The Future of Aged Care Facilities: Improving Regulation and Quality of Care in Malaysia: Otter Voice Meeting Notes

The Future of Aged Care Facilities: Improving Regulation and Quality of Care in Malaysia

Sarah Anati21min

PC Gan

00:15

Hi. Morning. So today we have got Delren with us and Delren is the president of Association of Residential Aged Care Operators in Malaysia. In short, AgeCope, so perhaps Delren, if you can just share a little bit with us about what AgeCope does?

Delren

00:34

We were formed in the year 2018. We were, we were - initially it started in the year 2016. We decided that we should have an association to protect all the care operators within Malaysia, because there was no body, no official body, to take care of all the needs and problems faced by individual care operators. Everybody was on their own, everybody were defending but by themselves, whatever the government said, was law. So there was a need to set up this association, and with the help of my ageing unit of University Putra Malaysia, we embark on this journey to start out this association, then the journey started the year 2018 we got our association registered. And our first meeting with the government to inform them, was with YB Hannah Yeoh, then she - she acknowledge our existence and from there onwards we inform JKM that we are going to embark on registering unlicensed and licenced operators to become under our wing, and anything they want to set up, at least, notify us so that we can give our feedback. The good point of starting this association is that after knowing of our existence, the government invited, and we can give our input during the meetings for Perancangan Malaysia Ke-12 on the ageing sector. And we raised up a lot of issues, especially after in the year 2017 under the Barisan National government they inacted a law, which was passed in 2018 whereby the current licencing of care operators under Welfare Ministry will be handled to the Health Ministry and will be under a new Act, Act 802 whereby, it'll be more stringent and all homes will be classified as nursing homes, but you will be under the Health Ministry. Of course when you do this, a lot of care operators cannot come up with the funds to upgrade your home to be as comparable to the requirements of a nursing care home, as compared to a welfare care home. So, this where AgeCope comes in we try to mitigate, lower down the standard a bit of the Health Ministry's Act, but upgrade the standard of the Welfare Ministry's Act, so we can come to a middle ground, whereby can assist all care operators. That's what our, our task has been doing. And our main issues we faced in the last two years since registering has been unlicensed homes. Members who cannot get licence for their operation. Normally, it's not that they do not want to be licenced, but because they have faced issues with the local authorities. To get a licence, you need to go to the Welfare Ministry first, uh number one. After the Welfare Ministry you get the, you go to SSM to register your company. And after SSM you will go to the Town Council to get it, endorsed approved, according to the perang perancangan unit, and after that you go to the kesihatan and bomba to get approval, finally go back to the Welfare Ministry. But most of us are stuck at the local council, because different towns, different states, different districts have different law in regards to operating a care centre in the area. So, this is I boil down to because every town council, their members, the exco, the councillors are made out from political connections. They look at scenarios, according to their towns, they - they look at scenarios, according to the needs of the people in the town and they sometime when they, when they do or pass new regulations, they overlook the federal government requirement of regulations. That is federal governments say that we need more care homes but Town Council put a lot of hindrance to getting more care homes. It's all continuity between the federal government and the Town Council. And when you have different, different political connections involved in the Town Councillors, you get 20 new Town Councillors coming in every two years in a - in a town. And each of them have different ideas, different rules to set. Imagine when you have more than, 400 town councils or. That's where the law is - has changed so much that in PJ example in PJ, you cannot have one centre, that is near to another centre within 100 metres from another centre, you can't have one.

PC Gan

05:57

Okay, but there's already so many especially in I think Jalan Gasing that side right?

Delren

06:00

Yes, possible they don't allow licence possible. That's why you have so many. Okay. And the law set for PJ back then was that you cannot have more than 50 care homes in the entire district of PJ, but this law was set back in the 1970s. But now you may need about 100 or 200 care centres, so when you're using old archaic law in new regulations and you impose new things, it makes it difficult to get licencing. Take example, certain states, I won't mention the area, otherwise the PBT will go and impose new rules. You don't need neighbours permission to start a care centre, you don't need. That means, if you get the Welfare Department approval, you get a Town Council approval, that's it. You can start operating. But in Kuala Lumpur or in PJ, you need to get the immediate neighbours approval. The moment one neighbour say, "no", you cannot. So, you may go to the Welfare Ministry. Now the rule is you go Welfare Ministry first, Welfare Ministry say yes, you can get it licenced, there, that area. Then you go to Town Council, Town Council ask the neighbour say cannot, you're back to square one.

PC Gan

07:20

Oh dear. Okay, so there's a lot of owners on the operator themselves to how to say weave through all these policies.

Delren

07:28

Yes, yes. So, if, if the, the Welfare Ministry is aware they should say that for states that or areas that require neighbours permission, you should go to the town council first, get their approval off then only come to us.

PC Gan

07:46

Yeah.

