ELDERLY CARE BIZ.

Today someone i knew came quietly with the intention to study and explore the possibility of opening an assisted living centre. I knew her purpose and i knew she came from a very renown private hospital. They have home care. And as usual because they have so many staff, money, resources and what not they are exploring.

But I can tell you that going into elderly care is a total different  animal, one must understand ageing, they must understand what business it is and why it is not a business for the faint hearted. It is harder than a hospital in some ways.

Point blank is that home care structure and business is different from that of daycare. and day care is very different from assisted living centre and independent living centre is different from assisted living centre.

There are people who wants to build a 3 stage retirement village from independent to , dependent to high dependent. This tells me that they don't understand ageing in Malaysia. They learned from overseas experience which if Australia is a bacon and eggs culture, if japan it is a sushi and sake culture but in Malaysia we are capati, wan ton mee, nasi lemak culture. We are different.

There is not short cut to cut and paste any model into your business. I don't like to call age care a business because then the elderlies are just consumers and we are selling a product. And people go into all these high fly marketing and branding which in operational reality means nuts.

I like to start debunking the difference of each of the above care needs.

Home Care - almost 100% of people do not like to age in a centre, and home is the preferred choice. I strongly suggest that people stay at home, because they deteriorate slower. Because their home has the smell, feel, touch and familiarity that reminds us of who we are and where we are.

But home care can be expensive and sometimes the family members saw that the home care does very little, only 20% to 30% of their time are actually caring for the elderly. Ad you have a stranger in your house.

Assisted Living Centre - This can be high care or just assistance for those with mental, medical and physical needs. it is generally more economical than home care, but it has its limitation. The place is not familiar and they elderly lose control and ownership and the sense of belonging.

Independent Living - is well really not necessary a retirement village which i am against, for now. it could be anywhere, you don't need to pay a bomb. It could be just your own current house.

Daycare is a different business all together, the client are usually mobile who just need company for the day, very much like a children's day care, full of activities for 8 hours or so.

Dementia care- this is a totally different from all the above, you need to have trained and competent staff to manage the elderly and the right systems and SOPs to deal with situations like ramming their head against the wall, climbing the fence and what not.

The differences in all the above care model are:
1.  Staff with right abilities
2.   Target clients differs.
3.    SOPs differs
4.    Operational models differs.
5.    Cost of investment and equipments differs.

Back to the opening story of a friend from a big corporation looking at investing into  elderly care my advise for her was, "Your organisation needs a major mind shift"  The reason being that big organisation are always out there to make the big bucks, their lingo is always let us corner the market. But elderly care is not something where we approach the usual corporate all guns blazing method. Elderly care is about the conditions of the hearts and not just the mind.

If this article has helped you in anyway, please share it.

THE LONGEST 18 DAYS

This is a story about the unfathomable mercy, abundance grace and the unmeasurable love of God for one man. It is also the story of what it is like to let God manage the work that He has ordained.

Mid August 2018, the relative of apotential resident, let’s call him Ed, whom would eventually check into De Home. The relative told us that it is for his uncle who had a tracheostomy and needed a place to care for him. We were told that it is easy, all we have to do was suction  every 2 or 3 hours, that Ed can walk and do things himself. The reason for the tracheostomy was to do a simple operation and to do biopsy on the lump and it was not confirmed if the lump was cancerous.  

So I visited Ed in GH Klang and discovered from the specialist that Ed needed high care, suction every hour or so and that he has severe back pain and cannot walk. The wound at the throat needs cleaning daily. I asked the Doctor the reason for the tracheostomy, and she confirmed that it was to remove a growth. I asked why the tube was not removed and the doctor replied that it was for potential further procedures and to prevent the lump to grow again and closed the throat.

Based on the doctor’s information I decided not to take Ed in, Ed needed real nursing care. At that point De Home has over 20 residents with 80%  immobile and needed assistance and high care. We were also short handed, with everyone stretched to the limit. This plus the fact that none of the carer was trained to perform suction and care except one nurse and we cannot depend on one person to care for Ed based on the doctor’s information. I needed a team. I told Pastor Alan that we seriously can’t take Ed in. Pastor Alan was supportive of the decision. At that point I did not know that Ed was from the church that founded De Home.

After turning down Ed, I was burdened by the text from Matthew 25:40 which says , “……….Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.” Please read the entire text from Matthew 25:34-40.

I started talking to the team from the top to the bottom to explain the mission of the De Home, to explain the conditions of Ed and to explain that we are to look beyond ourselves for we are here for ministry. Some agreed, some disagreed but all said they will support whatever decision I made with Pastor Alan. So it was set to bring Ed in.

Now, to manage Ed’s condition we need to separate him because it may traumatized the other residents, but all rooms were occupied by someone so making separation difficult, not until 1 September, A resident on short stay in a double room downstairs checked out and the room was immediately available , it was the best room because it is near populated area where we can meet Ed’s need at a moment notice. It was also enclosed. So Ed got the best room.

