Taking care of elderly in townships
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.
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.
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:
- Social participation,
- Respect and social inclusion,
- Civic participation and employment,
- Communication and information,
- Community support and health services,
- Outdoor spaces and buildings, and
“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.
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.
“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.
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.
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.