KING DAVID'S AGEING ISSUES

As I was reading and reflecting on the issues of ageing today, I decided to take a look at some historical figures in the scripture and decided to share a short review of King David’s life.

The paragraph of the book of 1^st king vividly highlights that King David, God’s chosen man, was not spared of issues related to ageing. In the paragraph it says,

1 When King David was very old, he could not keep warm even when they put covers over him. ² So his attendants said to him, “Let us look for a young virgin to serve the king and take care of him. She can lie beside him so that our lord the king may keep warm.”

Immediately we can see that the great King David, God’s chosen king was not spared from the trials, tribulations and realities of ageing.

His great wealth and castle cannot prevent him from feeling cold. All the amenities in the castle and all the blankets cannot keep him warm. Physically, it is true that older people find it hard to keep their temperature at 37 degrees Celsius. He was subjected to the deterioration of his once mighty warrior physique.  

Although he had queens, concubines and children, none of them were there for him. One of his sons was busy trying to take over the throne by planning his own ascension together with David’s general. Prophet Nathan was busy making sure Solomon becomes the king, reminding Bathsheba about David’s promise to make Solomon king.

Everyone was busy with their own agendas and plans, so why worry about an old, weak king. Why should they worry about King David’s need for heat and warmth?

The concubines and queens will be too old to care for David and probably they are either busy shopping, having dementia or dead.

So, who has the most reasons to keep the King alive? Of course, the attendants, their livelihood depended on the welfare of the king and his family’s welfare.

David’s problem was real then as it is real now. children busy with their career, building their own wealth, family and ‘kingdom’. Nothing wrong with that because that’s what most parents hope to see their children grow to be. Giving the best education, telling them to earn foreign currencies, no need to worry about their father and mother.

This led to an industry managed by outsiders, other people and professionals. I shall not delve into this, but I must point out that what happened to King David can happen to you and I too. And most likely will. What will you do to face that day?  

MONTI IN HONG KONG CANTONESE SHOW PT 2

LET’S GO BEYOND EMPTY WORDS OF DEBATE IN AGEDCARE

In Malaysia, there is this newfound debatable topic in ageing, the key words that flowed through the debaters’ lips are professionalism, knowledge, training and guidelines.

In all these debates, many people argued from a very self-contextual point of view and not one with a wholistic view of the benefits, business or trials and tribulations of operating agedcare centres.

Doctors and nurses kept pointing out that caregivers without a medical qualification must not administer treatment nor conduct any procedures for the elderly. I agreed, to a certain extend but medical is only a part of the entire ecosystem of ageing. It is an important part but not the only ingredient.

A friend once quipped that homes with trained nurses and doctors are better. So, I candidly asked him in what ways are they better. He replied that they can deal with diseases and emergencies. Of course, I agree that having doctors and nurses is a plus, but it is not the only thing. In my 20 years of involvement in elderly care, I can tell you that there are only a few types of emergencies and diseases that we need to deal with, and I can also say that eventually, no doctors and nurses can prevent the ultimate result, death.

You see, nurses and doctors are trained to keep patients alive and heal them and statistics had shown that over 90% of hospital patients do go home alive. But the opposite is true to elderly centres, where over 90 percent will not see their own home again, alive.

The most often question I get was, “what if the residents die?” My question to them will be, “You mean they will not die if there is a doctor around?” My other question I like to ask my friends and inquirers, “Then can you explain why people died in hospitals, in the hands of doctors and nurses?” I just like to do that to see the changes in the faces of the inquirers.

I have personally watched residents catching their last breath, closed their eyes and carried their remains to the holding room or place. Over my 20 years I can definitely say that most never leave my place alive, I know it sounds like a bad line from a horror movie, but that is the truth.

I just like to point out that there are at least two differences in perspective in managing patients in hospital and managing residents in an elderly care centre.

The first is that hospitals deals more in healing and saving lives while elderly centres we deal with certain death, pain, emotional and mental deterioration.

