Tag Archives: Carol Yip

Affordable Housing

Paying For Aged Care: Supporting Ageing-In-Place With Healthcare & Affordable Housing

As property prices rise, the topic of affordable housing becomes an increasing concern. Factor in the growth of the ageing population and you’ve got new variables to consider when planning anything from policies to finance, housing and infrastructure. To overlook these factors is to invite a slew of social issues. As such, it is more urgent than ever to bridge the healthcare-housing divide.

In our previous article “Paying for Aged Care: The Trends & Challenges”, we discussed how the appropriate placement of seniors with the right level of care is essential to effectively managing the cost of long-term care. Whilst in “Paying For Aged Care: Can Malaysians Afford it?”, we’ve identified accessibility to care is a need regardless of lifestyle.

Affordable housing is more than merely the ability to pay off the house loan. It’s also being able to meet long-term care costs – such as assisted daily living, rehab and medical care – when needed, apart from basic living needs like food, clothing and transportation.

So the question is: how can housing for seniors be made an affordable affair?

Preference For Age-In-Place
Malaysians have a cultural preference to age in one’s own home. We would rather remain in our communities with family, friends and neighbors for as long as possible during our old age. Yet many homes and communities lack key structural features that enables seniors to live there safely and independently.

Meanwhile, family members often provide the backbone of the informal long-term care routine at home, becoming caregivers and financing the senior’s care. It costs no small amount to pay for long-term care services and support when the senior requires assistance with daily living tasks.

Hence, while ageing-in-place is cost-effective, it is only so if the challenges in our care delivery’s efficiency – which naturally affects the cost – is addressed. To respond to these challenges and create affordable housing that supports seniors – and by extension their caregivers – we must more tightly link our nation’s housing and healthcare system under an integrated care model.

Home & Continuum Care
An integrated care model for ageing-in-place is a concept much practiced in developed countries. The model integrates a network of formal home care and respite care services with day care centres, as well as nursing homes into the community – catering to moderate and severe needs alike. Continuum care is a chain of services provided seamlessly from the moment one needs care till he/she no longer requires it is.

Embedding continuum care into communities would enable better utilisation of financial resources when households seek out care services, thus mitigating unnecessary spending arising from inappropriately allocation of care. In developed countries, day care centres are cost-effective alternatives to nursing homes.

For example, Singapore builds many senior activity centres and care centres as part of their initiatives for ageing-in-place within the community. The regulators aim to develop a range of aged-care services in every neighborhood to meet the social and healthcare needs of seniors, as well as to support their caregivers. This would also allow families to remain in close contact with the seniors while they are being cared for within their community.

As Malaysia is very much similar to Singapore, community-based day care centres would fit comfortably in our own integrated care model of aged-care facilities. Day care services would not only delay the need for entry into a nursing home or care centre, it is also a less costly route for seniors and their families to maintain their well-being if compared to home care – which can be more expensive due to the provision of personalized and skilled services at home. It’s a bonus that active seniors can enjoy social interactions with friends and neighbors, and learn new things to maintain positive mental and emotional health.

Setting Up The Pieces
In order to bring together a cohesive and comprehensive integrated care model while tightly linking our nation’s homes to the resulting network of continuum care, Malaysia’s stakeholders – public and private sectors alike – need to spur development of facilities, care services and new standards to uphold.

There are some day care centres for seniors set up by the Malaysian Department of Social Welfare throughout the country, however, the number are still too low and insufficient to cater to our growing ageing population. More day care centres within the community need to be built and operated by non-governmental organisations and business from the private sector.

Policy makers need to look into incentives for operators to set up more day care centres, while new standards for professional home care services – delivered by licensed home care operators – need to be designed in a manner that encourages provision of quality services at an affordable price. This would not only naturalise the use of these services by families as their first option, but also minimise the strain on limited government financial resources.

We also need to look into developing financial mechanisms that encourage sustainability of families to continually participate in the continuum care cycle. Financial support from the family may not always be possible due to the shrinking size of Malaysian families and emigration of grown children, as well as the possibility that family members may run out of money.

Examples of such mechanisms to ensure sustainability could be in the form of:

  • a means-test that determines how much subsidy each senior would be eligible for,
  • financial counseling and advisory initiatives to help families make better informed decisions regarding their ability to sustain payment for long-term care services. Or,
  • a compulsory long-term care insurance.

Conclusion
Time waits for no man, so does ageing. The question is if Malaysians can meet ageing prepared and on our own terms. The context of affordable housing has changed and the demand for ageing population is significant. We want quality communities in which to age well and enjoy life, free from deprivation of basic human needs. If we wish to age in acceptable terms, improved collaborations and efforts between stakeholders, regulators and the private sector is not only necessary, progress also needs to hasten as the window to come up with an integrated system that better connects our housing and healthcare grows short.

 


 

Source: Smart Investor, September 2017

Written By: Aged Care Group

*Quotation Source:
Yip, C. (2017). Provision of Long-Term Care and Payment Options for Elderly People Living in Kuala Lumpur and Selangor, Malaysia (Doctoral dissertation). Retrieved from Figshare Database. (MD5: 27fe2fa9e373fd58476ef48896a524c1)

Managedcare & ReGen Rehabilitation International Signs MoU – Providing Greater Accessibility to Care

Kuala Lumpur, 15 August 2017:- In a joint initiative to provide members of the public with greater accessibility to care, Aged Care Group’s wholly owned subsidiary Managedcare Sdn Bhd (“Managedcare”) signed a Memorandum of Understanding today with ReGen Rehabilitation International Sdn Bhd (“ReGen Rehabilitation International”).

The MOU is a cooperative endeavour to achieve specific objectives that enables public to easily find the appropriate care services they may require and offering greater outreach to those needing care.

The collaboration firstly is to increase accessibility of services such as rehabilitation, care administration and other various care services through mutual referrals of relevant services and products of both Parties. Secondly, is to grant exposure and increase accessibility to a wide range of care products and services. Thirdly, is to provide patients and their caregivers with choices on the continuity of care. Last but not least, for respective parties to leverage on opportunities to develop and manage rehabilitation through the provision of step-down care facilities.

Signing the MoU on behalf of ReGen Rehabilitation International is its Chief Executive Officer, Ms Sue Lee Tsui Ling, and Dr Carol Yip representing Managedcare. The witnesses for the signing are Dato’ Frank Choo Chuo Siong J.P, Managing Director of Managedcare and David Smith, VP Clinical Services from Select Medical International.

