in constant preparation, though I know that when a tragedy strikes, it will seem like no amount of preparation was adequate. If your family member or close friend has been forced into retirement by unfortunate and unforeseen circumstances, especially due to a critical illness (and is not yet at the official “retirement age”), here are some steps to consider:

Disease & End-of-Life Matters:

1. Do your best to educate yourself regarding the critical illness. This will make it easier to converse with doctors and to ask the right questions. Because of the healthcare system’s various incentives and economic pressures, coupled with a shortage of doctors in Singapore, there is an increasing need for patients (and their caregivers) to be educated consumers able to make informed choices, to understand what options are available, and to navigate through the system.

2. Have a frank discussion with your family member about his values. What does he enjoy? What makes him happy? What does he fear or worry about? Then you will need to identify what tradeoffs he is willing to make. For example, at what point would he consider his quality of life to be too poor? Would he want a treatment that can extend his life by 6 months but cost several years worth of salary? Would he want to spend his last days in the hospital under 24-hour supervision or be at home where the care is less intensive? How would he want his family to care for him? To remember him? How would he want his family to move on?

3. At the same time, you (and all other joint caregivers) need to discuss your values, needs, tradeoffs, and limitations. Caretaking can be extremely exhausting, and it is important to not sacrifice your own emotional and mental health as this can result in unintended health problems later. These conversations are difficult, but not having them is the most common and devastating mistake I’ve seen, which has led families to financial ruin and has inflicted emotional wounds that never heal. In one instance, I remember a wife who through 3 years of caring for her husband, suffered irreversible mental and health consequences herself which she has still to this day, over a decade later. Her children even remark that their mother (the caregiver) is now worse off than their father (the patient).


Legal & Estate Matters:

4. Does your family member have a Lasting Power Attorney (LPA) so that you are able to make financial decisions on his behalf in case he becomes incapacitated? Singapore now lets you create and file a LPA for free. There are even free talks, given by the Office of the Public Guardian to help you with the form.

5. Does he have a will? Do you know where it is, and has it been updated? Some assets, like CPF, are distributed based on the nomination form or beneficiary statement. Have these also been updated? If your family member still has capacity (in the legal sense), it is not too late to draft a will. Contrary to popular belief, wills do not need to be drafted by a lawyer. They can even be hand written.

6. Do you know where all his health records, asset records, and insurance statements are? As your family member gets progressively ill, things will become more and more hectic and the last thing you want is to have to go on a scavenger hunt for paperwork.

7. Has he established an Advance Care Plan (ACP) and Advance Medical Directive (AMD), and does the hospital have a copy of it? An ACP/AMD informs your doctor of your preference of using any life-sustaining treatment (resuscitation, tube feeding, etc.) when you become terminally ill, unconscious, or where death is imminent.


Emotional, Social & Spiritual Matters:

8. As a caregiver, are you scheduling time for your own respite care? Stress can impact your own health and wellbeing, so it is important to maintain and strengthen your social & spiritual networks. Remember that social support can be just as important as financial support. As a caregiver, you are likely to need others to do tasks and favours for you. If you’ve left the workforce to be a full-time caregiver, maintaining a strong network might come in handy in case you need to go back to work one day.

9. Maintain good relations with your extended family. Come to a consensus on who will be the main spokesperson based upon their ability and availability.

10. In addition to being educated about the critical illness, it is also good to understand and know about the grieving process. What sorts of things or people can help you to grieve? In 3 years, what specific things could have happened for you to say that this period of tribulation was handled in the best way possible?


Financial Matters:

11. Create a budget. Although you will not know what his future medical expenses are, it’s still essential to track the inflows and outflows of money, as well as how your predicted (budgeted) spending differs from the actual amount you spent. It’s only through examination and looking at patterns in your spending data that you will discover instances where money may be more effectively used and also places where you can make cuts. This may also be the time when you might need to dip into your emergency fund.

12. You might want to consider sharing expenses with other family members, dividing up tasks, and reducing expenses through the use of economies of scale. It may also be a good time for the family to practice frugality, which might make the financial aftermath more harmonious. Another big mistake I see is when financial matters are not discussed and agreed upon within the family, which can result in terrible feuds and family disputes.

13. Explore the possibility of generating supplementary income. This can be a freelancing gig, selling some of your or his belongings, or part-time employed work. There are several time-based and shift-based jobs that are available which you can also explore. In addition to income, having a job might also keep you connected socially.

14. Do you have any investments that generate passive income? Consider renting a room in your home, or moving in with children and renting your entire flat. The lease-buyback scheme may also be something to consider.

15. Are you qualified to make a partial withdrawal of CPF? Do you qualify for any government or community assistance schemes? To find out, you can make an appointment with a hospital social worker, the Agency for Integrated Care (AIC), your local community centre, or local community development council.

16. If you are working and find that it’s not economically feasible or worthwhile to reduce your hours or quit your job, can you afford hiring a caregiver or helper?

17. Consider consulting a CERTIFIED FINANCIAL PLANNER™. These planners (generally) are more educated, experienced, and ethical. Ask for a free initial consultation to see if you are able to trust and connect with the planner. It’s important that they do not try to sell you any financial products at this initial consultation. Try a few planners so that you can choose which one can best help you.

Sadly, tragedies are just a part of life; the only thing we can really do is to expect them and prepare for them. Please note that this may not be a comprehensive list, and that depending on your circumstances, some of these points may or may not apply.

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