Monthly Archives: April 2017

Integrated Care: Defining The Future Provision Of Care

A conversation with To’ Puan Dr Safurah Jaafar, Panel Advisor to Aged Care Group and Head of Sub-Specialty for Family Health in the Academy of Medicine’s Public Health Medicine Chapter, discussing the definition of integrated care and how its gaining importance in the future delivery of continuum care.

Trends are the sort of thing that comes and goes. Yet, they typically capture the moment and represent the times we live in. As of late, integration is a hot topic and buzz word in health care. With an ageing population and a growing number of people living with chronic or complex health conditions, alongside changing health needs and increasing demands on the healthcare system, it comes as no surprise that integrated care is the future in the provision of care.

Achieving integrated care requires that those involved with planning, financing and providing services have a shared vision, employ a combination of processes and mechanisms, and ensure that the patient’s perspective remains a central organising principle throughout.

Based on her vast experience in Health Services Management and Primary Healthcare, we interviewed To’ Puan Dr Safurah Jaafar, the esteemed former director of the Ministry of Health’s (MOH) Family Health Development Division, to take a closer look at what exactly is integrated care, what makes it an important element for the delivery of care moving forward and where it stands today in Malaysia.

Integration in Care Defined
As a buzz word being thrown around, integrated care as a term has been used loosely on various occasions. So, what exactly is the concept of integrated care, apart from an intangible impression? Globally, the term refers to the systematic coordination of general and behavioural healthcare to produce the best outcomes when caring for people with multiple healthcare needs.

“Integrated care would mean medical and social care provided as real-time as possible to members or individuals of a population needing such services at point of care across physical, mental and social health needs rendered through an efficient and effective orchestrated approached by all care providers within a country” says To’ Puan Dr Safurah.

To put it in perspective, the elements of integrated care consist of four components of care:

·         promotive care Refers to the process of enabling people to improve and increase control over their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.
·         preventive care Refers to the care you receive to prevent illnesses or diseases. It also includes counselling to prevent health problems.
·         curative care Refers to health care practices that treat patients with the intent of curing them, not just reducing their pain or stress.
·         rehabilitative care Refers to the restoration of patients to functional health and allow their return to useful and productive life

Likewise, establishing these four components requires the involvement of four parties; namely the public, private, non-governmental organisations and the Malaysian population itself. Each party must be unanimous in sharing the objectives and values to achieve together positive ageing and ageing with adequate financial and social support, whilst the provision of friendly and warm services observes dignity and respectfulness.

Putting all of these components together will require the medical and non-medical sectors; from the medical fraternity to architects, engineers, interior decorators and chefs – to name a few examples – need to envision and fit into the big picture and play their roles effectively.

“There should not be differences, instead there should be synchronization between all these players” says To Puan Dr Safurah.

However, she also notes that the outcome of care in Malaysia will differ from our neighbours. As resources in middle-income countries differ from their rich-income counterparts, the outcome of integrated care cannot be compared apple to apple with mature countries – such as Japan, Australia and Germany – that have the opportunities of the lead time to improve their care framework.

Integrated Care in Malaysia
In terms of delivery of care, To Puan Dr’ Safurah stated Malaysia – despite being fairly young in the aged care industry and not having earned an ‘integrated care model for the aged’ yet – has begun taking steps towards developing its’ resources to address the growing need for integrated care.

“The Ministry of Health has begun increasing the training of geriatricians and gerontologists together with their allied healthcare providers, while the Ministry of Women and Community Development has provided various facilities, shelters and assistance to support the needing elderlies.”

She also stated that the Ministry of Local Government is currently reviewing various standards and policies in the logistics requirements of city planning. Meanwhile the Economic Planning Unit is forming various committees to develop options that would best optimise and harmonise various efforts within delivery of care, both presently and in the future.

On the other hand, thousands of care providers and facilities have mushroomed to accommodate the growing needs of the ageing population. A fact made evident in the growth of hundreds of private hospitals that are well governed by the prevailing Private Healthcare Facilities & Services Act and patronized by growing communities that can afford it.

However, the needs are ballooning to proportions that Malaysia’s current healthcare system – with its’ fragmented delivery of care and social services – will be unable to sustain.

