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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

Better homes for elderly needed

YOU know you are getting older when hypertension and high cholesterol are what old friends tend to talk about at festive reunions. We wonder if we’ll break the average lifespan mark of 72 for Malaysian men, 76 for women.

Some athletic classmates, fit and fast in high school, however, have died in recent years from heart attacks. They had not even touched 60. That reminds us, the awkward nerds then, of the time we have left to enjoy with our loved ones.

After the usual “remember when” moments, we wax nostalgic. We ponder over about “what ifs” and “how old are your kids” – after guesstimating who has chosen not to, or could not have, kids. Then, we slide into pseudo group therapy. We talk about retirement, change in lifestyle, body aches, empty nests and how we cope with the sense of abandonment when children leave the comfort of home for distant cities – and different time zones – to start a blooming career and soon, a family.

“Raise them right, teach them well, let them go,” a friend quips, likening the stages of parenting to a rocket launch.

First stage: the liftoff. Or rather, the “thrust” at the moment of birth. Then, for about 18 years or more, the child relies on the parents’ guidance as it journeys forth to explore unknown territory. When our guidance has run its course, we recede. The child enters the second stage: leaving home.

The child, now 21, equipped with the values and moral compass acquired from the parents, powers up into newer experiences and realities. Parents continue to monitor the child’s orbit from the mothership, waiting for distress calls, communicating instructions only when needed.

Final stage: the child, now a mature adult, completes the orbit and catapults towards another yet unknown destination. Mission completed, the child, now past middle age, returns home. Usually, near retirement. Touch down. Life has turned full circle. The child becomes the parent, and the parent now become more like a child.

My friends and I have come full circle. We are the “sandwich generation” — still connected to our children while tending to ageing parents who need full-time care. As is the case with my 85-year-old mother, with all her six children living overseas. She now wilts away in an aged care home (often misleadingly called “nursing homes” by the operators) in Penang. Taking turns to visit, we despair at abandoning her. Our mother is now our child in need of full-time care.

We continue to look for other homes where the amenities are more geriatric-friendly and more caring. For now, she is living in a clean and bright airy beachfront home, with open visiting hours, sharing a living room-turned-dormitory with five chair-bound ladies around her age.

In my travels, I have seen geriatric-friendly homes and public amenities in Singapore, Japan, South Korea, even in Prague, where “senior citizens” are empowered to live their remaining years in “retirement villages” with dignity and a sense of relevance.

There is easy access to affordable public transport for the elderly and buses that “kneel” for those with walking frames. There are organised excursions for the old and infirm, opportunities for the more mobile ones to do voluntary work, light exercises and psychomotor activities, board games, piped-in music and reading material.

Loneliness and a sense of being abandoned by their children can cause chronic depression in many elderly folk. My mother is one of them. Hence, they are left to live in the past in their own silent world, oblivious to visitors and the cacophonic soap operas screaming from the TVs, which are turned on the moment they wake up at six or seven to when they go to bed, usually at about eight.

In providing quality care, nursing homes in Malaysia are evidently decades behind Singapore or Japan where geriatric-friendly facilities are regulated by the health and welfare departments. Aged care homes in Malaysia operate outside the Private Healthcare Facilities and Services Act 1998, which requires nursing homes and aged care to be registered.

Some operators I spoke to say they managed to escape the Act by claiming they do not provide health, medical or hospice care, but only food, board and “maintenance”, or assisted living. That exposes the elderly to exploitation and abuse by profiteering aged care providers, who employ underpaid and untrained helpers, usually foreign maids, instead of qualified nursing aides. The residents of these homes are fed, cleaned and objectified – kept alive — as a source of steady income for the operators. Monthly fees range from RM900 to RM1,300 in Penang.

From what I have seen in moving my mother to different aged care homes over the last seven years, the industry is evidently unconscionable. The authorities do not inspect these homes for minimum standards of care, cleanliness and human habitation. One home has five beds cramped into a room meant for three. Patients sleep on single beds in a room with no windows, ventilated by creaking fans, and dimly lit by fluorescent lights.

Gates are usually padlocked, grounds are overgrown with weeds and kitchens smell of food scraps. Garbage bins are soiled and uncovered, the beds are unmade, and white ceramic wash basins stained brown by leaky taps. The premises reek of incontinence problems.

The elderly are mentally and physically disengaged from their environment. These homes feel, smell and look more like a last refuge for the dying than caring homes for the old. Operators of these homes should be hauled up and thrown in jail.

As more ageing parents move from traditional family care to institutional care, the authorities must enact laws that require all aged care homes to be registered with the welfare and health departments and to be licensed and accredited with an independent governing body to ensure the care and facilities they provide meet the minimum standards. Without such regulations, we will see the old and infirm who need full-time care continue to be abused and commodified as a living source of income by unconscionable operators. – Comment by ERIC LOO

Eric Loo teaches journalism at the University of Wollongong in New South Wales, Australia. He worked as a journalist and taught journalism in Malaysia from the late 1970s to 1986.

Source: The Edge

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