Hospital see the patients for a few days and some a few months, while elderly centres live with the residents from a few months to as much as 15 years.

We are in the business of managing death. Our job is like a pilot. We keep the plane in the air as smoothly, as comfortably and as long as we can. But like all planes, it will eventually land, our job is not to stop the landing but to land it smoothly with as little bumps as we can.

Therefore, when I sit in conferences, meetings and discussions, hearing words without meaning like professionalism, training, knowledge and guidelines gave an empty resounding cacophony without accepting the fact that in agedcare, it is about dealing with death.

Recently at a Rancangan Malaysia Kedua Belas meeting or twelfth Malaysian plan, it was revealed that there are over 1627 elderly care centres in Malaysia, but according to the Welfare website there are only 382 registered centre in the list and I know for a fact that about another 100 in the process of application. So, what happened to the 1100 that are not registered with the Welfare department, are they illegal?

There are many reasons why they are not registered, in fact, there are too many to be listed in this blog here. But, let me share with you just one reason why they are not registered as several of them are good homes and I knew a few of them. They do not wish to be part of the system and be judged by professionals with their own set of knowledge, context and guidelines. They just want to serve quietly, providing the level of care needed for the price affordable to their selected target market.

Professionals from both private and public sectors are generally quick to judge but offer no solutions. If ever there are solutions, it is to close the centres down. Effectively denying the needy, both residents and family members of the only affordable solution in a location and community that serve their needs.

If ever all the 1100 centres are closed, there will be over 20,000 elderly residents displaced without any solutions in sight.

In my battle to make this industry better, I can only do one thing at a time, make sure I give my best and be professional, design systems and operations to make sure what I do is the best. I tried not to judge other centres, if ever I have to, I will help them to be better. I urge readers of this message to start giving your best and help out with centres without judging them but with love and understanding that all centres do their best in the only way they can, with the knowledge they have and against unfriendly guidelines that focus on correctness of rules and self-justifications by little napoleons in the each location.

If it is within my capability, I would like to propose to the Ministry to offer a general conditional amnesty to all centres, so that they can operate above board. I would like to see that to happen so that we can take a step by step help to make the ageing industry much better.

Let us not stop at empty meaningless superlative words, but take action in your location and in your community.

NO BEDS AT ACCIDENT & EMERGENCY AT PPUM

Let me start by saying that PPUM ((Pusat Perubatan Universiti Malaya) did not do anything wrong, their A & E was packed.

On Tuesday at 11.30 pm I received a call from my nurse that one resident was having difficulty breathing.

The vitals showed her SPO was low. My nurse had administered oxygen for her but the resident still have difficulty breathing. After discussion with my nurses we decided to admit her. Following our procedure we called a private ambulance , which usually is faster than calling 999 because they don’t ask too many questions and transfer the call.

Ambulance came at 12.30am and two of my nurses who had already packed all the essential items and documents for admission went on the ambulance to accompany the resident to hospital. On arrival at PPUM 5 minutes later, the person in charge at PPUM A & E (Accident and Emergency) told my nurses that there was no bed available.

We immediately diverted her to Assunta Hospital, a private hospital, A & E. At Assunta, the medical team stabilized her condition and did some diagnostic tests. My nurse informed me that everything was fine.  But I told her to call me back later, because I knew it is not over yet.  Remember I said Assunta is a private hospital? Well this was where I expected problems to arise.

A little bit more about the resident, she was single and the person caring for her financially is her 70-year-old sister who lives in Kuching. Her niece was fast asleep and her phone was off.

At 1.45 am, my nurse called the sister in Kuching and the Kuching sister called me in return.  The problem was Assunta told my nurse that the resident must be admitted in high care unit. But first we must pay a deposit of RM5,000. Now I must point out Assunta did nothing wrong here because this is the procedure at a private hospital.

