Disability/Caregiver Support/Theory of Change

Click on each outcome in the Theory of Change to explore services, gaps and ideas.

To change anything in this page, feel free to contribute directly or to propose revisions and amendments in the Discussion page.

Theory of Change

Short-Term Outcomes(skills, knowledge, attitudes)		Mid-Term Outcomes(behaviours)		Long-Term Outcomes(impact)		Social Impact
Respite care options are accessible to caregivers	→	Caregivers can easily access respite care	→	Caregivers are in physical health and psychosocial well-being	→	Caregivers can sustainably care for disabled care recipients to the best of their capabilities and capacities
Real and perceived barriers to regular self-care are reduced	→
		Caregivers have informal social support around them	→
				Caregivers are equipped with information and skills at different steps of the care journey
		Caregivers acquire reliable information and training to perform care	→
Access to touch points is reasonably accommodated to caregivers' needs	→	Caregivers can easily access touch points for information and skills
		Caregivers do future care planning	→
		Caregivers can access financial support	→	Caregivers can bear the financial costs of care

Respite care options are accessible to caregivers → Caregivers can easily access respite care

• Home-based respite services are convenient, but are expensive and not always available. Centre-based services are routinely available, but their operating hours can be restrictive for working caregivers. Caregivers also differ in their utilisation and acceptance of respite care services.

Programmes	Gaps	Ideas
Home Based Care Services Provides alternative care support for adults with disabilities, with the aim of keeping them in the community for as long as possible. Delivers services such as therapy, personal hygiene care, housekeeping and medication reminders. 2 service providers as of 01 July 2018 - AWWA and MINDS	Caregivers reported a lack of opportunity for respite, especially when care recipients require round-the-clock care [Need to know what are the costs like to use these services] [Need to know utilisation rates of services by caregivers of PWDs]	To consider commercialising caregiving (e.g. piecemeal/gig caregiving services) In light of an ageing population, decreasing family sizes and caregiver fatigue Can also consider tapping on people who live in the neighbourhood/not working with free pockets of time to provide paid, temporary caregiving services, with financial remunerations and incentives Examples from the eldercare space: Homage, Jaga-Me, Caregiver Asia, Active Global
Drop-in Disability Programme Provides social, recreational and/or therapeutic training activities for persons with disabilities for a few days a week up to 9 hours 4 DDPs provided by Thye Hua Kwan Moral Charities as of 01 July 2018	[What is the utilisation rate of these services?]
Day Activity Centres Community-based facilities that provide care and skills training to persons with disabilities aged 16 and above. 30 DACs as of 11 Sep 2018 Clients: 1,200 | 200 are young adults	DAC operating hours are mainly till 4 or 5pm, and caregivers find it difficult to work full-time (till 6 or 7pm), and part-time employment opportunities are limited too - if un-ideal	Consider operating DACs on a shift system to complement working hours of caregivers, e.g., 7.30am - 2.30pm | 12 noon - 7pm, or to open till later
Children Disability Homes (Short-Term Respite) Provides long-term residential care, but also short-term respite care for those whose families are unable to provide care temporarily. 3 homes provide respite care services as of 13 August 2018	[What are the costs like to use these services?] [What is the utilisation rate of these services?]
Adult Disability Homes (Short-Term Respite) Provides long-term residential care, but also short-term respite care for adults with disabilities whose caregivers are temporarily unable to provide care for them. 8 homes provide respite care services as of July 2018	[What are the costs like to use these services?] [What is the utilisation rate of these services?]
Respite services offered at selected day care centres and nursing homes under the ambit of AIC AIC page and E-Care Locator here.
One Child One Skill A volunteer project that sends pairs of tertiary students to homes to teach autistic children a skill over 8 one or one-and-a-half-hour sessions Parents identify skills that they would like their autistic children to learn and volunteers choose the child they teach based on the stated skills and location. Caregivers also obtain respite	While caregivers welcome the opportunity for respite, some are concerned about students’ abilities to take care of and work with their children without their supervision

Caregivers acquire reliable information and skills to perform care → Caregivers are equipped with information and skills on caregiving

• While referral, information and training resources are available, caregivers remain uneven in their knowledge about disability, and support received — they desire to access more rigorous training to better perform care.

