UNDERSTAND THE BUSINESS OF HOME CARE, INDEPENDENT LIVING CENTRES, ASSISTED LIVING CENTRES, DEMENTIA CARE AND DAYCARE.

Somtime in January 2020 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 models 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.

PATIENCE, PATIENCE, PATIENCE

I never thought that God will use my son and my mother to teach me patience.( I talk about my mother in the next posting)

Patience is not a commodity nor aptitude that I possess in any quantity. I was impatient, rash and reactive. The kind of attributes not required in elderly care. I believe God in his humor put me in a situation that I had to learn patience.

When my son was born in 1997, I learned one thing from his birth and growth, that is to be patient for he will grow.  Let me tell his story and my journey.

My son was born prematurely, and nothing prepared me to deal with his kind of birth and his growth from baby to adulthood. No books, no manuals, no nothing. Only experienced anecdotes from relatives, parents and anybody who had a baby before. Even friends who were not married came to give us advise saying, “I heard from this friend of mine who had a similar situation, and this is what they did.”

I got it from my gynecologist, well, my wife’s gynecologist that my son will be born on 15 May 1997, estimated of course. I got it all worked out by working backwards from May 15 until my wife developed PIH, pregnancy induced hypertension. I was thinking how can this be, her blood pressure was always low, but it did happen and her BP shot all the way up to 200 over 140, if it that’s the speed of my Proton Wira 1.3  I will be happy, but it is not. Dr Sheila, the gynecologist wrote a letter to University Hospital for immediate operation. I was s worried because this situation was not in my perfect plan of how my son should exit from my wife, it should be on the date stated of 15 May 1997. In fact, I was so worried that I do not know what to worry because I have no clue what to worry. Still he came and on 28 March 1997, my son was born.

 When he was a few months old, the babysitter could just leave him in front of the tv and he will not crawl. He just doesn’t crawl. He does not do anything a so call normal baby does, at least those I knew from friends. When he was two years old my wife and I noticed that he could sit in front of a tv forever. Once we gave him his favourite toy. He sat and played with it but when the toy fell from his hands and went out of his reach by a couple of inches, he just will not go and fetch it, that is unusual. In my heart I thought finish lah( A Malaysian expression). Something must be wrong with him, but I chose to stay calm and prayed for the best. Anyway, that is the most I can do besides any medical testing and he seems to be normal.

By preschool all the teachers’ complaint that he was too quiet and does not speak in school. When we asked him who was his best friend, he does not know any except the same boy who grew up with him with the baby sitter. By standard four his results were not something to shout about and I told my wife, we better get ready money to send him vocational school. My late father in law who loved this grandson of his very much, was a teacher also gave up teaching him. Then in standard five his results picked up and he even got 4 As for UPSR. Now he would not stop talking.

I know now that I just need to be patient and be there to watch. For my son will grow and I am sure yours will too. No magic formula just be patient. Now he is young man University, but that’s not the end, in 2019, just a year before he completes his degree, he called and told me,” Dad, I want to stop studying.” I do not need to tell you how I felt, but I was prepared for that day in 2019, because I knew my son well. I also knew that not all are meant to be top notch academics. I console myself saying even Lim Goh Tong the founder of Genting does not have a degree and Bill Gates did not graduate. I told him it is okay; you have to decide for yourself.

Most important for me is that my son returns home safe and sound, which I am thankful to God.

So how does this relate to caring for aged? Well, my son is now being trained as an administrator and caregiver in the centre which I started for Harvest Christian Assembly in Klang, called D’Home. The person whom I mentored to manage the place and the nurse whom I have recruited to help is now mentoring and teaching my son.

What did I learn from this? I learned that all things that we do today has value in the future. What ever entrusted to us to do and if we do well will comes back to us in a positive way. 

So, whatever that is not right today with your family, friends and things around, it is only part of larger picture and endgame shall be revealed in good time. Stay Patient.

MY SON TODAY

KEVIN, MY WONDERFUL CARING FRIEND

On 25 March 2020 I had a long chat with an ex colleague from Reliance. A wonderful caring guy who was ever so helpful. Let just call him Kevin.

It started with a whatsapp message, “You free to chat?” I said yeah. Actually, with the lock down I was pretty relax and chill. He told me that he has this idea to start food truck and hire special people with Down Syndrome and train them to work and be self-supporting.  

I told him, that is a great idea, not the food truck or self-supporting part, but very important was that he saw a problem and then decided to step out to help. And that makes my heart glad. He wanted my thoughts on how to start. He told me how he can help by setting up the truck and getting his cycling ‘kakis’ to be part of it.

