Tag Archives: Ageing In Place

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)

Taiwan's Elderly Care

Through The Lens Of Taiwan’s Elderly Care

Taiwan is considered more advanced in its elderly care services and is said to be facing a social time bomb as its population ages. However for a country such as Malaysia which is still making headway in addressing its ageing populations needs, it was certainly a welcomed sight to know what they have put in place.

A recent visit to Taiwan by Aged Care Group (ACG) offered a good insight into the aged lifestyle as we were introduced to the various living conditions built to cater to this growing demographics – apartments for elderly, a village concept for those who are still active and independent, an integrated service centre, community day care centre as well as privately owned facilities that are equipped with smart technology solutions that provide assistance to daily living for the elderly.

What was evident is the planning and thought process that was put forward in the design development of the places which can be segregated into 2 models “ageing in retirement village or apartment” and “ageing in place”. Taking a closer look into these living conditions – what is evident is that both models have its advantages.

Taiwan’s Elderly Care

1. Ageing in retirement village or apartment model

Ruen Fu New Life Retirement Home and Chang Gung Health & Cultural Village in Taipei. They are both Independent Living Unit (ILU) run by the private sector. Looking into their service offerings, they come with well-equipped facilities and age friendly environment.

Ruen Fu New Life Retirement Home location is just next to Tamkang University in Taipei, which is next to the school district, provides a lively feel where elderly could easily connect with the students. Their activities is held in a hotel-like complex space, where it split into different section such as gym room, mahjong area, reading area, performing stage etc. In term of security, they are providing security access card control system, 24 hours emergency call service, infrared sensing system in room. On health management side, they have 24-hours nurses on standby, providing clinic appointment, health information and health talk.

Chang Gung Health & Cultural Village is located in a more rural and remote area in New Taipei City which comes with a big piece of land. Its unique feature is that the outdoor spaces are accessible and open for residents and non-residents, trails for walks and fields within the plantation as well as engaging with the youngsters – watching them play basketball etc. There are also free classes for the residents to participate – calligraphy, computer, language, dance, drawing etc.

In term of security, residents are connected to the hospital monitoring system. Every building is equipped with nurse station and sphygmomanometer station, let their resident do their own blood pressure checking.

Chang Gung also using security access card control system but the card also functions as a debit card and stores personal health records. For example, the resident can debit all their food expenses by scanning their card, every time the resident wish to perform a blood pressure check also have to scan their card first, so that their health status will be recorded.

Those who reside in the retirement village or apartment are those who financially able as they pay a monthly rental with quite a hefty deposit.

What was noticeable for both the retirement apartment and village are that their staff are very friendly which is shown through the services and care offered. This makes the elderly feel at home with the warmth they feel and you can see that trust within their hearts as they are constantly having a smile on their face.

2. Ageing- in- place model

Ageing-in-place is a concept where an elderly ages within the comfort of their own home.

The Government of Taiwan have been promoting ageing-in-place since 2007 under their “Long Term Care 1.0” plan. After 10 years of implementing it, they are now enhanced into “Long Term Care 2.0”. This plan promotes a community based long-term care system which provides affordable care services to its residents. Government will subsidy the lower income group to access to the services.

Under their “Long Term Care 2.0”, they are expanding their 8 services to 17 services which includes daycare, transportation, home nursing, home (community) rehab, respite care, dementia care, caregiver support group, long term care service centre, small scale multifunction services centre etc.

The senior integrated service centre was built by the Taiwan Kaohsiung City Government to bridge the gap in social inclusion for the elderly. The centre brings together the elderly through leisure activities, learning programmes with daycare facilities and is even catered for those with Dementia. They have different classes and facility where all the active elderly can take part and interact with each other. The day care services not only providing the suitable & proper care for the elderly, but also helping adult children to ease their burden during working hours, while they can still bring parents back to home afterward.

While the senior integrated services centre serves as headquarters, there are also small scale multifunction services centre (satellite community care centres) in different residential areas set up. The function of community care centre is to provide daycare and homecare services within the community. The Kaohsiung City Government is working towards providing comprehensive services to allow ageing-in-place by integrating social activities into the care provision similar to what the retirement villages and apartments specific for the elderly.

It was a welcomed sight to watch the Taiwan elderlies enjoy the activities and services offered by the government. Throughout the whole visit, some of the elderlies also were excited to show us their works or what they learnt from the programmes.

The staffs informed us classes like dancing, calligraphy, ink painting are all hot in demand classes, where elderly need to wait for their turn to learn. Age doesn’t limit the passion of learning for those elderly, and yet they choose to visit services centre rather than just sitting at home – something that we Malaysians take note of.

3. Technology is an important enabler when it comes to ageing.

Imagine our living place is the hardware, the services or activities are the software, and technology is the lubricant that enables the seamless process.

Stipendiary Taiwan is a continuum care centre where daycare, short term stay, home nursing and homecare are embedded into their service offerings. Looking into their diversity of elderly and the care provision, technology plays a critical component where the utilisation of an IOT security smart environment with GPS to track elderly movement in particular spaces. Their wearable devices able to track elderly health status, smart mattress with motion sensor able to prevent elderly from falling down when they get out from bed. They have also progressed into developing their own Smart device solutions to compile and manage the process of homecare & home nursing services through app. It is a system to locate the people who need care and the status of care provider.

Like what we see from the retirement villages or apartments, both are using technology for security purposes, Chang Gung Health & Cultural Village even use the access card as debit card and health status recorder. What can be said that a successful formula in enhancing the quality and provision of care for our elderly would be that technology is the key enabler.

What we can learn from Taiwan

A survey done by ACG in 2015 shows that the top reason for why the elderly chose to stay in a nursing home or care centre is the lack of family support at home and family members not having the relevant caregiving skills to take care of them.

In other words, elderly would like to stay in their home, where they can always spend time with family——the rationale behind it is the Asian value and culture where we wish to look after our parents, and wish to stay with our family members until we passed away.

However, things just don’t turn out the way you want, the level of care that the elderly need might change overnight, which then requires them to need constant health monitoring.

That is also what Taiwan Government trying to achieve through their Long Term Care Plan, where elderly don’t need to leave the confines of their home or community, but a service team will be despatched to visit you.

Taiwan experience show that retirement villages and apartments have all the proper “in house” facilities and services, but the deposit and rental for staying there is definitely higher than staying at home; The costs for ageing- in-place is more affordable, but it can only work when there is a strong homecare and social service team just like the support provided by Kaohsiung City Government.

Another important element that we can learn from Taiwan is their “Human Touch”- how the staff or service team communicate or interact with elderly. This is the most important aspect that we should have whether you are running a community based services centre or retirement village, it is about creating a feeling for elderly that they are chatting, playing or eating with family member, not a stranger.

Ageing- in-place or ageing in a retirement village is about choices and options, they are pros and cons but in term of volume of people who will get immediate benefit, ageing- in-place seems like a model that can bring immediate impact to Malaysians. By embracing technology—— developing a homecare system or app to enable the whole process, could make ageing- in-place even better.

Although Malaysia is moving toward to ageing nation, but our facilities and services requires a lot of improvement. As sources are limited and to ensure that we are well prepared as our nation ages, bringing together the public and private parties in a collaborative effort would be something that really needs to be driven forward. As the saying goes- “One hand alone can’t clap, it takes two to make a difference”. Let’s work towards a better tomorrow not only for ourselves but also for our generations to come.

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