THE UNKNOWN CARERS

Among the heated liars, cheats and deceits of Malaysia’s politic, there are stories to tell us what we do is more important than what the politicians are doing.

Here are two stories of two residents who will be checking out of our assisted living centre and go home. No they are not dead, no, they just got well from the tender loving care of my lovely team.

The first story is about Uncle Lim who came in 3 months ago paralysed on the right side after suffering a stroke. His condition was so serious that his loving family members, his wife and daughter called for immediate check in. We gave him a single room near our kitchen and the wife and daughter came everyday just to be with him.

A Chinese acupuncturist was arranged for him and our physio comes daily to work on his physical strength. On top of that our team of nurses and carers continue with the activities and simple physio. Within 2 month his right leg was showing signs of improvement and on 26 January 2020 I challenged him that he can go home within 3 months. He said not 3 months and wanted to go home in 1 month I said ok but you must listen to what we tell you to do. He did and exactly one month later, on 1 March 2020 he will walk out of our centre, albeit with some help, but he is going home.

The second story is about Aunty Leong, on the first day of Chinese New Year her son called me and told me they needed help urgently. He said PPUM forced them to check out because they fear the Covid 19 virus or infection may be caught after the surgery and they were discharged on the eve of Chinese New Year, 24 January 2020.

The son called me urgently at 11 am. And after my Chinese New Year lunch I went to the centre and met them at 4pm. The son, daughter and grandson and another lady were there. They told me the mother has heart condition, breathing problem and need oxygen concentrator and cannot walk because she was very weak. She weights about 70 kg and 85 years of age. She was dead weight and she won’t sleep on the first night back and the family just do not know what to do. They can’t bathe her as she was deadweight.

Got a box of Penang Tau Sah Peah as thank you gift
from Aunty Leong's family

I told them not to worry and told them to check in immediately the same evening because I saw the family members were all over sixty and look weak. I said you better check in before the rest of you needs to check in too if you try to care for the mother for another night. In fact, the whole family was worried that we will reject their mother.

I told them, it is for people who need us that we exist. The daughter asked me, which they think is the most important question, “how do we pay you and how much?”

Our reply is simple, let’s take care of the most important thing first. Bring your mother in so that she can be cared for first, then you all can rest. As for the money, we talk about it later. Yes I did tell her the amount. Their concern was not the fee, they thought like private hospitals they must pay a deposit first. On normal circumstances that is our procedure, but because it was Chinese New Year and we were very busy, we waived the protocol.

Here is the beautiful news. The mother came in with breathing problem, cannot walk and many other ailments. On 29 February 2020 she is walking out of our centre. She do not need for oxygen concentrator for the pass week and wow her recovery was remarkable.

Here I want to thank my dedicated team of nurses and care givers in both my centres who gave all their hearts, all their strength and all their love to help these two uncle and aunty in their miraculous recovery. Their faces and names will not be mentioned but they will forever be in the memories of those whose lives they touched and cared for. I must thank God for His providence and guidance during such situations and gave us he strength to care and to love.

Please share these beautiful stories with others in a world where some are selfishly serving themselves. There is hope and love out there.

Writing these stories brought some humanity back in me, and a tear or two in my eyes.

AUNTY LEE CHA BOH

I have shared stories of trials and challenges of being in the elderly care industry. But I must say it is not always doom and gloom. Sometimes it is not even difficult to care for the elderly. There are more success and good stories to tell then sad stories of lousy children and ungrateful elderly people. There are more good children than bad children grateful elderlies than ungrateful ones.

Here is a happy story that I like to share with you that I came across over the last 3 years. By the way, I am not using the real names for privacy purposes.

Aunty Lee check-in after a double knee ops. She was in pain and wanted to go home. She can walk but the knees were in pain every time she tried and her 85 kg does not help. She was angry with her daughters and she blamed them for being useless for not able to care for her at home. Her daughter was only a mere 55 kg and a small frame lady.

Aunty Lee refused to eat, walk or exercise and it took 3 strong men to move her from bed to chairs. She complained and cry everyday, she has a wonderful son in law who took care of everything, as he was the son in law he was spared the agony of curses, scolding and word badgering unlike what his wife was getting.