So, her Kuching sister panicked and called me to help, now I live in Klang and I don’t like the idea of driving to Assunta to sort things out. So, what shall we do? How shall we solve this problem? Shall we transfer the resident to General Hospital KL? But it was too far. Here is the good news. I had the experience of managing a 24-hospital admission call centre for 12 years besides managing nursing homes and 10 clinics. 

I asked the nurse to let me talk to the admission unit and I asked the person one question, “Can we do online transfer to Assunta?”  He said ,”yes.”  Great . The next question is , “If we transfer the money to you will definitely admit her?”  He replied, “Yes.”

So that was done. The resident was admitted and I told the sister in Kuching, “not to worry, we have sorted the issue and now she is now admitted.” A side noe here, the sister in Kuching did not know that we can do online instant transfer, she relied on her accounts staff.

Government hospitals running out of beds is a possibility. After all, most people try to get the best care at the lowest possible cost or no cost at all. Private hospitals need deposit that’s a reality.

My key message is that we need to prepare in terms of finance and the people who can manage odd situations. It was a good thing that this resident is staying at our place with me and team who can deal with this situation or else it will be a long Tuesday night.

THE SKY GETS DARK , SLOWLY

This piece is not from me but something I received from a friend, which I found so profoundly accurate that i must share it.

It is Mao Dun literary prize winner Zhou Daxin’s latest novel to be published, “The Sky Gets Dark, Slowly”, is a sensitive exploration of old age and the complex, hidden emotional worlds of the elderly in a  rapidly ageing population.

In it he writes, “…Many elderly speak as though they know everything, but of old age they are in fact as ignorant as children. Many elderly are in fact, completely unprepared for what they are to face when it comes to getting old and the road that lays ahead of them.

In the time between a person turning 60 years old, as they begin to age, right until all the lights go out and the sky gets dark, there are some situations to keep in mind, so that you will be prepared for what is to come, and you will not panic.

1. The people by your side will only continue to grow smaller in number. People in your parents’ and grandparents’ generation have largely all left, whilst many your peers will increasingly find it harder to look after themselves, and the younger generations will all be busy with their own lives. Even your wife or husband may depart earlier than you, or than you would expect, and what might then come are days of emptiness. You will have to learn how to live alone, and to enjoy and embrace solitude.

2. Society will care less and less for you. No matter how glorious your previous career was or how famous you were, ageing will always transform you into a regular old man and old lady. The spotlight no longer shines on you, and you have to learn to contend with standing quietly in one corner, to admire and appreciate the hubbub and views that come after you, and you must overcome the urge to be envious or grumble.

3. The road ahead will be rocky and full of precarity. Fractures, cardio-vascular blockages, brain atrophy, cancer… these are all possible guests that could pay you a visit any time, and you would not be able to turn them away. You will have to live with illness and ailments, to view them as friends, even; do not fantasise about stable, quiet days without any trouble in your body. Maintaining a positive mentality and get appropriate, adequate exercise is your duty, and you have to encourage yourself to keep at it consistently.

4. Prepare for bed-bound life, a return to the infant state. Our mothers brought us into this world on a bed, and after a journey of twists and turns and a life of struggle, we return to our starting point – the bed – and to the state of having to be looked after by others. The only difference being, where we once had our mothers to care for us, when we prepare to leave, we may not have our kin to look after us. Even if we have kin, their care may never come close to that of your mother’s; you will, more likely than not, be cared for by nursing staff who bear zero relation to you, wearing smiles on their faces all whilst carrying weariness and boredom in their hearts. Lay still and don’t be difficult; remember to be grateful.

5. There will be many swindlers and scammers along the way. Many of them know that the elderly have lots of savings, and will endlessly be thinking of ways to cheat them of their money: through scam phone calls, text messages, mail, food and product samples, get-rich-quick schemes, products for longevity or enlightenment… basically, all they want is to get all the money. Beware, and be careful, hold your money close to you. A fool and his money are soon parted, so spend your pennies wisely. 