It is projected that with the coming of the Private Aged Health Care Facilities Act, the standards of care can be gradually aligned to improve the standards of delivering care, management of nursing homes and ensure sustainable development to benefit the aged.

Financial Affordability is a Two-way Road
Another immediate challenge facing public and private hospitals in implement integrated care lies not only in the area of financial affordability of the aged population seeking care. The sustainability of the facilities to maintain and provide the appropriate care while having a sound financial balance is also of concern.

According to To’ Puan Dr Safurah, the Economic Planning Unit and the Ministry of Finance are aware of this concern and are looking into developing various policies and financial plans.

“These plans are crucial as it will have bearing on the incentive and dis-incentive system. This is critical as it will be the principal factor that accelerates the advancement of aged care in Malaysia.”

Building Bridges
The structure of public and private hospitals in Malaysia raises unique challenges. On one hand, public hospitals are governed by the MOH, while on the other, the Association of Private Hospitals of Malaysia (APHM) represents private hospitals. Hence, collaborative efforts to deliver integrated care are thus hindered.

So how can public and private hospitals – with different challenges arising from different settings – overcome these challenges together?

“The public and private hospitals have their unique objectives and clientele. Each aspire to do their best for the aged population within the policies and resources they have assembled. What the can do is find common areas in which they can share resources such as human resource, professional expertise, equipment, beds or training. Many have already started sharing but can be further expanded.”

However, with each party having different models, To’ Puan Dr Safurah stated that seamless delivery of integrated care – the free flow of patients between private and public hospitals – may not develop the way we envisioned it unless the financial models are changed.

Conclusion
Currently many “green areas” exist in Malaysia’s delivery of integrated care, with many gaps to be filled in both medical and non-medical fields. Our infrastructure; from training, facilities, nutrition, food & beverage to our architectural, engineering, interior and technological designs, alongside communication and many other fields crucial to an aged care ecosystem – has yet to be fully developed and established.

However, while integrated care is a relatively new game to Malaysia, as a country ranked as the 6th best place to retire in 2017 by International Living – with our healthcare noted as excellent, we aren’t doing too shabby. We do have the foundation, resources and potential to evolve our healthcare system. It’s only a matter of time.

“Every seminar and meeting we attend, we will always find opportunities to work together to improve or offer more competitive ideas to enhance the development of care to provide the best care and survivability possible” said To’ Puan Dr Safurah.

 

Integrated Care: What Needs To Be Done

A conversation with Carol Yip, Chief Executive Officer of Aged Care Group, discussing why is integrated care important and what are the physical components and structure needed to establish an integrated care operation.

In our article ‘Integrated Care: Defining The Future Provision Of Care’, we spoke with To’ Puan Dr Safurah Jaafar and discussed what were the elements of integrated care. That it is the systematic coordination of general and behavioural healthcare that provides medical and social care services in as real-time as possible to individuals – at the point of care – encompassing physical, mental and social health needs.

These services are rendered through an efficiently orchestrated approached by all care providers within a country. This is to effectively reduce confusion, repetition, delay and gaps in service delivery of care.

We have also discussed the requirements of integrated care. Firstly, it keeps in view the care-receiver’s perspective as the central organising principle. Secondly, the people involved – those in planning, financing and providing services – shared a similar vision and employ a combination of processes & mechanisms to ensure that a human-centred approach remains the hub of the wheel.

Now that we’ve gone through a quick recap, the next questions are: what is its’ significance to us? How do we realise this concept? How does it look like as a tangible and physical structure?

In our interview with Carol Yip, CEO of Aged Care Group, we discuss the specifics of why developing integrated care is essential, how it functions, what are the physical structures that needs to be embedded, the current development we need to make towards integrated care to be provided seamlessly.

The Necessity of Integrated Care
“Everyone benefits from an integrated care framework, be it the young, middle-aged or seniors. When we have this system, everything becomes seamless and things work hand-in-hand to meet the demand while simultaneously creating supply for the need” says Carol Yip, CEO of Aged Care Group.

