When everyone is in pain
Many a time, helping a person is not as simple as just helping one person alone. Complicated family dynamics makes our helping more challenging, especially when there are multiple “casualties” in a case. The story below is such a case. Extraordinary perseverance, patience and empathy were needed to render help holistically.
The Client – Mdm Ho, 77 years old
“Life is so meaningless. I hope I can go to Buddha’s Paradise soon.”
Mdm Ho said this in a soft despondent voice every time when O’Joy counsellor Yat Peng visited her. At 77 years old, Mdm Ho suffered from multiple medical conditions – hypertension, hyperlipidaemia, diabetes, osteoarthritis in both knees, hip fracture and the most severe of all, renal failure which is affecting her eyesight. As a result of her weak legs and partial vision, she needed someone to assist her all the time with walking She moved around at home using a quad-stick but needed a wheelchair when she went out. Therefore, her husband was not keen for her to go out, even if it was a visit to the temple.
“My husband always scolds me. Everyday. My son does not understand how I feel. He is not here in Singapore. He does not know how difficult it is to live with his father.”
Left alone at home most of the time while her husband went out often to do the marketing with the helper, Mdm Ho felt isolated and helpless. She cried every day and even imagined that her husband was having an affair with the helper. Sometimes he returned home late and Mdm Ho became so hungry waiting for him to bring her lunch.
“My son does not care about me. He doesn’t want to talk to me on the phone.”
Mdm Ho’s son worked overseas and could only communicate with his elderly mother over the phone. However, she also worried about his job situation, and that he might lose his job. Hence when Yat Peng visited every fortnight, Mdm Ho always seemed to enjoy the counsellor’s presence as she could finally have someone to talk to.
“I am so useless. Keep giving people trouble. I should die.”
Frail and unsteady, Mdm Ho had a few falls accidents at home. She would sustain bruises and not be able to stand up, but her husband refused to take her to the hospital as calling an ambulance was too expensive. Instead, he asked the helper to apply some medicated oil for Mdm Ho. On another occasion, the elderly lady suffered bladder leaks and suspected uterine mass, but her husband refused further medical investigations. These incidents were always followed by her husband’s berating afterwards, adding to her sense of worthlessness and increased her thoughts of suicide.
Finally, one day after a heated argument with her husband, Mdm Ho tried to throw herself out of the kitchen window but was pulled back in time by the helper.
To reduce further perilous conflicts between the elderly couple, Yat Peng suggested for Mdm Ho to attend daycare. This was initially disapproved by her husband as he did not want to incur additional costs. Mdm Ho was not keen either as she felt tired and wanted to sleep all the time. She also withdrew herself from visitors and community workers.
Mdm Ho was eventually diagnosed with dementia and depression by a psycho-geriatrician, and her medications were streamlined to treat her low moods. She began worrying about her husband who was beginning to forget things.
The Husband, 87 years old
“For someone my age, I am still cooking and taking care of my wife. We can manage on our own. We don’t need help.”
Although quite elderly and frail himself, Mr Tay was a stubborn man who took great pride in being able to take care of his ailing spouse and manage the household on his own, with just the assistance of the helper.
Not only was he the dominant patriarch of the family, but he was also parsimonious when it comes to money matters. Sometimes the elderly couple would even share two packets of vegetable rice with the helper as their lunch. Even so, Mr Tay refused financial aid, worried that he would be forced into the Lease Buyback Scheme. He was very wary of O’Joy counsellor Yat Peng initially. Fearing that he would be judged for not taking good care of his wife, he did not want their lives intruded upon by outsiders.
“I want to leave my flat for my son.”
As Mr Tay was always angry and agitated with the people around him, Yat Peng suspected that he might be developing cognitive impairment. He would sometimes forget his keys, forget which bus to go home, or even lost his way on one occasion. However, he was uncooperative and refused to answer any of the doctor’s questions at the geriatric assessment. He also refused hearing aid or any paid services such as daycare or home nursing care for his wife and himself.
However, Mr Tay suffered a heart attack and had to be admitted to hospital. Despite that, he would demand to be discharged as soon as he felt alright. Subsequently, he was in and out of the hospital several times for various medical reasons. And eventually, he could no longer recognise Yat Peng.
The Son, 50 years old
Thomas had been living and working overseas for the past 25 years and could only come home to visit his parents every year around Chinese New Year. He had been laid off several times in the past few years and his income was unstable to support himself and his parents.
Although overseas, he kept in touch with his parents through frequent phone calls. His parents’ conflicts troubled him, yet he did not know how to console his mother. Whenever she complained about his father’s scolding, he could only avoid the subject. He was very concerned for his parents, but his work crisis did not allow him to return to Singapore. This often added to his stress.
Upon contact from O’Joy counsellor Yat Peng, Thomas was able to fix an appointment for his mother with a psycho-geriatrician. Mdm Ho could be properly assessed and subsequently diagnosed with dementia. This allowed her access to medications that uplifted her low moods.
During one short trip home at CNY, Thomas installed CCTV to monitor the safety of his parents. He also sought help from Alzheimer’s Disease Association (ADA) to conduct caregiver training for the helper. However, when he tried to broach the subject of Lasting Power of Attorney (LPA) with his father, the elderly man was livid and even chased the son out of the house.
