Monthly Archives: April 2016

ACG & Chinese Associations organises retirement planning talk for Chinese community

President of the HuaZong National Innovation and Modernisation Committee, Madam Tan Tat Chin stated that 20% of the elderly were abandoned by their children. According to Madam Tan the main cause of these incidents were because elderly parents had no money to care for themselves after spending everything on their children. In such cases, the elderly parents – due to familial ties and affection for their children – typically pay for their children’s’ gambling debts. Some even hand over all they possessions only to be abandoned by their children.

As such, Madam Tan believes that we should make plans for ourselves – not just for our children – and it is important to plan for your life during retirement.

In an effort to address the issue, Aged Care Group together with the HuaZong National Innovation and Modernisation Committee and the Federation of Hokkien Associations Malaysia co-organised a Retirement Planning Talk for the Chinese community. Madam Tan presented on the topic of designing one’s own lifestyle in old age – entitled “Be My Own Old Aged Designer” – while Fong Mun Toh – speaking on behalf of Aged Care Group and an associate of Managedcare Sdn Bhd – spoke on the current retirement planning situation of the Malaysian elderly.

More than 200 people – ranging from the elderly to young adults – attended the morning talk on Saturday, 23rd April 2016.

During her session, Madam Tan who turns 81 this year, shared her thoughts on the 6 factors that will guide the elderly to lead a happy life which are:

  1. ageing with healthy lifestyle,
  2. ageing in your own home,
  3. having medical support,
  4. seeking fun and happiness through healthy activities,
  5. making contributions to society and
  6. learning new things.

Additionally, she encourages the elderly to make contributions to society, their families and to themselves. They could volunteer themselves for social causes, cook a meal for their family and attend talks or pursue a religious life for their personal growth.

On the topic of finances, she stated that with people’s average life expectancy increasing to 80 or 90 years old, it even more important now to do financial and medical planning. She advises people to take precautions, such as obtaining a medical insurance to protect themselves from expensive medical fees. She also stated that people should learn and gain knowledge about healthy living while they are young as chances of getting hypertension, high blood sugar and high blood cholesterol is very high as one ages.

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Madam Tan stated that a lot of children eventually have to send their aged parents to old folk’s homes. Hence, to avoid from becoming a displaced person she advices elderly people to seek their own places to live on their own terms.

She also stated that elderly people be active in social engagements by communicating with their children or grandchildren and participating in social activities like dancing and singing to create positive emotions. Madam Tan stated “the elderly should not spend their time watching TV but find ways to exercise their brain to decrease chances of suffering from Dementia”.

She stated that we should instead “cultivate a lifelong interest – while we are young – that will continue to retain our interest as we age such as calligraphy, drawing, gardening or playing music”. She also encourages the elderly to surf the net to keep themselves current or read books to gain knowledge, stating that doing so will keep them mentally stable and emotionally edified.

She concluded with a message that you have to save money for yourself and to better plan your retirement early when you are still in your 30s or 40s to ensure you age in dignity.

Fung Mun Toh, basaed on his experience of working in nursing homes, said that there are 3 tiers of care which are:

  1. low care (independent living),
  2. medium care (assisted living) and
  3. high care (dependant living).

People need enough funds for their care in old age and the cost of staying in a day car centre’s single room would incur an estimated monthly fee of RM4000, amounting to RM48 000 a year.

Mun Toh stated the current challenges facing elderly care in Malaysia are due to the rising costs of healthcare, unpreparedness for potential life crisis, lack of financial planning and no support from the family or authorities. As such, he encourages people to make financial plans for their long-term care as early as they can for both themselves and their loved ones.

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To address the issue, Mun Toh recommended CareTRUST™ – a living trust where you can set money aside to ensure provision of continuum care that is financially sustainable – as part of their retirement planning. He stated that CareTRUST™ account holders can rest assured Rockwills Trustee will safeguard their interests and that their money will be invested in a cash management solution offered by KenWealth. Their money will be monitored and disbursed for their care according to the account holder’s instruction.

He explained that when a CareTRUST™ account holder is in need of care, Managedcare will assign a Care Manager to conduct a care assessment on the client and develop a care plan. The Care Manager will then identify, assess suitability of services and engage the care providers to administer the necessary health & long-term care services.

Mun Toh concluded his session stating that “there is still a long journey ahead when you reach old age before we pass on. But until then we need to know how we are going to take care of ourselves and plan appropriately for our long-term care.”

The 6 Attributes of an Innovative Service Delivery in Aged Care

This is Sean’s journal entry No. 2: the previous deliberations regarding being financially secure to pay the cost of healthcare leads me to the second part of the aged care conundrum in Malaysia: The delivery of service.

