Saturday August 18, 2012
Affordable quality aged care cornerstone of high-income nation
MONEY & YOU By CAROL YIP
THERE are two simple certainties in life ageing and death. Regardless of our efforts, we all will age, and along with aging comes physical and mental impairment and the potential need for long term care. Acceptance of this truism is difficult for most of us. Contemplating that other certainty, death, is even more challenging.
The age of the average Malaysian is increasing. We will soon be at a critical point. We need to accept the issues that come with an aged population and find some viable solutions to address them. Like it or not, our ageing population will continue to increase over time primarily due to a falling birth rate. There are other contributors including changing family and marital structure, longevity, medical technology advancement, plus rural-urban and overseas migration patterns of our younger generations.
Based on the National Population and Family Development Board (LPPKN) news report in August 2011 on the Second Population Strategic Plan Study, one of the main contributors to our ageing population in Malaysia was migration. Many young Malaysians have left to work in countries such as Singapore, China, the United States, Australia and Europe. The study also found states like Selangor, Johor, Negri Sembilan, Malacca and Penang have better job opportunities in the cities due to economic development and population density. This is resulting in a high rate of internal migration from rural towns to urban areas.
In the same article, LPPKN director-general Datuk Aminah Abdul Rahman commented that LPPKN planned to focus on several family issue trends, such as fewer senior citizens opting to live with their children, more people marrying late or not at all, and the tendency to keep family sizes to a minimum. According to her, a smaller number of children results in a smaller number of care-givers and, subsequently, the use of external support services such as day care and nursing homes for senior citizens and children are becoming more commonplace.
With these demographic and social changes, pressures on the family institution are heightened in many ways, especially elderly care responsibility. Families struggle with a host of financial challenges when there are fewer children to help out in paying their parents' medical needs and care. A worst scenario takes place when the children live away.
Current status of elderly care
Elderly care can be divided into different types. Low care services are designed to rehabilitate or compensate for loss of independent physical or mental functioning. These services include assistance with basic activities such as bathing, dressing, eating, plus physiotherapy sessions, nutrition, health, fitness and personal care programmes. For those elderly individuals who need high care services and 24-hour nursing care, the provision of services will require trained nurses and medical professionals.
The current elderly care facilities and services in Malaysia are mostly provided by public hospitals, government-funded welfare homes, NGO's and private sector managed nursing homes and hospitals. With a limited number of government-funded hospital beds for geriatric care and nursing homes in Malaysia, there is an acute shortage of trained geriatric professionals, beds and care services of different levels for the elderly, especially in areas where the concentration of elderly people is higher.
Coping with the demand
When aged care services and homes are not meeting the increasing demand, costs of these services will increase and will be passed to the elderly in a form of higher fees. If the elderly individual can't afford to pay and yet care is needed, family members are supposed to provide the financial assistance. If the family is not helping, where are the alternative sources of financial assistance and whose responsibility is it to take care of them our Government or community of charitable organisations?
Unless the Government and private sectors are able to collaborate to control and manage the increasing costs, create additional easy access and affordable medications, facilities, amenities and services, older Malaysians may not have adequate savings to pay for their long term care needs if the aged care fees continue to increase. Many will not be able to sustain themselves before they run out of money.
Recent retirement system developments
Recent government initiatives related to retirement have set the stage. A new minimum retirement age to 60 for the private sector has been introduced. The upcoming September launch of the Private Retirement Scheme has been approved by the Securities Commission. The message is clear every individual in Malaysia has to strive to save enough for their old age living, with the family envisioned as the primary provider of care for them.
Change of family structure in most Malaysian homes suggests that Malaysians must plan to be more self-sufficient and financially independent as long as they live. We will need an equitable and sustainable aged care framework, with a combination of institutional and community care provisions, elder's long-term care support at our own home and aged care centers with affordable pricing so that our retirement savings can be stretched over a longer period as we cope with longevity issues.
Affordable quality elderly care
It is more than just having enough money for old age care. By rights, elderly care shouldn't be a financial burden when it is easily accessible within our neighbourhood.
To experience quality care and live through the period of care with dignity, the key is to create a caring and sustainable community environment for our elderly. Only then, we will have positive reception to the idea of “checking-in” to a place which is perceived to have adequate quality care and surrounded with people who care for our well-being. This way, growing old and feeling respected at this vulnerable period of our lives will create a sense of fulfilment and purpose.
However, as individuals, we cannot foresee our old age, the possible illnesses and nature of long-term care we may need with a high degree of accuracy. Therefore, we need a sustainable personal financial system to mitigate the risks of financing long-term care costs until our end of life.
Looking at the current scenarios, we would need to have a strong collaboration from the Government, industry providers, families and communities to overcome the challenges presented. Otherwise, the success of retirement planning for Malaysians' who are trapped in the “middle-income syndrome” will be slim.
We require a joint effort to create a mixed bag of “public-private financing strategies and aged-care framework” to pay for our senior living expenses and services be it out-of-pocket from personal savings and investments, cost-sharing by family members, social or personal insurance, government subsidies and state welfare.
Let's learn from countries that have successfully implemented affordable quality aged care services and also from those that have struggled to overcome the issues. Affordable quality aged care is one of the cornerstones required to achieve our nation's aspiration of a higher income society and developed country.
I have a dream for our 55th Merdeka Day celebration: My wish to all Malaysians is that we start to think and put things into action, as individuals, industry stakeholders and regulators, to nurture a “1Malaysia age-friendly community” built upon our unique Malaysian culture.
● Carol would like to wish all Muslim readers, Selamat Hari Raya Aidilfitri and all Malaysians Selamat Hari Merdeka!