Before the sky gets dark, the last stretches of life’s journey will gradually get dimmer and dimmer; naturally, it will be harder to see the path ahead that you are treading towards, and it will be harder to keep going forward. As such, upon turning 60, it would do us all well to see life for what it is, to cherish what we have, to enjoy life whilst we can, and to not take on society’s troubles or your children’s and grandchildren’s affairs on for yourself. Stay humble, don’t act superior on account of your own age and talk down to others – this will hurt yourself as much as it will hurt others. As we get older, all the better should we be able to understand what respect is and what it counts for. In these later days of your lives, you have to understand what it means, to let go of your attachments, to mentally prepare yourself. The way of nature is the way of life; go with its flow, and live with equanimity.

KNOW THE RULES OF THE GAME - WHEN STARTING ELDERLY CARE CENTRE

Jose Maurinho, a famous football manager for teams like Porto, Chelsea and Manchester United. Jose knows the rules of football and it is simple. Rule number one, make sure no one can score against you, so he packed his defense, in fact football commentators call it ‘parking the buses’ by packing his side of the field with defenders to stop opposing strikers. His rule number two is to score more goals than your opponent, even one more is sufficient. Some people say that Jose’s tactics are boring, had it not been for the talented players in the team. But it works.

Just like the game of football, there many rules in the business of elderly care. The care business is an easy business,  it is all about love but the rules can be tough. If there are no rules, one can just take any building, get the right staff and market your services and you can start your business and on your way to be a millionaire or making a good living or just helping a lot of needy elderly people. But it is not like that and there are rules.

So then, rules are bad, right?

Rules, law and procedures are not bad. It is there for many reasons. One of the reason is safety. What would happen if there are no rules stating the specific requirement of fire escape, there will be nothing to comply to. And what would happen when fire breaks out?

Another is civil co-habitation within a location and area. How would we like it if our neighbours’ house is now a night club? Or a columbarium for placing the urns for the dead.

But with accompanying rules, we have this web of intricacies and maze that we ned to negotiate to get out, and hopefully see the light.

 One of the most common reply when making enquiries at government offices and counters on how to get things done is, “ OK, you take this form and this list of things, follow it and it is done.” Simple, right? No, it is just the beginning and if we get it wrong it is the beginning of a nightmare. There will be trips after trips of going in and out government and council offices and counters, from one building to another, searching for parking after parking..

The Law of Exact Criterion

I call the process the Law of Exact Criterion because that is exactly what it is. There are two parts to the Law of Exact Criterion. First applicants must meet the exact items on the guide list, failing which the application will be rejected, and resubmission is needed. Knowing the items on the guide list is only the beginning after that in part two it is our job to find out exactly what are the rest of the procedures.

I learned this skill when I worked with a market research firm right after my ‘O’ level or Sijil Pelajaran Malaysia as it is locally known. For three years I went house to house and shop to shop asking questions on products, services and what people think about issues or ideas. My supervisor Mr Ho told me that never take the first answer as definitive, keep probing, keep asking. Mr.Ho will remind us every meeting and briefing that no one is who you think they are. What people says may not be what they are really saying. I applied it here in my workings with authorities.

After the famous ‘take this guide list and follow it’ there will be subtext, context and ‘humanum elementum’ which means human factor or element. I chose Latin for this expression it sounds clever and to prove a point. The point is that some of the things may mean something simple but presented in a complicated form, humanum elementum.

Let us dive in a little deeper, what is subtext, context and humanum elementum.

Subtext

Subtext is what is not said but is running around in the government and council offices, something the knew that you do not know but should know. Things like the SOP, procedure or format that the authorities wanted them in.  you will get, “Oh this you can download from our website, very easy.” Trouble begins with ‘very easy’.

 And often clarification is needed, so knowing how to ask questions can safe time and simplify process. Asking specific questions like, “Can you show me a sample of what a completed forms or submission looks like?” helps.