This collaboration between Managedcare and ReGen Rehabilitation International came forth from their respective mission that complemented each other. With the vision to meet the growing demand for care at a price, quality and locality that is sustainable for different income levels, synchronising both companies’ aspirations to provide world-class rehabilitation care to patients who have suffered from debilitating injury or illness so they may live an independent, high-quality of life.

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

Where do the private sector and NGOs come in?

By BRIGITTE ROZARIO

THERE were many questions and several business models discussed for the retirement industry and aged health care at the recent Sustainable Retirement & Aged Care Conference (SRACC), organised by Kenanga in partnership with Aged Care Group (ACG).

While the one-day conference saw many questions raised, it also offered several ideas and solutions.

During the third panel discussion on Private Sector and NGOs Getting Involved in the Retirement and Aged Care Ecosystem in Malaysia, moderator Carol Yip, chief executive officer of ACG, pointed out that the budding industry faces many challenges:

  • Human capital
  • Infrastructure – It takes at least three to four years to build a purpose-built infrastructure.
  • Legal framework – What is the legal framework you need to comply with?
  • Standard operating procedures
  • Specialised care services
  • Enforcement

From a quick survey done at the conference, it was found that participants are ready to join this industry, but many are still unclear of how to go about building the facilities and providing the services.

Slow growth

Khoo Chuan Keat, director of several public and private companies and former partner and senior executive director of PriceWaterhouseCoopers Malaysia, offered his thoughts on why the retirement industry growth has been slow:

Niche market – Because it is a niche market, people are concerned that they will only be selling to a small group of people.

Business model – There is still a lack of Malaysian tested and accepted business models. So, those who are interested are not sure how to go about it. Some are taking a wait and see approach.

Khoo pointed out that while there are no tried and tested Malaysian business models, there are many in other countries that we can learn from and adapt to suit our country.

Return on investment – Business enterprises are concerned about return on investment (ROI) and wonder if they can get the same ROI as they would from building a condominium or office block.

Tax breaks – While Pemandu, Ministry of Health, Ministry of Finance and MIDA (Malaysian Investment Development Authority) are very supportive of tax breaks for those entering the industry, we will need to wait and see if the government approves the recommendations.

Legislative framework – The Aged Healthcare Act is hoped to be tabled in Parliament before the end of the year.

khoo-chuan-keat

Khoo Chuan Keat: ‘I am always a firm believer that the industry must drive the legislation, and not the other way around.’

“I’m very worried that if we leave it to somebody in Putrajaya to draft those legislations, without experience in the market place, they are likely to put everything, the worst of the lot that they can pick from all the other countries, just to cover themselves, to make sure that everything is so overly stringent that it will stifle the industry in its infancy. In this context, I am always a firm believer that the industry must drive the legislation, and not the other way around,” said Khoo.

No incentives

Tan Sri Datuk Dr Abu Bakar Suleiman, president of International Medical University, chairman and director of International Medical Colleges Malaysia, explained that aged healthcare did not just pop up overnight. The government has been talking about it for the past 20 years or so, but nothing concrete has been done.

He was the director-general of health with the Ministry of Health from 1991 to 2001.

“I think there are two things that are important in terms of funding. The health financing system has to be developed through a health fund. The proposals have been there for the past 20 years. Hopefully something will come out of this. The importance of this is, how does the coverage for the aged group be translated into the services? If you look at the policy now, we want good access, we want continuous, committed and integrated care from the living end to the end of life. So, how do we translate it?

abu-bakar

Tan Sri Datuk Dr Abu Bakar Suleiman: ‘We have to be creative, we have to be disruptive, and the care model cannot be around doctors or nurses, but based around the elderly and their families.’

“We have to be creative, we have to be disruptive, and the care model cannot be around doctors or nurses, but based around the elderly and their families.

“This is tough, but we’ve got to do that because if the healthcare system that we want to develop through a new funding system is based on the existing system, it will be a wreck. It will not be sustainable,” he said.

According to Dr Abu Bakar, the capability for technology-enabled care is already available but nobody is using or implementing it because there is no incentive to use it.

He highlighted that the truth is everything in the hospital can be brought into the home, and this is how we can keep the cost down.

“Around the world now, what we are fighting for in healthcare is safety and patient-centredness. Doctors are trying to learn this very late in the day. How do we get individual-centred services to people where they want to be. Let’s have care in the institution, care in the community and care in the home. So, there are actually market segments that we can address,” he said.

Complacency and sustainability

Tan Sri Dr Ridzwan Abu Bakar, cardiologist, executive chairman of Pacifixhealth and one of the directors of Cyberjaya University of Medical Sciences, said that the country has been slow to move so far because of complacency and sustainability.

“We are very complacent. This morning we heard speakers saying that we’re going to be an ageing nation in five years’ time. Now, that’s not a figure that’s been plucked out of the air. We will hit that figure in the year 2020. So, we’ve got five years. Have the government agencies, has the public been made aware of that – that in five years we will be defined as an ageing nation? I think that’s where we are a bit complacent.

“The other aspect about complacency is the particular setup that we have in this country. Most of us have elderly to take care of, but we also have an inexpensive way of doing it and that is by getting maids. So, many of us would hire maids, mainly from the Philippines and Indonesia. By paying for a couple of them, they would look after the loved ones at home, therefore keeping to the eastern philosophy of filial piety.

“So, that’s been the ongoing solution so far, but as we all know this system of getting maids in is going to be a big problem in the near future. Therefore, there is a demand very soon for an alternative way to look after the elderly,” he said.

According to Dr Ridzwan, the other reason why Malaysia has not moved faster into aged healthcare is sustainability, not just from a fiscal standpoint, but also from a provider’s view.

ridzwan

Tan Sri Dr Ridzwan Abu Bakar: ‘Is there a sustainable workforce that can look after the elderly that we want to take care of?’

“Those who are going to provide the services … can they sustain it? So, we’ve got to look at the workforce, for example. Is there a sustainable workforce that can look after the elderly that we want to take care of?

“Then there is the social sustainability part – the expectations of the country as to how they look after the elderly. These are the additional issues that we want to think about,” he said.

Which model?

Yip asked the panellists which model Malaysia should look at in terms of financing, where to start and who developers should partner with – the public sector, other private companies, or NGOs.

Khoo believes no one model will suit the needs of all. Malaysia will need to adopt several different models depending on the developer’s perspective and preferences. Some developers may only want to build and not manage it, in which case they may partner with an operator. Others may prefer to build and manage it. And, a third group may want to build, own and rent.