In his commentary of property trends in Malaysia (Oct 13, 2015), UOA Asset Management’s CEO, Kong Sze Choon, stated that more than just nursing homes, aged care also refers to adequate housing, healthcare and medical services, community and leisure facilities that meet the needs of the elderly. The challenge is in providing world-class medical and healthcare for the elderly.

Simply put, a binding agent for a refined service delivery system is one that is capable of consolidating and delivering the necessary facilities, technology and services to assist in connecting the elderly, and, by extension, people with disabilities, with the services they need. So, what does an innovative service delivery in aged care look like?

According to The World Health Organisation (November 2014 survey), a well-functioning health system has a network of service delivery that possesses six attributes that characterises it as innovative. These attributes are: Comprehensiveness, accessibility, continuity, people-centredness, co-ordination, and accountability & efficiency. Together they form a coherent approach that acts as the driving principle for the health care delivery system.

Bearing these factors in mind, a service delivery network which functions on the aforementioned six attributes is particularly critical to prevent and manage functional and cognitive decline – further aggravated by the aforementioned challenges in Malaysia’s case – which older populations are increasingly experiencing as they live longer. Furthermore, it also encourages a lifestyle that would naturalise ageing-in-place, thereby reducing the physical and financial challenges inherent in long-term hospitalisation.

Comprehensiveness
Just as the likes of Uber, AirBnB and Kaodim have revolutionised the model of their respective industries’ service delivery, aged care too requires a similar remodelling. The age of individual sectors in Malaysia – providing their respective services in isolation – will not be sustainable to keep up with the impending “silver” tsunami. A new formula of comprehensivity of services and information is unquestionably necessary to meet the evolving demand of care needs that even now rolls in with the first waves of the ageing phenomenon. Rod Young from Australia’s Aged Care Industry IT Council stated that healthcare providers should recognise that good clinical care, good management and good data are essential to the performance of their organisation (ICT in Aged Care, Oct 26, 2015).

Accessibility
By “Uberising” the service delivery network’s platform, the nature of accessibility to care services is transformed and new avenues of cost-saving solutions are made possible as information on technology, products and services – along with transparency of pricing – is made more easily available. Consumers would be able to find and rely on new solutions – such as ageing-in-place technology, home care and multi-generational housing – for their care needs that adapt to their lifestyle instead of standard options that are typically cost-heavy and restrictive in allowing independence.

Glenn Payne, CIO of Feros Care in Australia, predicted that self-directed care would be the next big innovation in the aged care business with clients being able to pick who they want from a provider that connects everyone (Adopting ICT in Aged Care, Aug 31, 2015). Ageing-in-place options would be especially attractive as services such as telehealth – a collection of means or methods using telecommunication to deliver virtual medical, health, and education services – would make it a viable alternative. The elderly could retain constant communication with their doctors for monitoring and follow-ups via telehealth devices while in the comfort of their own home, negating the extra cost incurred by hospital stays and travelling.

Continuity
Considering the cycle of retirement, inevitably as people move from an active retirement lifestyle to their final phase of life, the service delivery network needs to follow the elderly’s transition into each phase, smoothly integrating various resources in a seamless and continuous flow. From independent living to assisted living, and finally dependent living, the network must be able to act as a central hub that is not only capable of providing continuous care for each stage, but also enable the elderly to find sustainable options and resources to continue having access to care, mitigating obstacles arising from the depletion of funds.

People-centeredness
The World Economic Forum stated that many baby boomers don’t like what they see when they come into contact with the aged care system, be it from personal experience or assisting their own parents, and they want improvements. They want better food in residential aged care, aged-friendly communities and pathways to be built or maintained so they can continue to walk safely in their communities (Why Aged Care Needs an Uber Moment, Nov 19, 2015).

Essentially, the service delivery network must be people-centred in its approach and structure, creating or packaging services that people want to use and have access to, that provides support to ultimately enable consumers – the elderly and individuals with disabilities – to remain independent. People should feel dignified by using these services, not ashamed for needing them. It has to build a life-affirming culture that empowers people, encourages social engagement, and brings generations together.

Co-ordination
Elaborating on Rod Young’s earlier statement, co-ordination is the fifth attribute, and it characterises an innovative service delivery network. As the central hub, the network plays a key role of co-ordinating the flow of information between organisations. By connecting a person’s points of care to a central hub, service providers will able to define and administer more appropriate solutions by accessing the same data and level of detail concerning the client’s medical condition (IT and E Strategy and Action Plan, July 2014).

