What happens when dementia hits

By Lynette Tan

If you’ve only got a minute:

• With the prevalence of dementia in Singapore, it is prudent to consider dementia-specific insurance coverage to cover dementia-related expenses.
• The financial cost of dementia will include cost of a caregiver, medical expenses, and loss of income.
• Caregiving can be stressful and physically exhausting; it is important for caregivers to have support and to take care of their own well-being.

About 1 in 10 Singaporeans aged 60 and above suffer from dementia, and half of those aged 85 and above had dementia. By 2030, it is estimated that more than 100,000 people in Singapore may have dementia.

Like many other diseases, we cannot predict its occurrence, but we can take measures to alleviate the financial concerns. One key issue that dementia patients are likely to face is the financial impact of the disease.

Dementia is a collection of different symptoms characterised by a progressive worsening of memory and intellect (cognitive abilities), or orientation, that is caused by the diseases that affect the brain. With dementia, patients are likely to be unable to work, and may not be able to perform Activities of Daily Living (ADLs), such as dressing and eating, if the disease is severe. There is thus a need to consider the financial cost of having a caregiver, medical expenses, and loss of income.

Dementia mostly affects those above 60 years old, and Young Onset Dementia (YOD) typically occurs only after age 30. As such, individuals can consider shoring up their dementia coverage as soon as they start working.

Do you know that almost half of the dementia cases in Singapore are Vascular Dementia?

The good news is, you can lower your risk of vascular dementia by making healthy lifestyle choices such as: staying physically active, eating healthily, staying mentally active, being socially engaged and taking control of your health. Learn more at http://www.dementia.gov.sg/

Insurance coverage for Dementia

Since there is a high likelihood that a dementia patient will lose his ability to perform ADLs, a caregiver is needed. The cost of the caregiving can be supplemented by an insurance cover specific to covering dementia, and long-term care insurance such as the CareShield Life scheme and its supplementary plans.

To boost our long-term care financing ability, the Singapore government launched 2 long-term care schemes in 2020 – CareShield Life and Medisave Care. Both schemes are long-term care schemes aimed at providing protection and basic financial support for Singaporeans who become severely disabled.

CareShield Life payout starts at S$600, while MediSave Care allows a monthly withdrawal quantum of up to S$200 if the CPF MediSave balance remains above S$20,000. If the patient receives both payouts, it adds up to around S$800 a month. This may not be sufficient if a caregiver needs to give up his job to be a full-time caregiver.

To mitigate the risk of having insufficient long-term care coverage, consider the DBS-Chubb Dementia Caregiver Protect Plan which pays a lump sum as well as a monthly income benefit if the caregiver is required to stop working to fulfil caregiving duties. Do note that if the patient is diagnosed with dementia before age 55, the lump sum payout will be doubled. 

Other long-term care insurance includes a CareShield Life supplementary plan to enhance the CareShield Life coverage. Such a supplement enables you to receive a payout when you cannot fulfil 1 or 2 out of 6 ADLs, instead of the more restrictive criteria of 3 ADLs under CareShield Life. You will also receive a higher overall payout of up to S$5,000 a month, depending on the plan, the premiums, and the severity of the disability.  

Furthermore, a critical illness (CI) plan provides a lump sum payout when dementia is diagnosed. This payment can be used to supplement medical expenses, caregiving cost and some replacement of income. When selecting a CI policy, keep in mind that different insurers will pay out at different stages of dementia.    

Caregiver’s challenges

Caregiving for dementia patients is akin to a full-time job. If the caregiver decides to take up the full responsibility of caregiving, it is likely that he will need to stop work.

The newly launched Dementia Caregiver Protect Plan offers some respite for caregivers. The insurance not only pays out a lump sum dementia benefit upon diagnosis, it provides a monthly sum to the caregiver who has to terminate full-time employment to take care of the insured person. Moreover, if the patient is diagnosed with dementia before age 55, the lump sum payout will be doubled. 

If the caregiver is a high-income earner, it is worthwhile considering alternative options and it makes more financial sense, so that the caregiver can continue to work on a full-time or part-time basis and provide for the family.

There are alternative options to caregiving for dementia patients. They include nursing home, day care centres, Assisted Living Facility or hiring a caregiver (part-time, home-based).

Other than a loss of income, caregivers may face the following challenges:

• Hiring of inexperienced domestic helper - Hiring a foreign domestic worker (FDW) comes with challenges, including the lack of experience in dealing with dementia patients. Female FDWs may also find it difficult to assist male patients who are heavier and certain tasks such as bathing might cause embarrassment for both parties.
• Emotional and physical stress – The constant attention demanded of caregivers can be extremely taxing mentally and physically, leading to disruptions in both work and private life.
• Lack of support network – The caregiving responsibility may fall squarely on a family member who is single and/or living with the dementia patient. This caregiver may be unable to solicit help from other family members and work out a fairer distribution of the caregiving tasks and financial impact, nor find assistance from dementia-related support agencies.

It is heart-breaking to see a family member deteriorate over time and need help with daily actions of living. Support for caregivers is important as it can take a toil – imagine working every day, being “on-call” 24/7 and having no one to relieve your duties.

There are some resources provided by government agencies to support caregivers. The Agency of Integrated Care (AIC)’s website provides a comprehensive guide for caregivers of dementia patients, information on where to find emotional support and counselling services, as well as a list of alternative options for dementia caregiving.

Caregivers need to take care of your own well-being

Dealing with the demands of caregiving can be stressful and challenging. Not taking care of your own needs as a caregiver can cause chronic stress and may lead to exhaustion, burnout, sleep disturbances, mental health issues and increased irritability. In the long run, the stress will cause harm to your health and can also interfere with caregiving duties.

The Dementia Caregiver Protect insurance provides caregivers of dementia patients with reimbursement for necessary counselling (as prescribed by a psychiatrist or Psychologist) if they suffer from mental illness, as a result of looking after an insured person. 

It is thus important for caregivers to carve out some “me time”, give themselves “self-care”, take time out to guard their own health, participate in activities they enjoy and remain socially connected. Caregivers who take care of themselves will be able to better manage challenges, make informed decisions, and offer effective support to their loved ones.

DBS has partnered with major insurers in Singapore to make health insurance easily accessible online for purchase. You can now independently learn, compare and buy a plan most suited to your own needs. Find out more on DBS Health Marketplace.

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Disclaimers and Important Notice
This article is meant for information only and should not be relied upon as financial advice. Before making any decision to buy, sell or hold any investment or insurance product, you should seek advice from a financial adviser regarding its suitability.