When integrated care is embedded in a community or neighbourhood, communication becomes easy. You won’t get ‘lost’ in the system as your medical history is collected, centrally stored and made assessible to your neighbourhood care providers. Thus, a person’s health condition can be easily assessed and solutions can be applied without delay. Care providers would also have greater insight to anticipate potential needs or events and be on stand-by to take action.

“Hospitals need to be integrated because everyone who checks in will have all their data on their health and circumstances stored in the hospital. The hospital will then share with the family members, as well as the people who will be caring for the care-receiver” says Carol Yip.

Resources are also managed better due to economies of scale. When more people are connected via the system, the more we save on costs for both people who need care and the facilities that provide the appropriate services. In terms of operations, the processes and mechanisms are also more effectual and well-organised. Ultimately, an integrated care system is better off financially as opposed to care providers working in isolation which makes the cost of services expensive.

Tackling New & Existing Townships
Townships that are decades-old need to be addressed. In Malaysia, matured townships in rural and urban areas contain people who have been living within them for 40 to 60 years. Some could be very old and in need of integrated care services. So how can we inject integrated care to an established township – built for demands of decades passed – now in need to keep up with current ageing trends?

“One of the easiest way is to build Day Care Centres, a locale catered specially for seniors. They can get simple care, do leisure activities and meet their peers. The Day Care can also be an avenue for care professionals – e.g. nurses, caregivers, physiotherapists, etc. – to congregate and apply their trade. From the data collected, we can slowly progress to setting up nursing homes and other essentials for integrated care.” says Carol.

On the other hand, new townships are easier to handle as a location to set up care facilities – such as nursing home, day care and step-down care units (similar to confinement houses for postnatal-care) – need to be identified at the beginning stages of master plan.

Get the Ball Rolling
According to Carol Yip, another component to kick start the establishment of integrate care is home care services. Currently, home care in Malaysia is not regulated, yet it is the most required service at present. Nursing homes in the form of bungalow houses – which for a time filled the vacuum for home care needs – are no longer sufficient.

“The reason we need to address this issue is because there are no proper monitoring of the quality of care delivered. The priority is to improve our current home care services. Many felt the Private Healthcare Act – which currently regulates private nursing homes – is difficult to comply with. However, if we are providing care we should adhere to this requirement. We need to acknowledge that compliance is crucial to provide good service” says Carol.

She also stated that trained manpower – e.g. nurses, care workers – who are mobile to move from the home to hospitals or care centres and vice versa are another essential component to the structure of integrated care.

At present, the Ministry of Health’s are also working on policies to shift the public’s perception and attitude towards ageing and aged care services. As Malaysia moves towards an ageing nation, in tandem with the evolving care needs, we need to be more progressive and do things better with a difference.

Public – Private Partnerships
Partnerships and collaborations have begun to take form in Malaysia in an effort to cope with the increasing healthcare demands and actualise the first steps of an integrated framework.

At a recent forum discussion between University of Malaya and Aged Care Group, Professor Dr Tan Maw Pin – an Associate Professor in Geriatric Medicine – stated that 26% of those who attended University of Malaya Medical Centre’s (UMMC) emergency department in 2014 were seniors, which is an alarming statistic.

During that period, the general senior population surrounding UMMC comprised 6.1% of the total population. The disproportionate figure suggests:

• a lack of or inadequate community services for the ageing community in Malaysia and
• a lack of confidence toward primary care physicians and general practitioners.

When such data are shared amongst those with similar vision to provide continuum care, the work to actualise integrated care into our communities can begin in earnest.

“The non-medical private sector need a lot of support from the medical parties and public sector to give feedback on what are the challenges their facing. Then we will be able to find solutions together.

Conclusion
To summarise, Carol stated we needed to develop trained manpower and the government to hasten the development of aged care facilities, in order to get the ball rolling. We also need to establish the proper incentivisation for those who wish to take part in the industry when they offer their services. Currently, Aged Care Group has already collaborated with various organisations in an effort to establishing integrated care.

“For the last two years, we have created products that are unique such as CareTRUSTTM together with Kenanga and Rockwills to help Malaysians have enough money to sustain their long-term care. We partnered with EcoWorld to create CareHub at Eco Sanctuary, where the care component is embedded into a new township. We intend and will continue to create products and services that meet the Malaysian culture, context and setting of ageing needs.”