Dr Abu Bakar said that Malaysia should learn from others’ experiences and understand the model and see what we can do. But, before we decide on the business model, we first need to know what is the role of the public sector, the private sector and where does the public-private type of partnership come in.

He advised developers and operators to look at Eden on the Park in Kuching to see how they have done it and learn from them.

Khoo, who was involved in the Eden on the Park project, explained that it is a co-location model. It offers active independent living, just like any of the high-end condos in the cities. However, it also has aged-friendly features to provide residents with the opportunity to age in place. That means, if you move into that facility, you can stay there until the day you go.

According to Khoo, places like Eden on the Park focus on the lifestyle. That is their selling point.

“The people behind that project are nobody, they are not the big boys in town. They are just a group of passionate people who are prepared to put their money where their mouth is. That is where I see this industry being driven. It’s the smaller boutique developers who will say, hey, I can’t beat the big boys. If I build one condo, they are going to build five condos. So, I am going to play the game by focusing on a niche market that they may not get into yet,” he said.

According to Khoo, businesses need to cater to the middle income group. Those in the lower economic bracket will need government help, while those at the other end of the scale will be able to stay anywhere as they can afford it.

“I think the target market that we are looking at as a business enterprise is the 35% between these two groups. That itself is a big, big market for which we have very little alternatives right now,” said Khoo.

Dr Abu Bakar shared his experience with the National Kidney Foundation, where he is president of the Board of Governors.

According to Dr Abu Bakar, Malaysia is able to keep the cost of haemodialysis down because the public sector, private sector and NGOs work together.

“The public sector provides just under 40% of the services. The private sector, hospitals and clinics, provides a bit over 30%, and the balance is provided by the NGOs.

“The funding total – 70% is provided by the government. They provide the funding directly and through insurance and subsidies.

“As for the National Kidney Foundation, we raise about RM6 million a year through donations. From the RM50 per dialysis the government provides for patients who need the help, we receive the funds for that also. Whatever else we have to do, the patient pays only a bit.

“The NGOs’ contribution has a multiplier effect because most of us serving there donate our time and our expertise. I think we can learn something from this for aged care,” he said, explaining that he sees the aged care industry following a similar pattern of government, private sector and NGOs working together to cover the needs of all Malaysians.

The question of funding

Yip believes that while everyone is ready to start building the facilities, funding is still a big question mark.

Khoo expressed his opinion that there is a future in private equity.

“I’ve spoken to some private investors as well. They are also getting to be interested. The only thing is, they want to see a track record, they want to see an annuity of income. We don’t quite have that yet,” said Khoo.

He pointed out that investors also want to know what the exit strategy would be.

Dr Abu Bakar offered many suggestions to make aged healthcare more affordable.

“The issue right now is the services are not sufficiently patient-friendly or patient-centred. In fact, far, far from it. For example, can the hospital provide services outside the hospital because we have the expertise,” he said.

He suggested having video-conferencing or sending the doctor-nurse team to the home.

“That will not be an issue, but the long-term is a problem. How do we look at that? How do we fund that? And, I think we need to have a different business model for that because what you want is 24-7 and not transaction basis. That model is not there, doctors are not familiar with it,” said Dr Abu Bakar.

Dr Ridzwan gave the conference a very sobering look at the industry. He informed that despite heavy government funding, only 70% of aged care facilities in Australia are profitable. He said that 30% of them don’t make money at all.

“So, there are other problems involved that need to be addressed. In Malaysia, I think the additional problem is the legislative network. For example, if a facility is sold to an aged person, what happens when he passes away? The laws on inheritance in this country are pretty complex, depending also if you’re following the Islamic law or even the ordinary inheritance law. How do you prevent that aged care facility from passing on to a yuppie who wants to convert it into a normal condo? These are the things that we need to address. Maybe developers will say that they have the right of first refusal. I believe this is easier said than done. The laws in this country do not provide for the fact that if you set up a retirement facility that you can maintain it with subsequent generations. I think that’s another area to look at,” he said.

He pointed out that many developers may be waiting for the Aged Healthcare Act to come into force because they don’t want to run afoul of the law.

Both Khoo and Yip believe that developers need not wait for the Aged Healthcare Act, as it is merely a step down from the Private Healthcare Facilities and Services Act.

“As long as we comply with the Private Healthcare Facilities and Services Act, we will definitely comply with the lesser Act. That is what Eden on the Park has done – they opted to go for the gold standard,” said Khoo.

Dr Abu Bakar said that the aged care industry is now at the same point as the private hospitals were in the 1960s and 1970s when nobody wanted to build hospitals.

“So, who built hospitals? The doctors. Pantai Hospital was built with RM1 million by the doctors. Nobody else wanted to invest. They showed that it’s a viable business. After that, others came in.

“We are now in that stage of the game,” he said.

Sustainable retirement income – myth or reality?

MOST Malaysians are not prepared for retirement and ageing. Pension and EPF (Employees Provident Fund) will only take them so far and with the average lifespan for Malaysians estimated at 75 years, many will have to rely on family, friends and charity in the last years of their life.

Seeking to change this scenario, the panel discussion at the Sustainable Retirement & Aged Care Conference (SRACC), organised by Kenanga in partnership with Aged Care Group (ACG), delved into the topic of “Malaysia’s Financial Options for Retirement and Aged Care to Ensure Lifelong Sustainability”.

Moderator Carol Yip, the chief executive officer of ACG, outlined the current Malaysian retirement system based on the World Bank’s pension conceptual framework:

  • State
  • Pension for civil servants – mandatory
  • EPF – mandatory
  • Savings, insurance, unit trust, properties, PRS (Private Retirement Scheme), other investments – voluntary
  • Family, community, charity – voluntary

“We would like to see how financial institutions can work together because moving forward we need to have the money to sustain our retirement.

“In order to have a sustainable retirement, we have to continue saving our money. The question is how do we help Malaysians put it aside so that they will not use it until the day they need it to pay for their aged care services,” asked Yip.

Multilayered replacement income

Balqais Yusoff, head of EPF’s Strategy Management Department, said that EPF believes that in order to sustain financial security, Malaysians must have a replacement income after retirement.

“We believe people should have multiple sources of income to cover themselves, because when they become aged, they will need to have more income as they are no longer productive. So, they need to have an income to sustain their basic needs, wants, as well as the rising medical costs.

“Right now, in Malaysia, we are seeing an increase in life expectancy whereby the average life expectancy is 75. How do you accumulate your wealth during the 30-35 years of working life and can it cover the years after retirement?” asked Balqais.

Yip pointed out that there is a segment of society that wouldn’t have sufficient or any EPF savings. This includes homemakers and the self-employed who often do not make contributions.