Programmes	Gaps	Ideas
Diagnostic Agencies (e.g., hospitals)	For caregivers of children diagnosed with disabilities, touchpoints are poorly equipped in advising parents on where to obtain reliable help during the post-diagnostic phase	Recommendations from EM3 that MSF will consider Recommendation 3, Strategic Direction 1: Improve transition management For newly-diagnosed cases, to set up an agency to provide case referral, care planning and advisory services, and to facilitate smooth handover of information to other agencies Includes developing a standardised case management tool between primary support agency and other service providers
NeuroDiverCity Gathers and shares inclusive services and resources that can be reviewed by parents	[Need to know how useful and utilised the website is to how many users]
All In (in development) Aims "to be a one-stop platform where caregivers can find everything they need" on special needs - guides, assessments, e-shop, blog content, events and courses
SG Enable Currently provides the most comprehensive information covering financial assistance, hospital and training support Caregiver Service Matrix caa 02 August 2018 Hosts the Caregivers Pod, a space for caregivers of people with disabilities, and stakeholders to organise activities and events	Knowledge and level of assistance received by caregivers differ depending on the experience and knowledge of providers they meet Some caregivers deny that children have special needs [is this a significant number of caregivers? Why deny?] Some caregivers reject support services for those in their charge.	EM3 (Recommendation 13) For social service agencies to have a good understanding of community resources available for advisory and referral; one method is a one-stop portal to provide information on service, caregiving, self-care assistive technology and well-being Hub-and-spoke model for caregiver support, instead of having caregivers be supported through services accessed by care recipients. NCSS to pilot the model together with service providers. To assign one case worker for each PWD, for his/her entire lifetime Caregivers need help to understand the trajectory of caring – what to expect, anxieties and challenges, expectations as well as future planning - and to navigate the system of care To integrate various secondary caregivers such as social workers and medical personnel with primary caregivers To consider establishing dedicated Caregiver Spaces as neighbourhood CCs for caregivers' travelling convenience, and have CCs be touchpoints for access to SG Enable's information & advice on caregiver support services - a municipal service system
Caregivers Alliance Provides information, referrals, skills training and other support services
Caregiver Training Courses by VWOs and KKH/NUH Under the Caregiver Service Matrix, caregiver training and education are provided by 17 organisations as of 02 August 2018	Some courses that caregivers are interested in attending are only open to social service professionals [How many, and what kind?] Especially for low-income families, some programmes are unaffordable due to high costs of service and comparatively low levels of subsidies	Training on strengths-based approaches? - Helping parents and caregivers to support their children/wards in building strengths and abilities as opposed to focussing on limitations and disabilities. Ask caregivers themselves how they would like to be supported, in relation to the relevance, usefulness and utilisation of training courses and care services EM3 (Recommendation 13): To provide more and affordable courses (e.g., higher level training), and modes of training that are accessible to caregivers; for NCSS and MSF to work with relevant agencies to improve coordination and outreach to caregivers For service providers to make training options aware to caregivers
Caregivers Training Grant $200 annual subsidy for caregivers, per care recipient, every financial year, to attend training	[How sufficient is this to cover the costs of training to care appropriately for a disabled care recipient?]
Handbooks Who Cares? Transforming The Caregiving Experience in Singapore , a design ethnography by NCSS and fuelfor Caregiving...The Journey Starts With You! by AWWA Caregiver Basics 101 by AIC	[Feedback/utility rate/dissemination data on these publications?]

Caregivers are in physical health and psychosocial well-being → Caregivers can sustainably care for disabled care recipients to the best of their capabilities and capacities

• There are some community-based support services for caregivers, though caregivers have difficulty finding time to access them — they continue to report stress from care work, and the need for self-care.

Programmes	Gaps	Ideas
Community Counselling/Emotional Support Services 14 agencies provide these services as of 02 August 2018	Caregivers reported a lack of opportunity for respite, especially when care recipients require round-the-clock care.	EM3 (Recommendation 13) To expand the continuum of support and respite options, including the implementation of caregiving leave, and to build trust between caregivers and formal respite services Ease access to counselling services, such as counsellors, social workers or volunteers - be it coming to terms with diagnoses of disabilities or assistance with job placement, social assistance and marriage counselling Create more opportunities for caregivers to meet each other as a source of informal support, such as leveraging existing support networks to reach out further For service providers to take family relationships into consideration, as family dynamics are affected if a member has a disability. This could mean designing
Community Support Groups 13 agencies provide these services as of 02 August 2018
Caregiver Activities in the Community 14 agencies provide these services as of 02 August 2018
Caregiving Welfare Association - Caregiver Counselling Services For family caregivers providing care for a senior with physical or mental disabilities

Caregivers can access financial support → Caregivers can bear the financial costs of care

• Financial services such as tax reliefs, training subsidies and grants/concessions are available, though relative to the total expenses required to support a child/person with disability, it may not be enough.