After 2 months of moaning and crying and complaining of wanting to go home, I talked to her one day and said these words, “if you want to go home, you listen to me and what my team says, if you do, within 3 months you can go home. You want to go home right?” and she nodded.

So, I told her my plan. I said, “Step one, we will help you to lose 10 kg, simultaneously we will build your leg and arms muscles. Next you must go out for exercise with the community every morning. Everyday you must walk 20 steps twice a day.”

Building little well being goals is important.

I said that in early December. By early February she lost 10 KG, she was able to walk. By Chinese New Year she could actually go home. And then she dropped the bombshell. She said, “No, I don’t want to go home for Chinese New Year, I have my celebration with my family at the centre.” and she got someone to cook for her family and celebrated CNY in our centre, in Klang.

Today she is 65KG, mobile, she is happy and her family members are very happy with the team the people caring her in the centre.

This is just one of the many stories that I will share with you as an encouragement. It is moment like this that reminds me as carer that there is value in what I do, there is healing for both hearts and body, there is mending of relationships.

If you like this story then share to encourage others to care for others, it is worth it.

FINDING THE BEST CAREGIVER FOR AGED CARE

I get these questions.

“How do you find passionate people for this job?” or “ How do you make sure that the person has a passion for old people?”
“Why can’t you hire locals to do the job?”
“Why can’t you get Chinese nurses?”

I have candid answers to all these questions and also a question of my own. (haha)

HOW DO I KNOW THE PEOPLE IS PASSIONATE?

Easy, in assisted living centres it is a 24/7 job with shifts thrown in. The jobs involved cleaning the body, washing backside, cleaning feces, cleaning wounds, feeding, carrying a deadweight elderly, turning a deadweight elderly, cleaning the centres, washing dirty linens, listening to complaints, hearing the elderly moan I pain. These are not the top of the list jobs for anyone, let alone passionate about. No one can lie that they like these jobs. The jobs itself eliminates any pretenses.

I know many people who are members of religious organisations, NGOs, companies and festive well-wishers took loads of pictures visiting places like elderly centres once a year. They will appear singing, playing games and then post in their social media that the people are sad lonely and children don’t care for them and what not. That is not passion, that is self-gratification. For some doing good means feeling good, for some means buying credits to go to heaven or better after life, for some it is CSR to show how loving the companies or organizations are.

Passion is when someone is prepared to work, live, laugh, cry and mourn with and for the elderly 24/7, day in day out for a reasonably good salary. These same people could have gotten something better elsewhere. I have known and worked with many nurses who could have gone to Singapore and earn the big bucks, but they didn’t. I have caregivers who could have worked in supermarket or somewhere else for the same money, but they didn’t.

Once, a lady came to me looking for a job, she told me a beautiful story of how she loved old people. So I said ok, you start today and now. Within 2 hours she came to me saying she cannot take it and elderly care is not for her.  Many mistaken the joy of the moment during a festive visit giving angpau and oranges and singing as passion, it is not.

WHY DON’T HIRE LOCALS INSTEAD OF FOREIGNERS?

Same reason as why 80% of people working in Chinese restaurants are not Chinese. It is hard work and in elderly care it is shift work. Only really passionate people or desperate people who need jobs will do it. Like foreigners who came searching for better living. The locals who can do this job are foreigners in other countries earning their money for a better living in Malaysia.

I worked in UK over 30 years ago both legally and illegally once and I know what it was like to earn the British Pound. At that time in Malaysia my salary working in bank was RM500. After completing my study in UK I worked albeit illegally for sometime and earned 800 pounds in a Chinese restaurant at RM5 to a British Pound. So you do the maths.

Same goes with local caregivers and nurses they also need to earn the big bucks.

The locals are not actually afraid of hard work, they do all the difficult, dangerous and dirty jobs too, it is all about economics.

GOT ANY CHINESE SPEAKING STAFF?

OK most centres’ clients are Chinese and they like to say, “Oh, my mom only understand Chinese, Hokkien, Cantonese or Malay, I am worried she has no one to talk to, do you have Chinese speaking staff?”