When I wanted to apply for Accreditation for  training centres or ‘Pusat Bertauliah’ I called up the office and they told me the same thing, just go to the website. Now this is not a government bashing time, it is just explaining the rules of the game when working with authorities. So, I went into the website, and true enough there were many information and details with all types of forms. Once I printed out all the forms and procedures, it was only one centimeter thick. But, there were some information I needed clarification, so I went to the office and ask the officer the specific question, “Can you show me a sample of what a completed application looks like and he showed me a seven centimeters thick file and said, “This is how it should look like.” I asked one more question, “Sir, is this a normal application?” he replied, “Yes. But sometimes it is twice as thick”

Context

Context is the what you are applying for, where is it going to be located and what business license you are applying for. I shall go deeper into it in a moment.

Humanum Elementum

Have you ever come across a conversation where both you and your friend disagree over the meaning of a word and even when a dictionary is available and the definition is found and both of you still disagree? I have.

One of the word was ‘sexy’, this word alone has been used not exclusively to describe a disposition of the opposite gender, male and female, it is used to describe businesses, food and cars. “Well this business seems sexy.” “This red sport car is so sexy.” We found the meaning in Webster saying that sexy could mean either ‘Suggestive’ on one end or ‘Appealing’ at the other.

Just like the example above, rules, regulations and laws in the hands of human may have slight variation in interpretation. I once submitted a completed set to a Kuala Lumpur council, the officer at the counter says it is complete and will be submitted for review by the board members. A few weeks later I received a call saying that there are missing documents and we must resubmit the missing documents. Human elements play an important part in license applications.

What one officer from one department says may differ from another officer from another department.

Who are the players?

Let us now get to know the players or rather authorities who will be involved in the homes and centres licensing processes.

First we need to decide the type of entity that the home or centre is going to be. It could be a business under private limited or sole proprietorship or association or non-governmental charity organization, therefore, you need to register the entity who will be running and managing the homes and centres. All these three entities play under different rules.

The next player is Jabatan Kebajikan Malaysia or welfare department as it is generally known here. Make absolutely sure you know which district welfare department your proposed centre or home is placed under. Make a copy of the entity registration forms and bring all of them. You do not want to travel to the department a few times, where they are usually located in an off-beat place with limited parking lots. This, generally applies to most government departments.

The welfare department will issue you three letters, one each for the fire department, health department and the town or city council.  

The third player is the fire department. On receiving the welfare department’s letter, they will come and inspect your place.

The fourth player is the health department. They will inspect the food processing and cleanliness of the home or centre.

Finally, the fifth and most important player is the local council. They will give the final approval for the home or centre existence.

Each of them has their own rules and the authorities mentioned above worked together within the compound of each of their own rules. I like to use the term ‘working in unity in diversity’. Just like football, where the stadiums have their own management rules, the football clubs have theirs and then enter the national football associations, continental associations and then the world association. These entities function within their own rules and live within a diversity with one common goal, football.

This seems troublesome and daunting, but all the authorities in this elderly care game set the rules to protect the consumer. Without rules, there will be chaos.

Despite all the authorities and their rules, we still hear complaints about the poor standard of elderly care homes and centres. Try taking the authorities out of the game and we will have mayhem.

In my years of dealing with authorities I have encountered some difficulties with the process. But I must point out that I have also met many helpful officers who had helped and guided me through the processes. I encourage you not to mix the rules and processes with the person. The officers working with the government departments and councils are there to assist us.

Many friends and acquaintances told me their difficulties and many of them equated complex rules, difficult and long processes as a sign that ‘something else’ is needed to get things done quick. I cannot comment on their perspective, but I can tell you that it is not like that in my experience

WHAT IS THE GOVERNMENT DOING ABOUT IT?

Whenever there is a problem about aging and elderly care, the first question is, “What is the government going to do about it?”

Whenever I am at a health and aging conference the favourite question is, “What is the government going to do about?”