Dato’ Steve Ong, chief executive officer of the Private Pension Administrator Malaysia (PPA), which is the independent central administrator for the PRS, said this is where savings comes in.

“The big consequence is not that at age 60 you stop work; it’s that you stop earning. The minute you stop earning, your income stops. That is the crux of the matter.

“All of us who are employed are gainfully earning our income and that supports our housing, healthcare and lifestyle.

“So, when you stop working, it means you stop earning and you stop that income stream. You need that to have savings to generate a passive replacement income. We have to educate the public to really get the message across that EPF savings at the moment isn’t even enough. For those who withdraw their EPF money end up spending it all within five years, while their retirement might go on for 20-25 years,” said Ong.

He explained that this is where PRS can help as it offers Malaysians a way to save their money for retirement.

“PRS is not a product. It is a voluntary national scheme. It addresses the need to provide a formal voluntary pillar so that people can have the confidence that it is safe, regulated, and provides a system for private employees who have EPF but still need to top up; for civil servants who retire and have pension which is still insufficient; and for the self-employed who may not be contributing to EPF or putting money into the bank.

“We have various savings vehicles in the country. The question is, are they designed specifically for retirement? If not, then the issue is simply this: Most of the money that people save is in the banks. What do they do? It’s like a giant cookie jar. When they need money, they take it out. They take, take, take and what’s left is for retirement. It’s inadequate; it’s insufficient; and it’s not sustainable,” he said.

What about the role of insurance? Anusha Thavarajah, chief executive officer of AIA, said that 20 years ago, Malaysia was still a very young society and one where the family network was very strong. Because of this, we never worried about retirement. We assumed that our children would look after us. However, society has changed a lot in the last 25 years, and the baby boomers increasingly want to take care of themselves as they age instead of relying on their children.

Quoting Martin Luther King, Jr., Anusha said, “It’s the quality and not the longevity that is more important in people’s lives.”

According to her, it is important to create awareness on the importance of having enough.

“Today, what we want to do is make people aware that it’s important that they have enough. We’re teaching our distributors that when they meet customers and friends, they have a social obligation to make sure that their friends and family are adequately protected,” said Anusha.

Cohesive system

Yip asked the panellists if financial institutions can work together to make it easier for the elderly, so that when the money is needed, it will almost automatically pay for the care and services. This way, the elderly don’t have to think about which stream to get their money from – EPF, PRS, insurance or unit trust – as all of these would work together seamlessly to pay for the elderly’s needs.

According to EPF’s Balqais, the government is trying to establish a national social security task force to look at an integrated ecosystem. “That will cover not just healthcare, but also basic income security for working aged people as well as care for the aged. It will be a concerted effort that will require working with employers, employees, NGOs, academia as well as financial institutions to develop more products for pre and post-retirement.

“The national social security task force will look at this whole ecosystem and work with all the stakeholders to minimise duplication of efforts currently being undertaken by various agencies and also duplication of benefits. It will address basic poverty eradication and guarantee a comfortable lifestyle, especially for the aged,” said Balqais.

Toh Puan Dr Safurah Jaafar, director of Family Health Development Division with the Ministry of Health, said currently more than 70% of the elderly are sourcing medical care from the government.

“That limits their choices in terms of care and facilities. I think, if only they have the savings then their choice is bigger. How do you facilitate that?” she asked.

According to AIA’s Anusha, more and more Malaysians are buying private health insurance, which has extended its coverage in recent years.

“Originally, the insurance cover expired at the age of 60, then it became 70. Today, people are covered till the age of 100. So, basically people are covered for life. I think it comes back to awareness and making people understand that they can buy healthcare insurance,” she said.

Explaining one of AIA’s products, Anusha said that the public can buy a policy where they pay very minimally for the premium while still employed because their employer has group insurance coverage for all employees, so they wouldn’t need much cover then. But, when they retire, the cover then drops down to the first level.

“So, in post-retirement you continue to have this insurance coverage that you bought yourself which didn’t cost much initially and you continue to be covered until the day you die,” she added.

Anusha believes it all boils down to raising awareness so that the public knows what products are available to help them save for retirement and which ones offer them the best coverage in old age.

The public also needs to be educated on how to accumulate money while working and the decumulation after retirement. PPA’s Ong believes that it boils down to money management.

“As to who is going to manage this money … it’s very personal. I think most of us would like to do it ourselves until we can’t. In the case of when you can’t, because you are disabled or have dementia or some other serious illness that prevents you from making a conscious decision, the good thing about our society is we still have our family members.

“I think, that is our first line of defence because we have family members whom we can trust. Failing which, we would have to go to an outside party called a trustee. If you go to a trustee, then there are pros and cons. The advantage is that you can define what the trustee is going to do with your money, the disadvantage is the cost of doing that and losing flexibility because basically you are giving ownership of your finances and properties to an outside party,” he said.

Suitable model, products

In developed countries, the decision of who should manage your money is taken out of the equation. According to Yip, in those countries, the government takes on the responsibility of managing the money for the people.

“When you need it, they see how much you can afford to pay. Then, the government either subsidises or pays 100%,” said Yip.

She questioned if it is possible to have a similar system in Malaysia, with a central administrator working with the financial institutions.

Balqais explained that that type of system is quite different from the one we have adopted in Malaysia, and while it has obvious advantages, there is also a high price to be paid.

“In Scandinavian countries, for instance, the rights of the people are protected at various levels in terms of healthcare, education and maternity. So, when a person retires, they have a sustainable income because the income will come for life.

“But, in Malaysia, we are operating under a defined contribution system whereby there are no defined benefits. In most developed countries, there are defined benefits where you know you will be getting some sort of pension but that system has some concerns in terms of financial sustainability because of the demographic shift.

“But at the same time we also see a trend of high tax rate. In UK for instance, it is 40% and in some Scandinavian countries it is 60%. Are Malaysians ready to pay that kind of high tax regime to finance a defined benefits contribution system?” she asked.

Another option that the financial industry in Malaysia might look into is reverse mortgage since Malaysians still believe in buying property.

Yip questioned if it is possible for those who have properties to use reverse mortgage to pay for their care in their advancing years. According to her, this is one of the products that Singapore is trying out.

Anusha pointed out that reverse mortgage, which is currently not available in Malaysia, has its pros and cons.

Sharing her experience in the UK about 20 years ago, Anusha said a lot of elderly were real estate rich but cash poor there. They would buy a product called equity release where the insurance company would pay them about 70% of the value of the property. Some of the aged who took equity release used the money to enjoy the remaining years of their life. However, there were also cases which did not have a happy ending as the elderly failed to inform or explain their decision to their family members. When they died, their family members became very upset that the insurance company suddenly owned their parents’ houses.

