This is Part one of three of the feature series on ageing and its socio-economic impact
AGEING is an inevitable part of life. Yet, in today’s fast-paced era, not many will pause to spare a thought for what will happen to them in their sunset years.
Admittedly, it is not always a simple matter to consider. It is not necessarily comforting to think that someday, one will gradually become more dependent and even start losing the ability to carry out daily functions without assistance.
People worldwide are also living longer due to advancements in the fields of medicine and public health.
On top of this, the rate of population ageing in countries across the globe is drastically rising.
According to the World Health Organisation (WHO), the world’s population aged 60 years and above is expected to total two billion by 2050, an increase from 900 million in 2015.
Among other measures towards addressing ageing and health, the agency has highlighted the need for countries to develop systems for providing long-term care to meet the needs of the elderly.
Long-term care for senior citizens can be provided at home by family members or friends and it can also be sought at facilities such as nursing homes.
Women and Family Department Sarawak director Norita Bawi, when contacted, described old age homes as by-products of modernisation. “This is a support system that is crucial for old folk who have no families or heirs,” she said.
To gain more insight on ageing and eldercare now, New Sarawak Tribune spoke with Dr Ling How Kee, a social work educator and research consultant who retired from Universiti Malaysia Sarawak (Unimas) as an associate professor in social work and social policy, as well as Dr Sidiah John Siop, Senior Fellow at Unimas’ Faculty of Medicine and Health Sciences.
The eldercare landscape of today
Modernisation has seen changes in lifestyle and needs and a shift in the care of older persons.
Ling said that in Malaysia, family members were still the primary care providers for older persons. Nevertheless, she pointed out that even here in Sarawak, there was an increasing need for formal systems of care.
“Informal care refers to care provided by the family while a formal care system refers to care provided by the government, non-governmental organisations (NGOs) or private enterprises,” she explained.
She attributed the rising need for formal care systems to a combination of factors such as longer life expectancy and greater participation of women in the workforce.
“In the past, the daughter or daughter-in-law would be the caregiver. But now, women are increasingly participating in the workforce and therefore, are unable to provide care for elderly family members,” she said.
Another factor, she observed, was increased mobility and migration, whereby children might be working and living in other parts of Malaysia or overseas.
“This means there are some older people who are left without the kind of care provided by families in their twilight years,” she said.
As such, Ling said there was a rising trend of seniors being sent to residential care facilities, also known as nursing homes or old age homes.
She added that such facilities were mushrooming due to demand, especially in this day and age.
She pointed out that most of the care facilities in Sarawak were residential in nature, with occupants living there full-time and most of the time permanently until they passed away.
On the range of residential facilities available in Sarawak, Sidiah said there were old age homes for the destitute — such as Rumah Seri Kenangan run by the government — and also for people who could afford private services.
She said there were also NGO-managed facilities such as the Lions Nursing Home.
“I would say that the government is open-minded in the sense that we have many nursing homes which provide care for people who can afford it.
“We need these private nursing homes to provide support services because the government cannot take care of everyone,” she emphasised.
During New Sarawak Tribune’s interview with Ling, she emphasized the question of how we, as a society, wish to care for our elderly members.
“When we ask this question, I believe it is important to ask the older persons themselves — what do they want?” she said.
Having a say in the matter
Highlighting the concept of positive ageing or active ageing, she advised, “We should think of older people as someone with their autonomy, being able to control their own lives and having a say in what they want.”
Thus, she believed that seniors themselves should be active participants in the planning and delivery of eldercare services and programmes.
Similarly, she said the elders’ views and preferences should be considered when choosing a residential care facility.
“Sometimes, it’s a case of whether the older person wants it or the family feels that it is best for him/her,” she said.
Ling also said that when it came to eldercare, community participation was important.
“The government, the people, and the older persons themselves should all come together to plan and implement services and programmes on the care and support of older persons,” she urged.
Sidiah, who is also a registered nurse with a PhD in Gerontology, emphasised that people should start thinking about their senior years while they were still young and prepare for their old age as early as possible.
“It should not be only when they are already 60 years old that they start to think about where they are going to stay and who is going to look after them,” she remarked.
A range of options
Although residential care facilities can be the optimal solution in certain cases, this option should not be seen as the only pathway once a person has aged.
Ling highlighted the need to promote a wide range of facilities and support services so that people had a choice.
“For instance, we can have daycare facilities for the elderly. We put our young children into nurseries to be looked after
during the day while we work, and when we are finished with work, we bring them home.
“It will be very good if older people can also have such daycare facilities,” she said.
Ling also suggested other alternatives such as domiciliary support services; in-home care where a care provider visited a senior’s home to provide assistance and care.
Another option, she said, was a community-oriented retirement village. She explained that in such a setup, seniors would still have good interaction with their family members and the outside community.
Based on a study on ‘Ageing in Sarawak: Impact, Needs and Emerging Issues’ which she previously conducted with a team of researchers from Unimas, she shared that — given a choice — most older people would prefer to stay in the comfort of their own homes.
Although the study commissioned by the then Ministry of Social Development and Urbanisation was conducted over 10 years ago, the findings still hold true to this day.
“Some of them said that even if their children are not with them if they could, they would prefer to have the independence of staying in their own homes and to have someone come in and help them if needed,” she stated.