Delren

07:46

Okay, in Penang case, there is another dilemma. The neighbours may say yes. But what you get is zoning, the Town Council say yeah, the neighbours say yes but that is not under our zoning area.

PC Gan

08:01

Oh wow.

Delren

07:46

So, when in Penang said, no, this zone is not zoned for residential care within that area. You have to go and open another area that is zoned - zoning allows. So you do that sometimes the - the place is not convenient. You go and ask for someone to start here, the owner allows us to open here, the neighbours are okay with it but then now you're telling them that this is not a zoning area for care operator. You asked to open another area because you zone that area, but that area the neighbours may not allow.

PC Gan

08:34

Yeah, so that's just the setup. So but my question is also, is there any policy to govern the uh, how to say - the staff, or the people who are serving the residents in the, in the homes?

Delren

08:47

No.

PC Gan

08:48

Okay, Because most of the time. I mean, the ones that I see is often understaffed, so I guess it's also a question of, you know, who then will govern the quality of living in these homes?

Delren

09:01

Now, the guidelines is not there to say who is to serve or work in the care home under the Licence Ministry licencing department. Now, when you apply for a licence, they need a staff who is at least a nurse. One. It can be the care operator or can you, it can be like a non-nurse but one of your staff is a nurse.

PC Gan

09:25

Okay.

Delren

09:26

Okay, so at least one. But there is no law governing that does the nurse won't resign or secondly there's no say they must be there all the time. And although it stipulates that one staff for every 8 patients or 8 residents, but it doesn't say what type of staff.

PC Gan

09:46

I see.

Delren

09:47

It didn't specify that the staff must be trained. It just said a staff.

PC Gan

09:53

Then how then, you know, in this whether if it's government or people who are able to influence the quality of living like what do you think we can do to help in terms of how to say - providing them?

Delren

10:07

So when AgeCope came into the picture. On top of licencing issues, we also look into the long term caregiving, how to upgrade the care in all the centres and how to ensure that all these centres have enough staffing, where we are trying to find out what is the problem faced by everyone is it salary wise? When it comes to salary wise, some are paying very good, but yet people are still leaving. They don't want to work there long term. We had a problem with staffing, there was an acute shortage in the initial part of the MCO whereby nurses waiting for placements, normally take six months to a year to be placed in a hospital. While awaiting placements normally they will work in the care home, nursing home for part time. But during the first month of MCO, the government absorbed all the nurses at one go. So, when all the nurses left, despite some operators were willing to give better pay than the hospital. Yet they left, so there was an acute shortage. So now how to fill this gap was that we are looking into meeting up with the Human Resource Ministry to open up this sector, caregiving sector to foreign workers if locals do not want to work in this area.

PC Gan

11:30

But even with this pandemic, also we don't, I mean the borders have not opened so foreigners. So, we still -

Delren

11:36

Yes, will not allow. So we have to wait. So when you mentioned about caregivers, not being properly trained. One of the reasons is that when you have staff shortage, so whatever staff you get, you accept first. So we have no choice but to employ them first.

PC Gan

11:53

But since since we mentioned about MCO, so I've also read an article recently at MalaysiaKini about you know how nursing homes, somehow have contracted like high number of COVID cases.

Delren

12:06

How to prevent -

PC Gan

12:07

Yeah, so I think the first question, it's more of how did that even happen because I think during MCO visitors are not supposed to come in at all. So how did the residents, then you know contracted this cases?

Delren

12:20

Okay. Now, the goverment SOP of this, allowing visitors, was sent out to all the licenced home.

PC Gan

12:28

Okay.

Delren

12:29

Majority of the homes you see contracting or in being infected by COVID-19 are those unlicensed homes. The message didn't get to the unlicensed homes.

PC Gan

12:40

Oh dear. Okay.

Delren

12:42

In our country, there are about, estimated 1700 to 2800 care homes in the country, whereby only 361 are licenced. Yes, that leaves about another 1400 unlicensed operators throughout the country. Like I said again, not many that don't want to be licenced. Many want to be licenced but they are facing hindrance. So messages that are supposed to go to all these people are not being received.

PC Gan

13:16

It only reached to the 300 plus.

Delren

13:18

300 plus or to unlicensed homes that are AgeCope members. So we do pass this message to our members that no visitors. Now, on top of that, there was one of our member who contract - infected by COVID-19 and we found out subsequently is due to the staff who were in and out of the residence. Now, majority of the centres locked down the staff within the centre during the MCU. But not all centres can afford to do that because many of these staff have families of their own, they have children of their own. When the children go - don't go to school, someone has to take care of them at home. So they need to go back home. So when they go back home, in and out, in and out daily, the chances of being infected outside and bringing it in is high. Okay. Secondly, there were cases whereby the infection was brought in by new residents, whereby now we made it mandatory, all new residents coming in must have COVID-19 test conducted first.