Nonetheless, Anusha believes it is something that can be looked into here. “Perhaps back it with an annuity for life so you don’t give out a lump sum but have an income for life.

“Then when they pass away, the remaining value of the property goes back to the family. But it’s important that family members understand what’s happening,” she said.

While she believes reverse mortgage is a good product, Balqais reminded the floor that we have to look at it from a cultural context. “Are we ready to not have home ownership? Culturally, people want to own a house. At the same time, are financial institutions ready to offer this kind of long-term payment? In terms of take-up rate, we have to question and study that because the public may not be as prepared as the financial institutions,” she said.

PPA’s Ong agreed with Balqais, saying that for most Malaysians, our home is our biggest asset. He also believes that reverse mortgage works only if you have a debt-free property.

“The other thing about relying on your property to fund your retirement is that it’s not a surety because property values may fluctuate, depending on the location you are in and the property cycle. That’s something we have to keep in mind,” said Ong.

Conclusion

Having listened to all the possible financial solutions, Dr Safurah said she feels hopeful about the future of the elderly in our country. However, obviously a lot more needs to be done and inclusivity should be a priority.

“We say the product is not the main focus but I think at the end of the day, it still is because insurance companies do focus on very defined items that you can reimburse. We may lose a big portion of some groups of the aged who are not supported. Unless they are very ill, then only the insurance companies come in.

“How about those who are no longer earning but need insurance support to keep them well and prevent them from falling sick? I hope that that kind of product is something that financial companies can look at,” she said.

While Malaysia needs to find the right products and model to help its citizens save up for their retirement years, there’s no denying that awareness and education are equally important.

According to Balqais, the root cause of people not having sufficient savings is financial literacy. “The financial literacy rate in Malaysia is still very low. People do not understand about insurance – why do I need to pay when I’m not sure I’m going to get the money back?

“So, when we speak at public briefings, members of the public say they don’t want insurance because they would have more money without it, but in the event of financial shock or distress because of medical illness, they do not have sufficient savings,” she said.

She talked about EPF’s Retirement Advisory Services which offers free financial planning to the public. She hopes that this will help raise the financial literacy rate in the country.

It is hoped that with financial planning, the public will be more aware of the need to save.

As Ong pointed out, “There is no shortcut to saving for retirement. While you put money into EPF, you will still have to top up. Save more. The idea of saving more for retirement is that the money is earmarked for retirement. It’s not buying property for investment for retirement. Whether it really is earmarked for retirement is debatable. While the concept is good, you really need to have a earmarked retirement fund so that it is sufficient and it will sustain your retirement life.”

Main photo: ACG CEO Carol Yip (left) moderated the panel discussion. She was joined by panellists Toh Puan Dr Safurah Jaafar and Dato’ Steve Ong.

Stakeholders discuss building a retirement industry

RETIREMENT is not just about how much you have when you stop working. It is about your next phase of life,” said Ismitz Matthew De Alwis, executive director and chief executive officer of Kenanga Investors.

“What will you do for the next 20 years after retirement?” he asked the packed ballroom at the Sustainable Retirement & Aged Care Conference (SRACC).

Organised by Kenanga in partnership with Aged Care Group (ACG), the conference, held at the Majestic Hotel in Kuala Lumpur last week, saw representatives from the government, private sector and non-governmental organisations (NGOs) coming together for a day of discussions, networking and seeking solutions.

“Retirement is not something dull. It is not about the time when you stop working, go to day care and nursing home, while waiting to die. Retirement is the best phase of your life. It’s when you enjoy. Let’s get some colour into retirement,” he said.

He explained that even in retirement there are different stages with the last stage being when you would need more care.

There are many topics that can be discussed regarding retirement – from the financial side of things to where to live, what to do, and how to manage everything.

“This is a big topic to cover. We have a lot of questions. We hope from today we can start sharing that retirement is beyond numbers. Retirement is an industry that we need to take seriously, along with the whole ecosystem that comes with it,” said De Alwis.

The one-day conference featured three panel discussions.

The first discussion saw representatives from the civil service, private sector and government agencies talking about Malaysia’s financial options for retirement and aged care to ensure lifelong sustainability.

Can Malaysians afford to retire and how will they pay for their aged care? Will it come from the government, their pension, Employees Provident Fund (EPF), insurance, Private Retirement Scheme (PRS), savings, or all of these? Is it possible to have an integrated management system for all these, so that it is easier for Malaysians to pay for services?

The panellists explored this subject and even took questions from the floor.

The second panel consisted of foreign representatives who shared their experiences in retirement and aged care in Singapore and Australia.

The third panel discussed private sectors and NGOs getting involved in the retirement and aged care ecosystem in Malaysia.

While the conference did not conjure answers for all questions, it did start a lot of conversations and provided much food for thought.

Set the ball rolling

Panellist Tan Sri Datuk Dr Abu Bakar Suleiman, president of International Medical University, said, “In the 1960s and 1970s, no business wanted to build hospitals. So, who built hospitals? The doctors. Nobody else wanted to invest. They showed that it’s a viable business. After that, others came in.

“We are now in that stage of the game.”

While there are parties who are keen to get into the industry, many seem to be adopting a wait-and-see attitude and trying to find the best business model first.

“If we don’t build, we don’t have an industry and it becomes exclusive. When there are participants in the industry, then things will come to a palatable price. That’s what is important.

“At this moment the industry is in its infancy. We need to develop the whole ecosystem,” explained Kenanga’s De Alwis.

According to him, SRACC was held to get people from the private sector, public sector and NGOs to come together to look at the industry from a macro level and to look at building an integrated ecosystem, rather than working in silos.

“That’s why this conference is called Sustainable Retirement & Aged Care Conference and not a retirement conference. We are talking about the third phase of life, the things that we need to do to make it a colourful retirement.

“This is the next thing to come. It is going to be an industry. When the time comes, there are things that need to be catered for in this industry and we need the support of all stakeholders.

“As you can see it’s a huge ecosystem that we need to work on. We talk about government policy makers, private healthcare institutions, the entrepreneurs, the financial institutions like Kenanga, and the educational and training institutions. I think this basically will make up a sustainable aged care infrastructure,” said De Alwis.

Projects moving forward

In his keynote address, Fabian Bigar, Director (NKEA Healthcare) of Pemandu (Performance Management & Delivery Unit), spoke on “Delivering Transformation for Retirement and Senior Living in Malaysia”.