This is where information and communication technologies (ICT), such as telehealth, would be essential to assist in spinning the co-ordination cogwheel. With the growing access to fast broadband connections, video and monitoring technologies are expected to create greater engagement between healthcare providers and clients themselves in a variety of settings, including their own homes.

Accountability & Efficiency
As a binding agent that consolidates healthcare resources, accountability and efficiency is the final essential attribute needed in establishing best practice strategies when matching clients with the relevant service providers – pre-screened to ensure quality standards are met – and appropriately centralising records. This is to optimise the best use of financial resources, maximise medical information accuracy and avoid duplication, and lift overall productivity. This would provide further cost savings for the client and increase the providers’ efficiency in meeting their needs. Hence, the elderly or disabled person can avoid situations that incur unnecessary spending such as undergoing several consultations with different doctors before meeting the one suitable for their care needs.

Getting on-board
There is still a long way to go before Malaysia’s aged care service delivery network is a smoothly running engine, but there are significant opportunities. When innovative products and services are produced and assimilated into the network, the potential of improved engagement between service providers, clients and families will open up pathways to exponential growth in business and quality of life for consumers.

 

First Published in Smart Investor, April 2016, Issue 312

Finance: Addressing Malaysia’s long-term care needs

BY KHAIRANI AFIFI NOORDIN

Malaysia’s growing ageing population has created an urgency to address the need for adequate long-term care. This includes services that help meet the medical and non-medical needs of individuals with chronic illnesses or disabilities who are not able to care for themselves over an extended period of time.

According to the government’s website on the Healthcare National Key Economic Area, Malaysians are getting older, with those above 60 expected to make up 10% of the population by 2020 and 15% by 2030.

While nursing facilities and in-house nursing services have been catering for the rising demand in the country, there are also adult day care programmes and assisted living services available, which many may not be aware of.

“We do have specific care centres for Alzheimer’s or Parkinson’s disease. Private sector players and non-governmental organisations are operating some of the facilities or care centres throughout the nation,” says Managedcare Sdn Bhd CEO Carol Yip.

She says there are 244 registered care centres under the Care Centre Act 1993 and 16 registered nursing homes under the Private Healthcare Facilities & Services Act 1998, in addition to the services that are initiated by the Social Welfare Department, such as Home Help Services, Rumah Sri Kenangan, Rumah Ehsan, Pusat Jagaan Harian Warga Emas, and activity centres for senior citizens.

Yip says that to meet the growing need, the government has proposed the creation of more facilities and services for the ageing population and has encouraged the private sector to look at the business opportunities.

Setting aside money for care

In Malaysia, most people refer to long-term care as medical care and equip themselves with medical insurance to cover any large, unexpected medical treatments and hospitalisation costs. However, they neglect to prepare themselves for the daily living expenses as well, which may take a huge toll on their finances.

“We [still] have to pay for services such as daily living activities (feeding, toileting, grooming) and instrumental activities of daily living (managing finances, handling transport, preparing meals, shopping), which are recognised as non-medical care needs. This is because our medical insurance will not pay for these costs and this will potentially eat into our retirement savings,” says Yip.

Many Malaysians depend on their Employees Provident Fund savings or families for their post-retirement care, she adds, as the country is not a welfare state and private sector retirees do not receive a government pension.

Recognising the need for sustainable retirement care, Managedcare introduced CareTRUST™, a living trust that allows individuals to set aside money for their long-term retirement care or healthcare. The framework is the first of its kind in the country.

“It is a known fact that many Malaysians have insufficient money [for retirement] due to uncalculated risks such as longevity risk, medical inflation and high cost of living, which can make retirement life tough. Hence, the need for financing options that allow Malaysians to put aside money for long-term care,” says Yip.

The living trust framework is a collaboration between Managedcare, Kenanga Investment Bank Bhd and Rockwills Trustee Bhd. Customers can open a CareTRUST™ account with a minimum of RM30,000. The sum will be invested in Kenanga Wealth Management’s (KenWealth) Kenanga Principal Protected Income Fund (KPPI) — a diverse portfolio of short-term money market and deposit-based instruments that are not subjected to market valuation risks. The portfolio is fully managed by KenWealth.

The fund does not promise a guaranteed return but it provides a high level of liquidity as it is a money market fund. If the account holders prefer their funds to be invested more aggressively, they are allowed to direct the trustee to switch to the existing 280 unit trust and Private Retirement Scheme funds offered by KenWealth at no cost.

As the independent trustee, Rockwills is given the custodial rights to manage the funds, safeguarding the account holder’s interests by monitoring and disseminating the monies for care according to their instructions when care is needed.