PC Gan

14:24

So like, back to this pandemic also. So, um, do you see a high number of seniors into this nursing home or do you see them prefer to recuperate or recover at home or at medical centres?

Delren

14:39

The initial part of the MCO, intake drop because some homes were afraid to bring in -allow new intakes. The initial guidelines by JKM was to discourage new intakes. And since we do not allow visitors, so some cannot even see what the environment of the home was, so they do not want to send their parents and since more people were working at home. There was not a necessity to send their parents to a care centre to take care when they can take care of them at home themselves. So, there was a reduction. But as time goes on, people start working, they start going to work when schools start opening and closing and that kind of stuff. Yes, there was a slight increase again, of people coming to the centres, especially those who have stroke. Those who have other illnesses. So there is a sudden rise again.

PC Gan

15:39

Then maybe the next question that I have is the drop, do you think is also because recent unemployment so people cannot afford even a nursing home right now?

Delren

15:50

True, true. That was one of the reasons also. But initially that wasn't the actual reason. The actual reason was no visitors, I'm working at home I can take care myself. Because the unemployment thing all started almost the year end, ending of year 2020. Most of the employment companies closing down, hotels closing down for good, were all in the later part of 2020 not the initial part - the later part yes, may have forced some to - to forgo sending to nursing home, but the, it won't effect if they are sending to the charitable homes. Charitable homes are wouldn't be affected. I mean, it won't cost me much or will make much of a difference because I'm not paying for the charitable home. I'm just sending them there to be taken care of because I can't afford.

PC Gan

16:42

Okay. Okay, Devin maybe the last question is more on the vaccinations. So, I would like to get your thoughts on that priority right - so first one is the frontliners and then the next one, the seniors. So what are your thoughts?

Delren

17:00

We are asking the government to treat care centres as frontliners as under the first phase. Because during the initial MCO, there was confusion whether care centres, nationwide were considered essential workers. Later it was clarified by the Welfare Ministry that care centres are part of the essential worker because they are caring for residents. On that basis, you should put us on the phase one frontliners to be vaccinated. But if you can't put us under phase one, then you want to put us under senior citizens phase two. Then put us under the priority phase two, because you have 30,000 residents on the spot there, who require vaccination because they are being taken care in group community. So it's higher risk than those individuals staying at home, elderly staying at home. So, we are asking to be placed under phase two and KKM has agreed to put us under phase two. But the response from our care centres, has not been as good, especially for unlicensed homes. The reason why a lot of these unlicensed home are afraid to come forward is because they're afraid that by coming forward, they reveal their information to the Health Ministry. Subsequently, someone may come and ask them to close down.

Delren

18:25

Yes.

Delren

18:26

Subsequently, someone may ask - tell them you're unlicenced, you're running illegally. So, they're afraid to come forward. Now, I have assurance from Dr. Nora Liza from KKM the family unit department, assuring us that they won't take action. Yet, there is still that fear.

PC Gan

18:45

Yeah, of course. Because there is no guarantee and I think most of the time, if it's just, you know, a verbal agreement, it's quite hard to -

Delren

18:55

Yeah, and it has happened. One case was in April. Initially the government did a very good job by testing all the residents in all the old folks home, in the country for COVID-19. Free test conducted. But when they came - they came with the police, they came with the Welfare Department they came with everyone. They went to all the homes and some of the counsellors threaten that after all this COVID thing is over we will come for you. So when you say that you are scaring people away. That's one. Second case was by whereby in KL, Klang Valley, 16 February, the care centre submitted the list to be vaccinated. 18 February they received a warning letter saying that you are pusat yang tidak berdaftar. But the submission was to Health Ministry, but the letter came from Welfare Ministry. On 21st February, Welfare Ministry stated again another letter saying that we were informed by Health Ministry that you are unlicenced we would like to meet up with you to further have discussion on how to get your licence. So, based on that second letter we are aware that the Health Ministry staff was the one who informed the Welfare Ministry initially those two were separate issue. But that issue has been resolved, AgeCope went in to help the centre because he's our member, actually the lady was in the process of registering everything but, you know, when it comes to red tape, there's a delay and you go and report so you create a fear again. So now if you report once, are you gonna report again.

PC Gan

20:35

Wow, so it's actually quite tough when the different departments are just not talking to one another and then for the operators themselves, it's - there's just so many red tapes. Anyway, okay, maybe one final one is that maybe for the operators out there or people who want to open a care centre near their place, is there a way that they can contact you?

Delren

21:01

Yeah, can. They can contact us through our email myagecope@gmail.com

PC Gan

21:09

Okay.

Delren

21:10

And see what's the problem of licencing or what the steps they want to get to do or should they perform to get their licences.

PC Gan

21:17

Okay, sure. Okay, thank you so much Delren for your time. I think that is all that we have for today so it's good to know that we have quite an association out there that's just looking out for operators.

Delren

21:30

Yes, thank you.

PC Gan

21:31

Okay, thank you.

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