He provided the background of retirement and senior living in the Pemandu NKEA (National Key Economic Area) lab.

According to him, it is estimated that the retirement industry would create about 10,000 new jobs and RM1.7 billion in terms of GNI (gross national income) in the year 2020, when Malaysia becomes an ageing society.

After the completion of the lab, Pemandu presented its findings to the Malaysian Cabinet. Apart from the Entry Point Projects, Pemandu also requested for:

  • New act for aged care;
  • Reverse mortgages;
  • Transformation of existing old folks homes;
  • Insurance coverage for long term care and mobile services;
  • Financial incentives for the industry;
  • Trustee to manage finances for the senior citizens who are in homes; and
  • New skills standards.

“We received agreement in principle for all of this, of course subject to further discussions with the various agencies. Not everybody is moving at the same speed, so we have to leverage on those who can work faster,” said Bigar.

According to him, the Private Aged Healthcare Facilities and Services Bill will be ready for tabling at Parliament by the end of the year. However, as there are many other items waiting to be tabled as well, the Bill might only see the light of day next year.

While waiting for the Bill to be tabled, Pemandu has been working on the regulations.

“We started this year, so that when the Bill comes on stream we can enforce it in a short time,” explained Bigar.

In addition, the Department of Skill and Development has come up with the National Occupational Skills Standard (training syllabus) for the training of caregivers.

The Malaysian Investment Development Authority (MIDA) has been looking at incentives for the industry to be gazetted as a promoted industry.

While the Department of Town and Country Planning has developed “Physical Planning Guidelines for the Elderly Facilities” which will serve as a guide for the planning and designing of a senior living facility.

“These four agencies are already moving. As for the others, for example, finances and insurance, we will make sure that these things are put in place next year.

“Obviously, there is a lot more to be done. I hope at this conference we will find some clues, if not answers, on how we can move this agenda forward,” he added.

Innovation

De Alwis said the takeaway from the conference is that if you are a business owner, an NGO or individuals needing helping or who have questions related to the elderly, you would now know who to contact. ACG is positioning itself as a platform for all parties to work together towards elevating the retirement industry.

CareTRUST was derived to provide an avenue for those in the financial line to help clients manage the accumulation of their money and then the decumulation after retirement when they need to pay for services and facilities.

This collaborative effort sees more than 12 unit trust companies, four insurance companies and seven PRS providers on the bandwagon so far.

With ACG as the Care Administrator, CareTRUST would also see to it that the client’s wishes are fulfilled in terms of how they want to be cared for and where they want to live, when they are no longer able to execute these decisions for themselves.

This is just one of the new products targeted at retirees. De Alwis added that the retirement industry will spur product innovation. “It is something that we will continue to search for at Kenanga, be it within our group or working with various partners. It doesn’t matter if the money goes here or there. At the end of the day, we are enlarging the pie.

“We just need people who are brave enough to join in to build the industry. It’s not difficult and it’s not just to cater to one part of it. It’s a big part of the economy. It also can be very profitable if it’s done correctly. It’s an industry by itself.

“We need to create a retirement industry, then everything will come into play. There are various programmes now like Malaysia My Second Home, but everything needs to link together. We have to look at the whole ecosystem of retirement.

“On top of that, when we have more retirement products and services, of course, the cost will come down. It becomes a commodity. But, at this moment, no one dares dabble into it. If you look at it, five years down the road is a very short time, but in 10, 15 years, this will be a booming industry.

“We are quite excited. It creates more dynamism in terms of how we treat this product-wise and services-wise,” said De Alwis.

ACG chief executive officer Carol Yip pointed out that some parties in the country are already building facilities and offering services for retirees. However, demand is still more than supply. To speed things up in time for 2020, more players need to enter the market place. This would reduce the cost, and these facilities and services would then be more affordable to the masses.

Conclusion

Speaking to reporters, De Alwis said that this year’s conference was more of an introduction to the infant industry, and next year should see a drill down to more intense topics.

“We hope to see that there is growth and development, and we will be able to share more, get more speakers and expertise coming in to provide more advice.

“Once retirement becomes an industry, Malaysians will take it more seriously and the whole ecosystem will fall into place. Our theme today is ‘A shared synergy towards an integrated ecosystem’. For an integrated ecosystem all the stakeholders have to come together in their own way. Like a jigsaw puzzle, all the pieces must fit together,” concluded De Alwis.

Main photo: Ismitz Matthew De Alwis, executive director and chief executive officer of Kenanga Investors, presenting his keynote address at the Sustainable Retirement & Aged Care Conference.

Providing a platform for aged care services

THE time for creating awareness is past. Now is the time for us to educate families on the type of quality care needed for their elderly parents and where they can go when they need help.

“No matter how much we want to advocate holistic care services for the elderly, one of our biggest challenges is education. We are no longer talking about awareness because I think a lot of us know what type of services are available here compared to the western countries and that we are about 30-40 years behind them.

“It’s about time we educate the adult children because they are the pillars of the aged care for their elderly parents.

“Is having a helper to take care of your aged parents good enough? Does it help to give your parents quality of life?” asked Carol Yip, Aged Care Group (ACG) chief executive officer.

She was speaking at the 11th National Geriatric Conference organised by the Malaysian Society of Geriatric Medicine at the Grand Seasons Hotel in Kuala Lumpur, where the theme was
“Grey Matters: Sifting the Evidence to Optimise Care”.

According to Yip, her first priority is to educate families, in particular adult children, on what needs to be done and what is quality care. From there, they need to know where to go to get such quality care.

She emphasised that government, private sector and non-governmental organisations (NGOs) should work together to provide such services as well as inform families where they can obtain the necessary assistance and care in each state.

She informed that getting help for the elderly is not so straightforward because sometimes the elderly themselves do not want to come forward to get the care and help that they need. It might be that they don’t want to pay for the care, they can’t afford it, or they don’t want to inconvenience their family members who might have to pay for it.

So, what happens? They suffer in silence.

Senior living

Yip, who was involved in a senior living laboratory facilitated by the Performance Management & Delivery Unit (Pemandu) in 2012, said that while there is a very small number of licensed homes for the elderly, there are many unlicensed ones.

This is not helped by the fact that there is no one legislation to regulate the care centres and nursing homes in the country. Currently, there are two Acts governing the care centres and nursing homes in Malaysia – the Care Centre Act 1993 (Act 506) which regulates the care centres and is under the purview of the Welfare Department; and the Private Healthcare Facilities and Services Act 2006 (Act 586) which regulates the private nursing homes.

