KUALA LUMPUR, May 24 – Concerns over the welfare of senior citizens in care homes have prompted calls for greater regulation and guidelines in Malaysia.
However, industry players argue that the Senior Citizens Bill may not be the appropriate place to address the issue.
“Those concerns are real and have happened in other countries,” Total Investment Sdn Bhd executive director John Chong told CodeBlue when contacted. “I agree that there should be some regulation and guidelines for these matters. The question is should they be addressed in the Senior Citizens Bill or some other legislation?”
Chong, a director of GreenAcres Retirement Village in Ipoh, Perak, the first modern retirement village in Malaysia developed by Total Investment (also known as TI Homes), suggests that the Private Aged Healthcare Facilities and Services Act 2018 (Act 802) is better suited for regulating elderly care facilities, rather than the Senior Citizens Bill.
Act 802 was passed in Parliament on November 29, 2017, and was gazetted on March 29, 2018, but its regulations have not yet been approved by the Attorney General’s office. This means that the law cannot yet be fully enforced, as the regulations are necessary to provide guidance on how to implement the law.
Act 802 is meant to be a more comprehensive legislation targeting elderly care facilities, including nursing homes and day care centres, compared to the Private Healthcare Facilities and Services Act 1998 (Act 586) and the Care Centres Act 1993 (Act 506).
For example, under Act 802, private aged health care facilities and services are required to obtain a licence from the Ministry of Health (MOH) to operate, as opposed to simply registering with the Social Welfare Department (JKM) under the Care Centres Act 1993.
Registration ensures that minimum care standards are met, while licensing involves a more rigorous process, including meeting higher standards of care, such as having qualified medical personnel on staff, implementing infection prevention measures, and providing a safe and secure environment for residents.
While registration under the Care Centres Act 1993 is mandatory for care centres in Malaysia, licensing under the Private Aged Healthcare Facilities and Services Act 2018 is an additional requirement for care centres that provide health care services to the elderly, once the latter comes into force.
Those who argue for separate legislation to regulate care homes say that the senior living industry is complex and requires a distinct set of regulations and guidelines. They suggest that the Senior Citizens Bill should instead concentrate on areas such as preventing abandonment and offering financial support to caregivers.
Others suggest that the Senior Citizens Bill, which seeks to support and protect the elderly with dignity and respect, should include measures to improve the regulation of elderly care facilities.
Such measures may involve setting quality standards, carrying out regular inspections, and ensuring transparency regarding fees and visitation policies, all designed to safeguard the rights of the elderly.
While opinions differ on the appropriate legislation to regulate private care facilities, there is consensus among industry players on the necessity for increased regulation and oversight.
Rashidi Yahaya, the group chief executive officer of Seterra Group of Companies, which is pioneering modern Islamic aged care services in Malaysia, said the concerns raised by caregivers about the lack of oversight in private care facilities are valid and need to be addressed to ensure that the elderly are protected and cared for appropriately.
To prevent abuse and neglect, the proposed Senior Citizens Bill could include measures to ensure that caregivers and staff members are adequately trained and equipped to provide high-quality care for the elderly, Rashidi told CodeBlue.
“Access to training programmes, respite care, and other resources can help support caregivers in their roles and ensure that they can provide the best possible care for the elderly,” Rashidi said.
The upcoming Senior Citizens Bill should also take into account the affordability of elderly care, as many seniors may not be able to afford quality care.
Rashidi said providing subsidies or other forms of financial assistance for seniors who need care would be essential.
Making Elderly Care Affordable For All
CodeBlue previously published two separate stories (“Senior Citizens Bill: ‘Who Will Take Care Of Care Partners?’” and “Senior Citizens Bill: Family Caregivers Shed Light On Issues Plaguing Elderly Care”) that featured responses from seven caregivers.
These individuals shared their unique experiences and challenges in providing care, as well as their expectations for the Senior Citizens Bill.