Ling thus expressed her view that, as much as possible, it would be best if older people could remain at home with different kinds of care and support provided to them.
“But there are times where this is not possible, especially when the older persons are facing a declining level of performing activities of daily living (ADLs). Then, alternative care in a residential facility becomes a necessity,” she said.
Meanwhile, Sidiah noted that those who were able to afford it would have more options — to live in their own homes and employ care providers to look after them or to be placed in high-end nursing homes or retirement villages where they would be well looked after by professionals.
She observed that seeking such eldercare would certainly be an issue for people who simultaneously did not have the means to pay for such services and also did not meet the criteria to be admitted into the government-run old age home.
“However, there are also religious bodies that have homes for people who are in need. For example, there is Home of Peace which is run by Catholic nuns as well as Sarawak Hun Nam Siang Tng which is run by the Buddhist society,” she said.
In Kuching alone, more individuals and enterprises have taken the initiative to respond to the need for eldercare by expanding the pool of facilities to include non-residential forms of service.
For instance, Trinity Methodist Church set up Trinity ElderCare Centre, an integrated daycare facility for the elderly, with activities and exercises carried out.
Another example is Kenneth Care Home which has multiple branches in Kuching. It provides three forms of services for the aged — 24-hour residential care, daycare, and home care nursing.
Additionally, iCare Home Nursing offers nursing services to patients within the comfort of their own house.
Emphasizing quality of care
In circumstances where residential care facilities are needed, these centres have to be developed with several crucial aspects in mind such as quality of care.
Ling said there was a wide range in terms of the quality and standard of care provided at different facilities.
“In this regard, imagine you are at a care facility and consider this: If your parents or grandparents are placed there, do you think they would be happy? Would you be happy to see them there?” she posed.
She said another concern was the level of training of the caregivers, including proper training in eldercare.
“In addition, in the context of eldercare in a residential care setting, I believe there are certain guidelines on staff-to-resident ratio as stipulated in the Care Centres Act 1993.
“There is often the question of whether there are sufficient trained staff members and if the elderly residents are being cared for adequately,” she remarked.
Ling said this would also depend on the needs of the older persons.
She pointed out that some might be more independent and required less assistance while others, such as those with
dementia and Alzheimer’s disease, would require greater supervision and intensive care.
“This does not mean that residential care is not good, but it’s more that we have to look at the quality and standard of care in terms of the staff and the adequacy of care such as whether the facilities meet the range of needs. This is because there are physical needs, psychological needs and social needs,” she elaborated.
On the latter, she said seniors would need social contact and activities to allow them to have meaningful relationships with their fellow residents as well as with their families and the people outside the centres.
“We do not want to have the idea that sending our older people to a residential care home means that we cut them off completely or even abandon them,” she said.
Ling advised that a homely environment should be provided in nursing homes, rather than having a hospital — or institution — like atmosphere.
“We want to have nursing homes that provide a homely environment where older people still have participation rights and they can still have a lot of contact with the outside community. That will be the criteria of a good old age home that has the wellbeing of the older people at heart.”
At the same time, Sidiah said it was important for children or family members of seniors to do their homework first — evaluating the options and facilities before deciding on placing their old folk in a residential care facility.
“They should look at all the barriers in the home before they decide to put them there. They must also think about whether they can afford it in the long run.
“If their parents are going to live there for 10 to 20 years, do they have the financial means to pay for this?” she said.
Nursing homes a ‘no-no’?
Even though modern society has grown to be more developed and open-minded, some actions are still viewed as a taboo by many people. One example is the social stigma attached to the act of placing one’s elderly parents in residential care facilities.
Ling believed a key factor that had brought rise to such a stigma was cultural tradition.
“In Malaysia, it is very entrenched among the various ethnic communities that we should care for our elderly persons. There is the idea that we have to be filial towards our parents.
“As for the older people, they may expect that as they have brought up their children, then their children should repay them by caring for them in their old age,” she said.
Nevertheless, she pointed out that such views were shifting now. She explained that sometimes, it was a necessity to send seniors to nursing homes. At times, it was considered a better option as there are seniors who were neglected or even abused in their own homes.
“If a family really cannot care for an older person adequately, then I think it is a responsible thing to do — to choose an elder care home that is best for this older person, instead of neglecting or abandoning him/her at home,” she remarked.
Ling said the social stigma towards nursing homes also stemmed from concerns over substandard care facilities.
“If the eldercare homes are of a very high standard, then there will not be a stigma,” she said, pointing out Japan’s premium nursing homes as an example.She pointed out that with the provision of the right kind of facilities and beneficial options, the social
stigma attached to nursing homes would change and fade.
“The care of older persons should be based on a human rights approach following the five A’s principles established by WHO (2017) — availability, accessibility, affordability, acceptability and appropriateness,” she said, citing a recently completed study on ‘Health Rights of Older People: Comparative Perspectives in Southeast Asia’ in which she led the Malaysian team of researchers.
Sidiah also stressed the importance of education to destigmatise old age homes and other forms of eldercare.
She said people should not be afraid to seek help when needed about caring for their elderly parents or family members. She added if both the husband and wife in a family were working, looking after ageing parents and their children at the same time could cause burnout stress.
She also pointed out that society was changing and that many women now were working and earning money to support their families.
“People have to be open-minded as there are many options,” said Sidiah.