According to her, one of the most important outcomes of the Pemandu lab is the impending Aged Healthcare Act which the Ministry of Health (MoH) is now working on.

With one Act to govern all the elderly care centres and nursing homes, there will be better adherence to regulations and a rise in standard of living in such homes.

According to her, there is still much to be done as the aged care industry is in its infancy here. Business investors know that the aged care industry is now ripe for picking. It is just a matter of finding the right model that gives them the return on investment.

While property development has been a booming market in Malaysia over the past 50 years, the area of senior living has sadly been neglected until now.

“In any township you must have a school and a hospital, but how about a registered nursing home? The problem is that it’s not in our township regulation guidelines. So, it’s really up to the property developers if they think they want to provide that type of facility in the township,” said Yip.

She revealed that in the pipeline are town planning guidelines that look into the inclusion of nursing home facilities.

But, nursing homes are not the only type of senior living facilities needed. The other models that need to be looked at are home care, day care and retirement villages.

“And there is the integrated residential care centre (IRCC) instead of the nursing home. Nursing homes make people think of old folks homes.

“The IRCC would be purpose-built homes for the elderly which can look as good as a hotel. It can also be rated two, three, four or five-star, depending on what facilities and amenities you provide.

Then we have step down care, rehabilitation care, palliative care, and more importantly, dementia care.

“If you look at Malaysia now, how many dementia care centres can you find? Sad to say, we have less than five. Whereas in Singapore, I was told, there are at least 15,” said Yip, noting that dementia care is another area that the country needs to look into.

She revealed that during a recent meeting with the MoH, there was mention of dementia care centres. However, such a centre would need specialised medical practitioners and a special licence.

“If I were to build a four-storey building with about 200 beds for the elderly, focusing on dementia care, can you imagine the manpower I would need … the skills, the doctors, the therapists, and where would I look for them?” she asked.

Staffing is not a matter of just hiring foreign workers or even new graduates. In the area of elderly care, it is key to have experienced personnel and skilled workers.

This is why ACG is also working with hospitals, universities and NGOs to find, train and develop the necessary skills for aged care.

“We want to be a platform where we can collaborate with all the medical practitioners, hospitals and geriatric doctors,” she said.

Day care

As for those who prefer home care, Yip questioned how qualified helpers are to take care of the elderly, not just physically but medically, socially and emotionally as well.

“Perhaps a day care centre might be an option. Just like a child care centre, but for old folks. A place where you can drop off your parents when you go to work, and take your parents home after work,” she said, highlighting the need for day care centres.

Of all the senior living facilities, the day care centre would be the easiest to set up as you can have it in an existing neighbourhood clubhouse or a shoplot, unlike building a brand new retirement village or an IRCC.

Yip explained that ACG focuses on the mental, social, physical, emotional and financial aspects in all its programmes.

“Why do we want to do this? We want to transform the perception of ageing in Malaysia. We want to be the preferred choice in enriching the lives of the elderly in the space of continuum care, that means from home care right up till end of life care.

“Our philosophy is that whatever care plan we come up with must always feature these five areas.”

According to Yip, the financial aspect is the biggest challenge in the aged care industry.

“In Malaysia, sad to say, our retirement planning depends on ourselves. We have to save enough money for our retirement and aged care,” said Yip.

Having been in financial planning in the early years of her career, Yip has noted that many Malaysians don’t think about their old age care and how much money is really required for it.

In her doctorate thesis, on how senior citizens pay for their aged care, Yip has found that 100% of those surveyed don’t have EPF savings, while more than 90% depend on their family members.

She informed that insurance products in Malaysia currently do not allow any claims for old age care.

“We are now working with financial institutions to help our clients, and for all of us, so that we know when we have to go to a nursing home, we will have money to pay for it,” said Yip.

She emphasised that ACG wants to work with everyone in the healthcare and aged care industries to come up with a structure, a system and a platform to improve the aged care services in the country.

“Let’s move forward by putting in a system for our elderly parents,” she said.

DF Pharmacy helps monitor food intake, weight

SENIOR citizens don’t just need to take the right medications and dietary supplements for optimal health. They also need to get the right nutrients, especially if they are recovering from ailments.

With this in mind, Aged Care Group (ACG) and DF Pharmacy recently signed a Memorandum of Understanding (MoU) to provide easy accessibility of healthcare services to the community.

The MoU was signed by Jeff Kong Jiang Foong, DF Pharmacy managing director, and Carol Yip, ACG chief executive officer.

The collaboration aims to provide a holistic approach to elderly care in terms of dietary needs. At the signing ceremony, Kong explained that DF Pharmacy Dietetics Services will help the public, especially the elderly, monitor their food intake and weight. This service will ensure they have the necessary nutrients to recover from ailments.

“People are growing older in Malaysia, but we do not have enough aged care services for them. ACG offers a good platform for professionals to come together to provide a better lifestyle for the elderly in Malaysia,” said Kong, adding that DF Pharmacy hopes to play a more active role within the aged care sphere.

DF Pharmacy’s website can be found at http://www.dfpharmacy.com/.

Taking care of elderly in townships

By BRIGITTE ROZARIO

 

THE population of Malaysia is ageing – this much is clear. In just five years, the number of Malaysians aged 60 years and older is projected to increase to 3.4 million, making up 9.9% of the population.

This presents many challenges to aged care operators and property developers who grapple with how to provide the necessary facilities and services to this segment of society without breaking the bank.

“This is an opportunity,” said Carol Yip, Aged Care Group chief executive officer, at a FIABCI Malaysia morning talk at the Bukit Kiara Equestrian & Country Resort, Kuala Lumpur, last week.

She was talking about aged care facilities within new townships and the transformation of existing ones.

Current situation

Comparing Malaysia to developed countries such as Australia, New Zealand and England, Yip said the aged care facilities in those countries are highly regulated.

“Everything is audited. Why? Because the government gives them the money to operate. But in Malaysia, we have to take care of ourselves,” she said.

There are many unlicensed nursing homes and care centres, operating from bungalows and terrrace houses in the towns and cities across Malaysia.

This shows that there is great demand and not enough supply.

To make matters worse, there is no one Act in Malaysia to regulate both the care centres and nursing homes. Currently, the nursing homes (for dependent elderly) is regulated by the Private Healthcare Facilities & Services Act 1998, under the purview of the Ministry of Health.

While the care centres (for those who need a low level of care) are regulated by the Care Centre Act 1993, under the Department of Welfare of the Ministry of Women, Family and Community Development.