The accumulated money will be used to pay for long-term care if needed. In the event that the account holder’s balance falls below the minimum threshold of RM25,000, Rockwills and Managedcare will send a written notice to the account holders to top up the money in their account. Upon falling below the minimum threshold and the death of the settlor, the CareTRUST™ account is automatically dissolved and the balance paid to the beneficiaries.

The account holder will be charged a RM1,500 set-up fee (excluding Goods and Services Tax and stamp duty), an annual fee of 1% of the gross value of their trust assets, payable on a quarterly basis, and a monthly care administration fee of RM300 (excluding GST) upon commencement of the care services.

Account holders are allowed to revoke their accounts at any time, with a dissolution fee of RM2,500 (excluding GST). If they do not top up the money in their account after receiving notices from Rockwills and Managedcare, the accounts will be dissolved.

There are three phases in having a CareTRUST™ account — the savings phase, care phase and exit phase. After opening an account, the account holder will top up money on a regular basis in the savings phase. When they reach the age where they need care, they enter the care phase and receive long-term care services administered by Managedcare, where the trustee will use the money from their trust to pay for their needs. The account holder enters the exit phase once he or she decides to revoke the trust.

“There is no specific duration between each phase, which means you can save more money and top up even when you are in the care phase. [There is] no big difference between opening an account at age 30 versus age 50. However, there is a possibility that the 50-year-old will enter the care phase before the 30-year-old,” says Yip.

As the care administrator, Managedcare coordinates, monitors and oversees healthcare service providers for the account holders. Yip says there are several categories of long-term care services for the account holders to consider.

“Typically, these services need to be tailored to suit each individual’s needs and level of support. There is no one-size-fits-all solution. Instead, a combination of care services are often put together after a thorough assessment of an individual’s needs,” she adds.

To cater for account holders with special conditions and disabilities, for example, Specialised Care Services are offered for those with Alzheimer’s disease, dementia, Parkinson’s disease, Down syndrome, autism and learning disabilities, among others.

While in the care phase, Managedcare conducts a care assessment to design a care plan for the account holders. It will review and update the account holders’ care needs periodically. Managedcare also manages the account holders’ care records and generates care reports as a means of monitoring the account holder’s progress and to inform the family of his or her condition.

 


 

Long-term care in the region

The aged care industry in Malaysia still has a long way to go compared with other countries in the region. For instance, the Agency for Integrated Care was formed by the Singapore government’s health ministry as an independent corporate entity to look into the enhancement and integration of the long-term care sector.

According to Yip, the Singapore government has been proactive in ensuring the infrastructure development of elderly care and long- term care facilities, in addition to implementing financial products and subsidy schemes such as Medisave, Medifund and Eldershield to help individuals finance their future medical needs.

Meanwhile, the Hong Kong government introduced the 2015 Population Policy Strategies and Initiatives document and the 2016 Policy Address in an effort to address the challenges of their ageing population. The 2015 Population Policy Strategies and Initiatives is a five-pronged strategy that includes building an age-friendly environment, promoting active ageing and tapping the valuable pool of elderly resources. In the 2016 Policy Address, it is stated that the Hong Kong government will provide about 70 additional subsidised day care facilities, among other initiatives, for the elderly.

Long-term care is available as a rider in the policies provided by insurers in Hong Kong. However, the long-term care benefit under a life insurance plan is normally only paid if the care is determined to be medically necessary or in the event that the insured individual is unable to perform daily activities, according to Hong Kong-based CCW Global Insurance Brokers on its website.

In Japan, due to the long life expectancy and low birth rate, the government initiated a mandatory public long-term care insurance (LTCI) in 2000. Under the system, all Japanese residents above 40 are required to pay for long-term care insurance premiums, half of which is subsidised by the government. This enables the elderly to lead more independent lives and relieve the burden of family carers.

A 2015 study titled, “Considering long-term care insurance for middle-income countries: Comparing South Korea with Japan and Germany”, shows that five years after the implementation of the LTCI, Japanese citizens had become more aware of their entitlement, thus causing the number of eligible individuals to grow to 16% of its elderly population, exceeding the initially projected 12%.

The system’s actual expenditure also exceeded the projected ¥5.5 trillion, reaching a total of ¥6.8 trillion. As demand rapidly increased, the supply of long-term care facilities and providers also grew, creating competition in the industry.

Apart from the LTCI, the Japanese government is looking to develop other areas of long-term care. Last year, Tech Insider reported that the government would allocate one-third of its budget to developing caregiving robots that can assist the elderly. This would address the shortage of caregivers in the country.

 

Source: The Edge, April 11, 2016

http://www.theedgemarkets.com/my/article/finance-addressing-malaysia’s-long-term-care-needs

http://www.theedgemarkets.com/en/node/273770

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