So Ed checked in on 5^th September, we were definitely not ready to receive someone like Ed. He called us every hour or so, he demanded special food, he has many whims and fancies and worse of all he smelled like dead rats. Training was given to all by the relative’s wife to perform suction to remove phlegm from Ed’s throat. At first only the nurse, me and a few others were  willing to do the suction. But slowly and surely all the other staff slowly chipped in and started to do the suction. Ed continues to demand all sort of exotic food like curry laksa, fried kueh teow, KFC and what not, so he got his friends to get it for him. Ed is actually an obnoxious person, he called some of us stupid, actually he meant idiots. He is unappreciative, not that we crave for it, but at least don’t call us idiots.

Here is the best part, Pastor Alan told me the Board has agreed to cover his entire cost, which means it was free for him. Now the staff did not know about the free part except for a few.

Care for Ed was 5 times harder than anyone of the high care residents. By the 12^th day Ed was there , none of us could take his stench of death, in fact we tried putting minyak angin or deodorant on our mask to enter his room. He attracted flies into his room and also most part of De Home.

I saw on the CCTV one day when Ed rang his bell, all the staff froze and waited and watched (including me) to see who will go to Ed to do the suction or clean him, by the way his stool was the darkest black I have ever seen. I said to God , “Help” and suddenly an Indian couple contacted me and appeared in front of De home and they were perfect for the job. The wife had taken care of someone like Ed before.  Here is the miracle among many miracles, we cannot house the couple who came with a baby. Miraculously, we found a room right opposite of De Home that belongs to a lady who is the sister of one of our resident. The couple moved in and started work the next day.

The entire team were relieved after 14 days, and Ed got the best care for four days right before his demised on the 23^rd of  September. We handled all the proceedings from the home to the parlour. Ed’s daughter later told me personally that she was thankful that her father was cared for not in just another home but departed from the best home, God’s home. She thanked the team and to the home for making the final funeral arrangement so effortless.

By the time of Ed’s departure, he had rang the bell over 300 times for service or suction in 18 days, an average 1 ring every 1.5 hour. The team was exhausted. We even had a resident complaining to us for neglecting her because she saw us rushing to Ed’s room all the time. I am not sure if other residents felt the same way. Ed’s room took over a week to remove the stench.

But here are the real outcomes, when the 4 children came to pay the bill, we told them that De Home’s bill was covered  and they were stunted. Finally, the children offered a donation as a gesture of thanksgiving.  But most important was that Ed’s final days and death brought reconciliation to the family for they saw the grace and mercy of the  home and church of God.

The De Home team were strengthened and I told Ed’s daughter that, her dad’s final moments taught us all many things. His presence in the De Home taught us what is love, mercy and the grace of God. The team in De Home also learned to trust God even more and knew that De Home is the Home of God and He will manage it through us all.

Matthew 25:40 which says , “……….Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.”

NOT ALL MOTHER IN LAWS' A WITCH- STORY OF RUTH

MIL and DIL’s relationships are popular backbones to many dramas and it is not usually portrayed in a positively light.

But here in the scripture we have a rather unusual situations where the DIL, Ruth, who refused to leave her MIL although her husband is dead and that her MIL has no financial way whatsoever to support her. The central words in 1:16-18 sums it up so dramatically and emotionally that we ask, “wah where to get a DIL like that?” Read the followings:

¹⁶ But Ruth replied, “Don’t urge me to leave you or to turn back from you. Where you go I will go, and where you stay I will stay. Your people will be my people and your God my God. ¹⁷ Where you die I will die, and there I will be buried. May the Lord deal with me, be it ever so severely, if even death separates you and me.” ¹⁸ When Naomi realized that Ruth was determined to go with her, she stopped urging her.

The story happened about 3000 plus years ago, at a time where women do not have much rights, what’s more if they are widows. It begins with a man took his wife and two kids from Israel to the land of Moab to escape famine. The man died and his two kids married two Moabites ladies Orpah and Ruth.

Then both the sons died leaving the old lady Naomi and her two DIL. Naomi wanted to return to Israel and she knew there is no future for her two widow DILs, so she told them to leave her and find another man. Orpah left but Ruth stayed and hence that beautiful passage above.

It is really amazing for an old widow, Naomi to ask her two DILs to leave her and find someone else. Perhaps she feels that it is better for one to suffer than for three to suffer.

Both women the MIL, Naomi and DIL, Ruth were amazing women of their time and also a model of our time.

One thing for sure we do not know who will take care of us when we aged and old, but one thing for sure even when we are old and troubled always think of others. Be nice to others, you just do not know…..for the young ladies maybe you will ask, “wah where to find a MIL like Naomi?”

In fact Naomi is so nice that she later found her DIL another husband.

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.