EXISTING RESOURCES	GAPS AND THEIR CAUSES	POSSIBLE SOLUTIONS
Caregivers Training Grant $200 annual subsidy for caregivers, per care recipient, every financial year, to attend training
Home Caregiving Grant Replaced the Foreign Domestic Worker (FDW) Grant from October 2019.  $200 monthly cash payout to support your loved ones with at least permanent moderate disability, i.e. always require some assistance to perform 3 or more Activities of Daily Living (ADLs).   This grant can be used to defray the costs of caregiving expenses, such as the costs of eldercare and caregiver support services in the community, or hiring of a Foreign Domestic Worker (FDW).	Even after subsidies, the remaining cost to hire an FDW is still more than many low-income families can afford Employers must be of sufficient mental capacity to hire an FDW, and cannot have a disability that impairs mental capacity to this degree
Foreign Domestic Worker Levy Concession Lets families pay a monthly foreign domestic worker levy of just $60, instead of $265
Community Long Term Care / Financial Planning Services 4 agencies provide these services as of 02 August 2018		Can we quantify how much financial schemes alleviate total expenses for caregiving? See Chia Ngee Choon’s op-ed for example
Additional Financial Support for Care Recipients with Disabilities Assistive Technology Fund (ATF) (from 2020) CareShield Life ElderShield Senior's Mobility and Enabling Fund ComCare
Handicapped Child Relief (HCR) Eligibility: Child is below the age of 16, and parent earns less than $4,000, which includes income from bank interest, dividends and part-time jobs. $7,500 per child		Raise or remove the 16-year old limit cap, in the case of single parents as marital breakdown is more common among parents of special needs children, and single parents from the middle/low income group will face additional stress to raise their children single-handedly

Caregivers do future care planning → Caregivers are equipped with information and skills at different steps of the care journey

• Although long-term care planning services exist, caregivers worry about the lack of supply of such services and the lack of options beyond loved ones in residential homes.

EXISTING RESOURCES	GAPS AND THEIR CAUSES	POSSIBLE SOLUTIONS
Assisted Deputyship Application Programme (ADAP) Helps parents of graduating cohorts in Special Education (SPED) schools apply to Court to be deputies for their child, so that they can continue to make legal decisions for their child after he or she turns 21	Demand for affordable deputyship applications greatly exceeds supply of available help, including NUS Law undergraduates - in MINDS, the waiting list runs to a few hundred parents	EM3 (Recommendation 14) To simplify deputyship and Lasting Power of Attorney processes for caregivers MINDS is heading a pilot to simplify deputyship applications for caregivers of graduating SPED students For the government to take up the mantle of facilitating deputyship applications, free-of-charge if possible
Special Needs Trust Company (SNTC) Trust Allows family members to set aside money and assets in SNTC accounts, and aims to safeguard these assets to enhance the beneficiary's financial security and well-being 447 SNTC accounts have been opened, out of 117,000 estimated people who might require it (ST 29 Mar 2017)	While caregivers acknowledged that SNTC was a good start, they were worried about the lack of options for future care needs and planning, beyond placing their loved ones in Adult Disability Homes	EM3 (Recommendation 14) To raise awareness of importance of legal, financial and care planning, and services. SNTC to continue expanding outreach to caregivers, and consider partnering agencies providing direct services to disabled people for more integrated and holistic support to caregivers Service providers, including the Office of the Public Guardian and Law Society, to educate caregivers on legal/financial matters such as applying for deputyship To create a system of support at caregivers' natural touchpoints, that would help them in future care planning such as identifying the next caregiver and transitioning of the caregiver role when the time comes, and including documenting and passing on caregiving knowledge. Enable disabled care recipients to make more independent decisions for themselves for the future, something which caregivers tend to do. Depending on the disability type and functioning level, some caregivers can unintentionally prevent their care recipients from learning useful independent living skills through mollycoddling.
Special Needs Savings Scheme Enables parents to set aside CPF savings for the long term care of children with special needs Parents may nominate their loved one with special needs to receive a regular stream of fixed pay-outs upon the parent’s demise.