Stethoscope: How to improve aged care – The Edge Markets MY

This article first appeared in Forum, The Edge Malaysia Weekly, on February 28, 2022 – March 06, 2022.

On Feb 14, Prime Minister Datuk Seri Ismail Sabri Yaakob announced the Census Report 2020. In 2010, 5.1% of Malaysians were above 65 years old. In 2020, 6.8% of Malaysians were above that age. In just 10 years, the absolute number of older persons had increased a staggering 57%. Indeed, according to the World Bank, Malaysia was already an ageing society in 2020, and will become an aged society in 2044 (14% of population 65 years old) and a super-aged society in 2056 (20% of population 65 years old).

All these older persons need suitable accommodation, healthcare and social care. In this article, we focus on accommodation, and in a future one, we will focus on health and social care. Here, we distinguish the different types of accommodation for older persons, examine three gaps in delivering quality accommodation for older persons, and propose solutions to improve the accommodation for our parents and grandparents.

Different types of accommodation

To start the conversation, it is helpful to distinguish between retirement communities and aged care facilities. Around the world, “retirement communities” refer to retirement villages or residences for older people mostly living independently. On the other hand, “aged care facilities” refer more to nursing homes or care facilities, which cater to those in need of physical care, mental care or living assistance.

Retirement communities are popular in the western world, with Florida retirement homes being the most common cultural icon. However, retirement communities have not taken off in Malaysia for several reasons. One, consumers are still purchasing residential properties based on traditional criteria like location, price and features. Two, the concept and importance of retirement planning is not yet deeply ingrained in our Asian society. And finally, older persons still overwhelmingly prefer to spend their golden years in their current homes amid familiar surroundings, with the belief (or hope) that their children will care for them.

In Asia, almost all of us grew up in multigenerational family homes, with two or more generations under one roof. Due to these societal and cultural expectations, there is another emerging school of thought on retirement living that challenges the notion of placing elders in an exclusive seniors-only retirement community. This has led to increasingly inclusive communities being promoted, which welcome residents of all generations and physical abilities.

Therefore, Asia and Malaysia may see the growth of the concept of “ageing in place”. In practice, ageing in place has two approaches. One, old homes are retrofitted to allow senior citizens to live in their existing residences, with additional features like non-slip floors, better lighting and handrails. Two, new homes are purpose-designed and purpose-built to allow senior citizens to move in, to live with their families if desired and to retain their independence and dignity.

The intention of ageing in place is to allow older persons to live comfortably in their home for their entire lifetime. The built environment and residential buildings can promote the concept of ageing in place with practical approaches. For example, universal design is important for residents requiring walking assistance or wheelchair accessibility, or for visually or cognitively impaired persons. Fire protection is important because older people may not have mobility during emergencies. Communal spaces like lounges and farms will help older residents remain active and socially engaged. Healthcare facilities near the residence will allow much greater access to healthcare for older residents. One co-author of this article is turning these approaches into practice, by developing a senior-inclusive multigenerational residential building in the Klang Valley.

Current gaps

We detect three gaps in the care infrastructure for the “silver tsunami”, which refers to a surge in the number of senior citizens in Malaysia. First, there must be sufficient opportunities for multi-stakeholder dialogue between senior citizen organisations, care professionals, policymakers, regulators and property developers. Appropriate channels of communication and mutual learning can improve the regulatory infrastructure and planning guidelines to make it more viable for developers to build senior-friendly accommodation. Physical residences should be an integrated part of the care infrastructure, and not as standalone residential projects that may become white elephants.

Second, there is a need for harmonised laws to govern aged care services and facilities. These facilities must meet minimum standards and be properly run by trained professionals. Such facilities or premises should have basic universal designs and address safety issues such as fire hazards and adequate ventilation. This will help resolve the issue of the typical aged care facility in Malaysia, which is a nursing home operating in a semi-renovated residential bungalow.

Unfortunately, these operators find it difficult to meet the minimum safety or quality criteria, and face licensing challenges because commercial activities are not allowed on residential properties in the Local Plan. As these businesses address a social need, local city councils do grant operators a temporary conversion of residential properties for commercial usage for a short one- to two-year period, with no certainty for renewal. These licensing limits discourage business owners from investing in safety or quality compliance, for example, in fire protection, installing lifts or enforcing health protocols.

Third, there is an absence of a coherent long-term infrastructure strategy for the silver tsunami. Right now, residential properties are built without sufficient thoughtful strategies for health impact or impact on senior citizens. The Ministry of Housing and Local Government and city councils have important roles to play, to set appropriate regulations (and introduce appropriate deregulation) that guide the multi-decade strategy for infrastructure to serve the ageing population of Malaysia.

Two strategies come to mind: retrofitting old buildings and building new purpose-built buildings. Both strategies have their challenges. The first strategy involves existing office towers or hotels, modifying lifts to accommodate stretchers or modifying toilets for wheelchair users. The second strategy involves finding commercial land at the right location and price, before submitting plans for local council and/or Ministry of Health and/or Community Welfare Department (Jabatan Kebajikan Masyarakat) approvals. Therefore, a clear strategy and periodic review of planning guidelines by the Ministry of Housing and Local Government is crucial to resolve these development bottlenecks.

Specific solutions

We offer three specific solutions to build better accommodation for senior citizens in Malaysia. First, there is a need to review and harmonise existing planning guidelines and regulations. Specifically, we need to update the Physical Planning Guidelines for Senior Citizens, published by PLAN Malaysia (Jabatan Perancangan Bandar dan Desa). Some of the guidelines could be reviewed to improve the viability of development. There is also an immediate need to gazette the regulations in the Private Aged Healthcare Facilities and Services Act 2018, so the aged care industry can begin implementing these regulations.

Second, smarter regulations must be implemented to encourage private sector innovation and competition for senior-friendly accommodation. Developers are equipped with the know-how, capital and expertise to develop purpose-built commercial care facilities that are compliant, licensed and designed for efficient operations. For example, multiple operators in a single care facility can achieve economies of scale for shared resources such as fire protection, lifts or laundry services. It also allows for synergistic businesses such as clinics, pharmacies and therapy services to operate within the care facility premises. Indeed, a well-planned senior-friendly development can reinvigorate neighbourhoods by creating a hub for social care and economic activity. A case study can be found in Kampung Admiralty in Singapore, which “integrates housing for the elderly with a wide range of social, healthcare, communal, commercial and retail facilities”, according to the government website.

Third, the tangible built environment must be integrated with the intangible social care environment. Tax incentives, subsidies and non-financial incentives must be developed to encourage investments in the accommodation and care of senior citizens. If done correctly, these incentives can smoothen out demand and consumption hitches, encourage proper retirement planning and promote dignity in the golden years.

Ageing with dignity

We owe our parents and grandparents a debt of gratitude that can never be fully repaid. One way to try to repay that debt is to provide a physical and non-physical environment in which they can thrive, live with dignity and independence, and enjoy their golden years. The World Bank projects Malaysia to become a super-aged society in 2056. The quality of the built environment for older persons in 2056 depends on the political, regulatory and financial choices we make in 2022.

Dr Khor Swee Kheng is a medical doctor specialising in health policies and global health. James Tan is CEO of Suntrack Development, a property developer in Malaysia.