Several caregivers highlighted the high expenses associated with providing care for seniors, particularly when relying on private elderly care services and facilities. Many emphasised the need for the government to provide subsidies to help offset the cost of assistive devices and home health care items, while others mooted price controls to curb excessive fees.
Chong said a practical solution to addressing the cost of elderly care services and facilities is not to impose price controls due to the industry’s complex and diverse nature, but for the government to provide subsidies based on a means test to ensure those who need financial assistance receive it.
“Price controls are tricky. There are a lot of variables (in terms of aged care facilities and products) so it’s not practical to impose price control. The alternative, giving a subsidy, as what is practised by a number of countries – I think this is a better idea, and of course, it is subject to a means test to ensure that subsidies go to those who really need them,” Chong said.
A means test involves assessing an individual’s eligibility for government aid by examining their income, expenses, and assets against a predetermined threshold. If their financial situation falls below the threshold, they may qualify for assistance.
When considering price controls or subsidies for elderly care services, Rashidi cautioned that both options may have unintended consequences, such as discouraging investment and increasing the risk of abuse or fraud. He said policymakers should carefully assess the benefits and drawbacks of each option before making a decision.
“It’s important to strike a balance between ensuring that seniors have access to affordable care and maintaining a healthy and sustainable elderly care industry that can provide high-quality services,” Rashidi said.
Senior Citizens Bill Should Tackle Abandonment, Not Punishment For Care Home Placements
The government has not yet released details of the proposed Senior Citizens Bill. However, Aiman Athirah Sabu, the Deputy Minister of Women, Family and Community Development, has suggested that the upcoming legislation, expected to be introduced next year, may include penalties for individuals who send their elderly parents to care facilities.
Referring to several practices implemented abroad, Rashidi said that imposing penalties on adult children for sending their elderly parents to care homes is unnecessary.
In Australia, the decision to move an elderly parent into aged care is typically made by the family after consultation with the elderly person. The government provides various aged care services, such as residential care, home care, and respite care, to cater to the needs of the elderly person and their family.
Australia does not have penalties for adult children who send their elderly parents to care homes; instead, the government offers financial support, including subsidies for aged care, to assist families with the cost of care.
Similarly, in the UK, there are no penalties for adult children who send their elderly parents to care homes. However, legislation exists to safeguard vulnerable adults, including the Care Act 2014. The Act includes measures to protect older people from financial abuse, physical abuse, and neglect. Local authorities are required to investigate allegations of abuse and take appropriate measures to protect vulnerable adults.
The UK government also provides financial support, including subsidies for aged care, to help families with the cost of care.
In Japan, family caregiving is considered a responsibility. However, recognising the challenges of caring for elderly parents, the government provides financial support, including subsidies for aged care, to help families with the cost of care. There are no penalties for adult children who send their elderly parents to care homes in Japan.
In fact, there is a growing trend in Japan of adult children moving their elderly parents into care homes due to the challenges of balancing work and caregiving responsibilities.
“I believe you can see where I am going with this. There should be no penalties for adult children who send their elderly parents to care homes,” Rashidi said.
“Having said that, if the new Bill is adamant to impose penalties, then it should do so on clear cases of abandonment of the elders. Our world today, post-Covid, is a different world than yesterday.
“Families are trying to get their lives back on track and navigating changes which affect their careers and children, whilst caring for their elders are taking a toll, especially with families whose elders are dependent on them.”
Chong also believes that imposing penalties on adult children for sending their elderly parents to care homes is unnecessary. There may be valid and justifiable reasons why someone may need to send their elderly parents to a care home, Chong explained.
Instead, the focus should be on addressing abandonment, where children leave their elderly parents behind or stop paying for their care.
“The bigger issue that should be addressed is abandonment, where the children abandon their elderly parents (by the wayside or even put into a home, but then stop payment after a short while),” Chong said.
However, Chong added that it may be worth considering if the government introduces a law that requires a deduction from the children’s salary when they send their parents to daycare centres or nursing homes for the elderly.
“This may be worthwhile to consider, to ensure some kind of security if a child sends their parent(s) to a care home.”