LIKE death and taxes, getting old, ill and dependent is inevitable. It’s an easily dismissed subject when you are a strapping lad but with the passing years, the realities of illness and ageing cripple some of us who are not prepared.
In trying to understand how we as a nation can better deal with managing care for the ageing, we should appreciate how developed nations cope.
Japan’s population will fall by a third in 2060, with nearly 40 per cent being above 65 years of age. Lifespans tend to be longer for developed societies with access to medical technology and high standards of medical care – in Japan’s case, their life expectancy is about 83 years.
As we approach high income, developed nation status, we are heading in a similar direction. The average life expectancy for a Malaysian in 1957 was just 56 years. Now it is at 75 years. By 2020, the number of Malaysians aged 60 and above is expected to hit 4.46 million up from the current 2.32 million.
For this article, let us look at life in three phases – phases that we are all likely to go through, in some form or another.
For the young and mobile, this is the on the go phase. We will eventually slow down – perhaps as we touch our late 50s – I call this slow go. Some will reach the point where they become fully dependent on others for care – the no go stage. People who are debilitated or those caring for them, suffer the most.
My father was diagnosed with Alzheimer’s a few years ago. At that time, my siblings and I faced the harrowing, heart-wrenching process of accepting that there will come a day when he will no longer be the strong, capable leader and father he once was. We also had to seriously consider how best to take care of him.
From my observation, care and support in our country for the slow go stage is acceptable. There are public and private hospitals that cater to a range of medical needs with the assumption we can still care for ourselves. But when bedridden or fully dependent, this is where the real struggle begins.
Reflecting on our experience in caring for my father, there are three aspects to getting aged care on the right track:
Ensuring proper standards
The elderly require various levels of care, and services must be catered to fit these purposes. For those who need minimal support ‘low care’ will be the right choice and cost for such level of attention will be minimal. The ones who are in the dependent stage will require ‘high and intensive care’, and we will see costs escalate.
The new Aged Healthcare Act, to be completed at the end of this year, addresses these needs. The Act regulates the provision of services and facilities for aged care – aimed at transforming aged care facilities and services and upgrading skills requirements for caregivers.
The government also encourages the development of senior communities such as retirement villages, and is pushing for a robust mobile healthcare industry that caters for those who want to age in the comfort of their homes that can be covered by insurance.
Prepare for the future
I cannot stress enough on the importance of savings and insurance. While still working, people should deliberately save enough money and get sufficient insurance for old age. Insurance premiums tend to be low for the young. Locking the rate in early means you are able to secure medical care at a much lower cost.
Just one large calamity can leave you in dire straits if all you have is your EPF or Socso. Being prepared for the eventuality of old age is crucial.
Right now, in Malaysia, public health is highly subsidised. That is why it is one of the most affordable in the world. For example, a GP treatment at a government hospital in Malaysia is charged at an incredibly low RM1, a rate established way back in 1982! Going forward, the level of subsidy in the current public health system is unsustainable.
Strong cooperation from all parties
We need the strong backing of all groups that contribute to a dynamic healthcare system for the aged. Social welfare agencies, healthcare providers and the medical profession
must find avenues to collaborate. Presently they work in separate areas but if the industry can set up one-stop centres for aged care, this will be a practical collaboration.
Geriatric-friendly housing is the next natural step. In Singapore, such buildings have features like bathrooms with grad bars and emergency buttons in each room, with a doctor on standby in each building.
My father is a brave man. Upon diagnosis, he organised a party and invited all his friends and family. As the celebration was underway, he stood up to speak.
“With my disease, I will die twice – once mentally and the other, physically. Say to me tonight everything you want to say because the next time I meet you, I may not know who you are,” he said.
We all sang ‘Amazing Grace’ that night with so much choked emotion. Tears flowed freely. For us as his children, it was a brutal realisation of the daunting days ahead. My parents then made the decision to leave their beloved Bario to move to Kuching to live with my big-hearted sister in order to access medical facilities.
Whenever I get the chance, I return to Kuching. The roles have reversed. Sometimes, I would lie in his bed and hold him as how he held me when I was a child. I remind him of stories of our past to trigger his memory, and we spend many an afternoon laughing and praying together.
As much as I talked about the practicalities of managing the elders, caring isn’t just about money. The old and incapacitated are most vulnerable. What they need is our time, our attention and our unbridled love. My brother, who lives in Australia generously took up almost a year to stay with my father in Kuching. Indeed, we should all give grace to the people we love so they can age and, eventually, depart with dignity.
Datuk Seri Idris Jala is CEO of Pemandu, the Performance Management and Delivery Unit, and Minister in the Prime Minister’s Department. Fair and reasonable comments are most welcome at [email protected].