My favourite question is, “Is aging only a government issue?”

The government knew that there will be over 5.5 million population over the age of 60 by 2030 and we do not have enough facilities, infra-structure, manpower and in this case mostly women power to deal with this aging wave. The government has only limited homes under both federal and states management.

The homes and centres by NGOs, associations and religious organisations and companies are also limited. The nucleus family is getting smaller. Most children of the elderly who are married and their spouses need to work to cover the cost of living and can hardly find anytime to look after their own parents.

Taking care of an elderly is no easy task, they are more than 10 times the weight of babies and far bigger than babies and harder to carry. The elderly feces are smellier than baby’s and some may have funny body odour. If they have other wounds, well that adds on to it too.

So, taking care of our own elderly parents is not easy. So, if you and I find it hard and the government also have too little resources what choices do you have? I have 3 unpleasant choices for you.

The first is one of the spouse to quit his or her job and then try to adjust to a lower income lifestyle. The second is to send the parents to care homes or centres which cost a lot and very often with suspected standard and finally, get a maid which is cheaper or get a professional home care giver, which is more expensive.

You can see that all 3 choices involve money or lowering of standard of living without having a guarantee that the parents are well taken care off or cause inconvenience to you. This is a lose-lose-lose situation. It is like between a rock and a hard place.

I know how it feels, my dad at time of writing is 87 years of age. He was cycling and playing mahjong until age 85. Then one day age caught up with him and he cannot ride his bicycle, he cannot paly is mahjong. My dad told me, “Son, I cannot play mahjong because I am too slow.” And now he is suffering from pain on right knee, so now he cannot walk and his leg muscles deteriorate like a melting snow in the spring. So he needs physiotherapy that cost a bomb if we do it everyday. So I need to discuss with my siblings on the cost. I need to work out with my wife and business partner when I can go to my hometown in Ipoh, to see my dad and help and where I can give my mom a moment of relieve from caring for my dad.

All these decisions I had to make is not based on logic, I like to think that it is based on logic but really it is based on love. If it is based on logic, I would send my dad to elderly care centres, its cheaper and my mom can take a break. I don’t have to make inconvenient choices to travel back to see my dad every week.  If it is based on logic, I will probably say, “Well he is going to die anyway, let’s give him less care and let him die faster.”

Logic, is simply just not enough for me to make any decision, it has to be love. I still remember the days when my dad will do all it takes to get what I needed. I remember I came back from school and told him dad, I need a whole coconut tree leave, and by 3 pm it was lying at the back of our home. There are many more stories like this and my dad is my hero.

Why can’t the government monitoring the standard of the homes and centres?

This is a real problem here, most homes and centres are not up to standards of most consumers but are they below the standards set by the government. The fact of the matter is most homes and centres and I use ‘most’ because it is a known fact that there are homes and centres operating without license or permit and some are still applying for it. There are many homes and centres, that I have visited and in my opinion, are well below the standard I have set in chapter two. As I am writing this book I am still researching this together with my mentor from the welfare department.

The question then is, why don’t the government act against such homes. The answer given at a conference a few years ago in 2016 was, “If we act against such homes and centres, where will the residents go to?” Again, it is like between the devil and the deep blue sea. How are we to implement a law that will affect hundreds if not thousands of lives? The authority has laws, acts and information, but to take action is also an act against humanity and compassion. No answer here. Total silence.

The fact is we cannot solve today’s problem using today’s solution.

No problem can be solved from the same level of consciousness that created it. – Albert Einstein

That is the reason this book is written, it is to encourage people, young and old, entrepreneur and corporations to help look at today’s problem at a new level of consciousness.

This book on riding and impacting the aging waves is not just a self-help book, it is an idea, a movement to get everyone to be part of a new consciousness to solve our own problems with a renewed mind, desire and commitment.

In the next few chapters I hope take you through the understanding of the function and key performance procedures and maybe, just maybe, you can see something that I missed.