Some four million people in the Netherlands help take care of ailing relatives or friends, but one in three admit to losing patience, according to a new survey published on Tuesday.

A research by the government’s socio and cultural policy unit SCP found 9% of carers admit to shouting or being rough with their patients. The main reasons include being overstretched or feeling isolated, or if the patient is aggressive and ungrateful, the SCP said.

While one third of Dutch adults are carers of some sort, 610,000 people have been helping out for at least eight hours a week for longer than three months.

Five out of six carers also have a paid job in addition to their care duties. The SCP defines care duties as offering domestic help, running errands, taking people out and providing company.

The government wants to encourage more friends and family to take on care duties in a shift to what it calls the ‘participation society’ and home help services to the frail elderly are being cut.