 

 

Tingkat Kualiti Penjagaan Warga Emas

Harian Metro, 19 April 2017

Kuala Lumpur: Universiti Malaya (UM) dan Aged Care Group (ACG) menjalinkan kerjasama bagi membangunkan Continuum Care dalam usaha memastikan penjagaan warga emas di Malaysia diurus dengan lebih baik, berterusan dan menyeluruh.

Inisiatif penting membabitkan sektor awam dan swasta itu bagi menangani cabaran dihadapi warga emas seperti kekurangan pusat penjagaan dan kemudahan mencukupi untuk mereka, modal insan yang terhad termasuk kekurangan pakar perubatan dan pusat pakar perkhidmatan.

Menurut Naib Canselor UM Prof Tan Sri Dr Mohd Amin Jalaludin, pada masa ini Malaysia menghadapi keperluan akut untuk kualiti dan perkhidmatan penjagaan orang tua yang berpatutan.

Menurutnya, melihat kepada demografi semasa, Malaysia sedang bergerak ke arah sebuah negara penuaan pada 2030 di mana rakyat berusia 60 tahun dan lebih tua akan menjadi sehingga 15 peratus daripada jumlah penduduk.

“Tujuan kerjasama ini adalah untuk menangani beberapa cabaran dihadapi landskap penuaan iaitu kekurangan infrastruktur yang lebih mesra warga tua, bekalan terhad modal insan dan perkhidmatan penjagaan khusus yang tidak mencukupi,” katanya ketika berucap pada majlis perjanjian persefahaman (MoU) itu di sini, semalam.

ACG inks MoU with UM in Continuum Care for older Malaysians

KUALA LUMPUR, 18 April 2017:

To lead a hassle-free life when they need care, a joint initiative between Aged Care Group and University of Malaya will be undertaken to provide continuum care for older Malaysians.

The Memorandum of Understanding (“MoU”) sees a cohesive effort between the public and private sector to address some of the challenges confronting the Malaysian ageing landscape namely lack of aged care and intermediate care facilities, limited supply of human capital including medical specialists and insufficient specialised care services. One of the reason for this collaboration including the need to increase “professionally trained and skilled human resources” to cater for the increasing demand of ageing population.

Continuum of care is a concept involving an integrated system of care through a comprehensive array of health and care services. Each institution will engage on a shared advocacy strategy bringing forth their skills and expertise to encourage leadership by offering a vision for the future and to provide a framework for the delivery of optimum care.

As education plays an important success factor, both sides will pursue many significant activities, such as knowledge sharing and exchange within the community; the promotion of activities to create public awareness, seminars, workshops and conferences in the area of education and training for the aged care industry. The partnership will build networks that benefit the public especially through collaboration for education and advocacy that will lead towards human-centered continuum care.

Both Aged Care Group and University of Malaya urge Malaysians to learn and know more about aged care as we are moving toward into an ageing nation.

 

About

Aged Care Group Sdn Bhd

Aged Care Group (ACG) is an organisation engaged in the business of elevating and providing aged care services in Malaysia. ACG is driven with a strong vision to advocate innovation and transformation in ageing by offering continuum care as a premium choice for enriched living. We operate in an ecosystem that provides integrated care services and products through meaningful partnerships business community, government, public sectors and corporations.
A detailed profile of who we are can be obtained at www.agedcare.com.my.

 

University of Malaya

University of Malaya, or UM, Malaysia’s oldest university, is situated on a 922 acre (373.12 hectare) campus in the southwest of Kuala Lumpur, the capital of Malaysia.

It was founded on 28 September 1905 in Singapore as the King Edward VII College of Medicine and on 8th October 1949, it became the University of Malaya with the merger of the King Edward VII College of Medicine and Raffles College (founded in 1928).

UM’s mission is to advance knowledge and learning through quality research and education for the nation and for humanity.

For more information, please visit https://www.um.edu.my/

 

For media assistance, please contact:

Aged Care Group Sdn Bhd
Corporate Affairs
Tel: 03-2142 7166
Email: cheehong@agedcare.com.my

University of Malaya
Wellness Research Cluster
Tel: 03-7967 7809
Fax: 03-7967 7813

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