The answer is yes, can you afford it? Like I mentioned above most locals, especially Chinese  also want the big bucks for a better living for their family.  In the elderly industry if one can speak Chinese or they are Chinese, they will be either ,the owner of the centre, or working in a bigger establishment like hospitals or pharmaceutical companies or working in Dubai, Singapore and Australia.

So my solution to all, make sure you learn foreign language before you check into an elderly centre.

MY QUESTION TO YOU

This if especially for the Malaysian parents, “Would you let your children work as a care giver for elderly?”

No need to answer, in fact don’t bother to answer. We all knew the answers.

The usual retorts I get are, “This job so difficult I cannot let my children do it?” or “My children are degree holders in finance, law, IT and what not, they are over qualified to do this job.”

Now what the first retort means is that the elderly are too difficult to handle so it is not suitable for your children. Which means, that one day when you are old, you will be too difficult to handle for other people too. Ironic.

The second retort says that there is a class system at work here via education and through education levels ones station in life are determined. This means that when one is old they do not deserve the best of the best, and then moan about the quality of people in aged care. I can sense people squirming to my statement here, but that’s the truth.

Now your question to me is, “You talk so much, what about your children, are they in aged care?”

The answer is, “YES, my son is under training to be a caregiver, my daughter is working with me” now how about you?

RETIREMENT VILLAGE- BUZZWORD, BALONIES OR IS IT FOR REAL?

RETIREMENT VILLAGE- BUZZWORD, BALONIES OR IS IT FOR REAL?
I have my reservations about all this current Malaysian’s developers current buzzwords, retirement village, retirement condo and senior living community. I suspect, to put it mildly, is used to sell their properties in this current slowing and rather sluggish property market, especially high-rise developments.
They promised services like medical, convenience, activities, emergency assistance, making new friends with like-minded people and community living just to name a few. The place to retire.
But hey, aren’t all housing estates a retirement village then, it has all the above. Let’s debunk the buzzwords and look at what the 3 basic components of a home for retirement.
Medical services and convenience. Medical services is the first important convenience needed by all in an aged community. Hospitals, clinics, pharmacies and Chinese medicinal shop. Some developments promised such convenience in their development, a few may keep their promised but most development will fail.
Housing estates are developed along an existing medical care infrastructure like, being near to government hospitals, government clinics and later on the emergence of private hospitals and pharmacies in the estate as the housing estates mature. In the retirement village the process is reversed or generally brought forward by promises of the developer. The existence of medical services are promised as a package of sale, which, is what it is a promise.
For any medical facilities to exist, it needs a matured market, example, Desa Park city did not start with a medical centre but 15 years on, Desa Park and its surrounding area matured and attracted private players in the community. For private medical services, sustainability is important. And new developments just do not have enough business to sustain it.
Therefore, the developers promise will fail and if they insist they will include in the package, will cost them heavily to sustain a promise, which like some projects, will be abandoned.
The second need is the convenience of amenities like wet market, shops, coffee shops, restaurants and 24 hours convenient store. People need to get these at their convenient.  Again, for them to exist in an area it has to be able to sustain. They need the density of population numbers to support its existence.  A friend was telling me that he wanted to have a in house coffee shop with many stores in his development with 600 plus units of retirement home. I tole him the coffee shop must be opened to the public for it to survive. He then told me that this will lose its exclusivity and privacy. I replied that each store will need to sell at least 100 bowls of noodle or what not at RM7 a bowl for it to be survive. Food and labour costs will kill them.
So it is not viable.
Finally, transport, public transport, easy access, parking spaces are all part of these eco system. When we aged, our mobility may depend on public transports, although currently we have a few more options than before, it still needs to be better.
So, my conclusion about retirement village, it is just another buzzword and quite a bit of balonies. One don’t need to a retirement home because all homes are retirement homes. It is built in a community, you have friends and we call them neighbours. As for activities, if one is not already into any activities and it is not their habit to do so, going into a retirement home will not help.
It will not be sustainable for developers to have activities all the time. It will be a big cost to keep those providing the activities on a full-time basis and on part-time or freelance basis all the yoga teachers, fitness gurus are already working with some celebrity gym.
In short, most developers will not be able to keep their promises, and all the retirement village is just another condo with a promise.
So, is there any hope of making a retirement village? The answer is yes, but not the way it is done now.

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.