Eventually, Thomas became very overwhelmed with remote caregiving and communications with many parties. By this time, there were multiple community partners involved in this case and were converging upon Thomas for decisions and instructions. Under intense mental and work stress, his own health crumbled and began to suffer insomnia and severe migraines. The pressure became so unbearable for him that he withdrew himself from the community workers.
Unexpectedly for Thomas, his father developed serious medical complications and died. Although he could rush back in time to say his goodbye, the sudden demise of his father shocked him. He decided to return to Singapore for good to look after his mother.
“I am glad I came back to Singapore and able to spend precious, quality time with my mum for the last few months of her life.”
The Helper, 25 years old
“Very easy to look after Ah Ma. She is very sensible and works with me. Ah Gong is total opposite. Angry all the time.”
When Lala first came to the household of senior Mr Tay and Mdm Ho, it was her first time in Singapore and away from Myanmar. She was tasked with cleaning the flat, giving Mdm Ho her medications and accompanying the elderly couple for their medical appointments.
Initially, Mdm Ho showed some animosity towards her, as Lala would accompany Mr Tay for marketing trips that took a long time. But gradually the elderly lady softened and warmed up to her. Lala learnt to massage Mdm Ho’s arms and legs whenever she had aches and pains, and genuinely cared for her.
When Mdm Ho was diagnosed with dementia, Lala received caregiver training from a Burmese-speaking trainer from ADA where she learnt how to better take care of the elderly lady.
“Sir is not in Singapore. I find very difficult. Who to listen to?”
Lala however felt more afraid of senior Mr Tay as he was always angry and scolding Mdm Ho. Sometimes she found it hard to comply with his instructions and had to message Thomas for remote directives. Eventually, she became more assertive and independent in caring for the elderly. For example, taking care of the marketing and cooking the meals to make sure that the couple ate properly.
“Ah Gong did not pay me last month. I think he forget. I scared to ask.”
As senior Mr Tay began to show signs of cognitive decline, there was once when he did not pay Lala. Tension within the house also heightened at that time as both elderlies were easily agitated and upset. Mdm Ho tried to commit suicide and was stopped in time by Lala.
Lala herself developed gastric problems and had pain in her stomach which became worse with stress or exertion. Due to her foreigner status, she could not get proper medical help. Lala contemplated returning home, but Mdm Ho urged for her to stay.
How O’Joy helped
When O’Joy counsellor Yat Peng first visited Mdm Ho, the elderly lady was very depressed and often expressed thoughts of suicide. Her sense of self-worth plummeted under her husband’s daily reprehension. She was also at risk of isolation and spousal abuse or neglect.
During her fortnightly visits, Yat Peng would provide comfort and counselling for Mdm Ho, teaching her ways to cope with her husband’s scolding and to improve her relationship with the helper. Through reminiscence therapy, Mdm Ho could talk about the past with a smile on her face, recalling the happy times when she worked as a cashier in a shopping centre. This improved her self-esteem. Yat Peng also accompanied Mdm Ho to the temple for her spiritual needs, and to assess the helper’s ability to push Ah Ma up and down slopes on the wheelchair.
When Yat Peng conducted a mini-mental state examination (MMSE) for Mdm Ho, her score suggested that she might have moderate dementia. However, she could not be followed up by a psycho-geriatrician as her son was overseas. Yat Peng persuaded Thomas to fix an appointment with the psycho-geriatrician, accompanied Mdm Ho to the appointment, and facilitated for Thomas to act as the spokesperson remotely. Mdm Ho could then receive the necessary medications and care to slow down her cognitive decline and improve her moods.
As the elderly couple had multiple needs, Yat Peng worked with various community partners to ensure that they were closely monitored for safety and medical escort services were being arranged to accompany the couple for their medical appointments. A lot of collaboration had to be sorted out between community partners to clarify the roles of each agency so that communications with Thomas could be simplified.
Even though Mdm Ho was not keen to attend daycare initially, Yat Peng continued to persevere and eventually, Mdm Ho decided to attend daycare for short hours, and with her husband’s approval. The social interaction at daycare helped to reduce her sense of isolation and uplifted her mood.
When Mr Tay passed away quite suddenly, Yat Peng could provide bereavement support to Mdm Ho and Thomas. Over the ensuing six months, Mdm Ho became calmer with her son by her side every day. As her health deteriorated during the COVID pandemic break out, the palliative care team came on board to support Mdm Ho, Thomas and Lala. Yat Peng continued to check in with Thomas over the phone as she could not visit Mdm Ho during the Circuit Breaker period. After Mdm Ho passed away, Yat Peng wanted to offer bereavement support for Thomas, but he was able to cope and eventually managed to move forward after finding a job and a new life in Singapore.
* The names and photos of the beneficiaries have been changed in this story to protect confidentiality and privacy.
Yat Peng served Mdm Ho for a total of three and a half years, journeying with her through the difficult times in the last few years of her life. O'Joy's Services for The Elderly would not have been possible without the help and support from you. You can help to enable joyful ageing for more elderly like Mdm Ho by donating here: https://www.giving.sg/ojoysg/elderly-services.