So, there are two ministries, looking after two Acts. Plus, some of the nursing homes have low-level needs elderly, while the care centres also have high-level needs elderly – which is a non-compliance with the two Acts.

Realising that there needs to be better regulation, the Health Ministry is coming up with the Aged Healthcare Act.

What is needed?

Likening the elderly to children, Yip said we need to recognise that older people need as much attention and care as children.

She pointed out that the elderly need:

  • Mental and physical wellness;
  • Social and personal wellness;
  • Community and relationship wellness;
  • Health and emotional wellness; and
  • Community care.

According to Yip, cities and towns need to have continuum care, with property developments that cater for the active as well as the dependent, and with care facilities that take into account all stages of care until the last stage (palliative care).

Types of care needed:

Home care – This is for those who are still independent but need a bit of home care, which might only be temporary.

Day care – They might be lonely if they stay alone at home. At a day care centre, they would be able to interact with other senior citizens and participate in activities.

Integrated residential care centres (IRCCs) – If they have had a bad fall or are bedridden, they will need more care. This group would need an IRCC (also known as a nursing home). They would also need rehabilitation care.

Dementia care – As dementia is a very common problem now, society needs to be dementia-friendly. This means more awareness and education on dementia is needed. Dementia patients would also need a home where they can walk around, socialise and perform daily tasks in a safe and secure environment, instead of being cooped up in a room or house.

Integration

In addition to providing aged care facilities, townships should also look into the inclusion and integration of the elderly into the community.

“In townships, you must have schools and hospitals, so why not nursing homes? But the problem is all of us want to stay in our own homes,” said Yip, explaining that no elderly person wants to move out of their home. If they are given a choice, they would want to continue living in their home.

In which case, she asked if it is possible to develop houses for different generations, where the property buyers can stay from young until they are old.

“In the township, can we make it easier and safer for them to go out? We don’t allow children to go out on their own because it’s too dangerous. Can we do the same for the elderly?” asked Yip.

To be inclusive of the elderly, towns and cities need:

  • Walkways, jogging trails, bicycle/wheelchair/stroller paths;
  • Gardens, parks and playground for elderly and children;
  • Security and safety measures like help kiosks in public areas;
  • IRCCs for nursing and palliative care;
  • Care club facilities for elders and children; and
  • Intergenerational community living with aged-friendly and wheelchair-friendly infrastructure for apartments, houses and public areas.

How to do it

Yip spoke about building homes that are aged-friendly with security, panic buttons and wider doors and bigger bathrooms so that wheelchairs can go in and out.

She said that developers building new townships or those wanting to transform existing townships and cities need not start big.

“Cities and townships can start with a basic club for the elderly to provide them with a place where they can participate in activities like karaoke, which the elderly seem to enjoy.

“From there, developers can build according to demand, keeping in mind the elderly when they design homes, walkways, buildings and parks,” she said.

The World Health Organisation (WHO) has taken the lead in aged care, saying we need to build friendly townships and cities for the elderly.

These are the infrastructure requirements for an aged-friendly city according to WHO:

  • Housing,
  • Social participation,
  • Respect and social inclusion,
  • Civic participation and employment,
  • Communication and information,
  • Community support and health services,
  • Outdoor spaces and buildings, and
  • Transportation.

“Which is easier – focusing on new townships or transforming existing ones? I have spoken to developers in new townships and those working on existing townships, and I can tell you both are just as tough,” says Yip.

While admitting a lot needs to be done, Yip asserted the situation in Malaysia presents business opportunities within property development.

Township trends

Also at the morning talk was Ishmael Ho, chief executive officer of Ho Chin Soon Research. He commented that aged care facilities are necessary and, in fact, this is a future trend.

“Currently, no developer that I know of has integrated these facilities and used it as a selling point. If they were to integrate such facilities, it can be used as a selling point.

Ishmael Ho: 'Developers need to be brave and more visionary.'

Ishmael Ho: ‘Developers need to be brave and more visionary.’

“If they look at the ringgit and sen straight away, of course it might not make commercial sense, but if they have the vision to integrate the aged care facilities and use it as a selling point, then they will be able to give value to the purchasers in their townships.

“Developers need to be brave and more visionary,” said Ho.

Challenges

While the needs are there and it is a growing trend, trying to get all stakeholders to work together and move in the same direction looks like a gargantuan task.

According to Ho, progress must be made, and by right it should start with the government and the town planners.

“For the government to adopt something new is very hard especially when you’re talking about town planning laws. We still see parts of the city using old restrictions, for example plot ratio and density – these are old laws. Moving forward, we should actually change, and yet we are so slow to change,” said Ho.

He believes the government and town planners need to see a successful model in order to consider amending current laws and requirements to accommodate the elderly.

“To show them a successful model, it is the developer who has to take that initial step. We want to see a developer taking that risk and building a really fantastic township. Then people will start to recognise that at the end of the day, we need wholesome living and facilities for the aged, because everyone will get old one day. Therefore, moving forward, all other townships would follow suit as it is good for the people and the community,” added Ho.

However, the bigger challenge facing property developers is finding the right business model.

“The business model is still not very clear. It is still open to suggestions, and for the service providers to work with the developers. There’s so much to consider … the land bank size, the township, the immediate catchment nearby, whether they’re in KL, Penang, Johor … all of this needs to be considered.

“The developer themselves will play a role, in terms of whether they are financially strong, cash rich, and what their attitude is in business development. Some developers have a very fast turnover time, and they may not be keen to go into aged care facilities. The marketing strategy for their township also comes into play, as aged care may not gel with their marketing theme. So, all of this will affect the arrangement between the service provider and the developer,” he shared.

Working together

To get all stakeholders to buy in, Ho said there needs to be a good platform for discussion.

He pointed out that ASLI (Asian Strategy & Leadership Institute) would be able to offer a good platform for all stakeholders, including developers, the government and town planners, to thrash out the relevant issues.

“You don’t want only two parties talking. For example, the service provider talks to the ministry and the ministry makes changes; and then, everyone else gets upset. If you were to impose an aged care facility in a township, it would affect the developer. Now, they are operating on commercial land status and commercial land is very valuable, so if they have to use commercial land for aged care facilities it would be very tricky for the developer. The developer would have to build aged care facilities and forego building shophouses which are very profitable. Those are some of the concerns,” said Ho.

While there are challenges, he believes they will all be sorted out in time as there is no stopping this trend of building and transforming cities and townships to include the aged.

“It’s more about changing the stakeholders’ attitude towards aged care, then the law will change to accommodate the people,” he summed up.

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