I told him that I don’t know much about down syndrome. The first thing is to recognize that care for different community takes on a different mind and skills set. In the care community there are several core groups which the welfare department had identified. They are women with issues, special needs, orang kurang upaya/disabled and elderly care. And in each category, they have sub categories.

For example, in special needs we can sub categorize them to autistic, down syndrome and spastic just to name a few. And in disabled you will have the physical disability like wheelchair bound and visually challenged. In women we have the abused women, single mother and unwanted pregnancy. In elderly care we have the medical care, dementia care and assisted living only. Now there are even more but very often centres cross served multiple sectors of care due to dire needs and lack of resources to serve all sectors individually.

I shared with Kevin that, very often caring is not just about passion, it is a calling and some are called to be very specific like me, in elderly care. Before we can help anyone in any sector, we want to serve in we must do the following 3 things.

First, we must understand the down syndrome and its varying spectrum. We must learn the behavior the conditions and understand it as if you are one of them.

Next, is that we must ask the most important question, “Do they the down syndrome needs help?” Most of us will answer yes they do need help. But ask this one more question, “Do you think the person with down syndrome knows he/she needs help or even wants help?”

 Finally start to understand them, go through them as a human being, ask simple questions like, “What makes them happy?”, “What makes them laugh?”, “What does he/she likes to eat?”, “What does he/she likes to do?” Learn to understand their expressions, each one will have different expressions expressing he same thing.

In any care community, there is a person under that skin, that look, that condition. There is that person that we need to know and understand. Perhaps then we will see ‘help’ very differently. We may not look at the special people as someone who need help. Perhaps through them we can see that we are the one who needed help more than them. Perhaps through these people we can truly see who we are. Through our reactions to the sufferings of others, truly then will we see ourselves. Perhaps these special people are the mirror to our soul, the empty void that our achievements can never bring. The deep dark hole that crave filling and fulfilling and even fulfilment.

Remember, before we can help others let see what help we need too.

To all you lovely people of bangsa Malaysia, who love and care for these people, may your life be the light and beacon of both their life and yours too.

And to my good friend Kevin may you be the light for others.

ONE LEGGED MR KONG TO WALK AGAIN

Went to visit the centre which, I have completed my mission. Brought my daughter there as she is still working there covering admin and hr. Had a few chats with my ex colleagues and then this Mr. Kong came down the lift by himself.

What so special about this 62 year old Mr Kong is that he is diabetic with both his kidneys gone and he needs dialysis 3 times a week. He came into our centre around end of November 2019 after he had his right leg amputated at Hospital Universiti Kebangsaan Malaysia. The amputation was just below his right knee.

When he first arrived, he was just like a lump of jelly. He kept falling off the bed, toilets and what not. This was due to the fact that he had not got used to the idea that he does not have a right leg anymore. Each time when he tried to walk, he will fall because he can’t put his right foot forward. Couple by the fact that he was in the hospital for a couple of weeks and plus his operations, he was left with very little muscle’s mass to support himself.

Because of his regular moving in and out for dialysis plus dinners with family, he fell a few times and hurt his right leg’s wound and resulted in further amputation until above his right knee.

The funny part about Mr. Kong is he always carry this hope that he will walk and even drive again. And in January, after his second amputation I told him that yes he can walk again and perhaps even drive but he must listen and work with us. He said yes and we laid out a plan for him.

I told him from my experience and based on his personality, mental health and out look he will probably recover by April and be fitted with a prosthetic leg by May. However, to be fitted with a prosthetic leg, one must have arms and leg muscles to support the prosthetic and not the other way around initially. So, I say you must do what the nurses and caregivers tell you to do. So, we started with building his arm muscles by getting him to push himself in his wheelchair, his family members hired a physiotherapist for him and couple with staff daily exercises he recovered his muscles very well. Today on 27 March 2020 my colleague gave me an update that Mr. Kong can now transfer himself from wheelchair to bed and vice versa. He can take himself to toilet and shower himself. In fact, he could stand by himself.

What an amazing transformation. Mr. Kong told me he is ready for his prosthetic. I told him I think so too. So once the Covid 19 lockdown is over, he can get a prosthetic leg fitted in May as expected.

I have seen many miraculous recoveries over the years, and I believe that all healings and recoveries are divine, be it through the wave of God’s hand or very often through the loving hands of the medical professionals, family members and caregivers. The most important is that we do not lose hope.

Here I thank the medical professionals, Tim the Physiotherapist and my team of caregivers colleague for doing such a wonderful job.

May this story brings encouragement to anyone who reads it.

THE CAREGIVER'S OATH

Over the course of me developing training programmes for carers and operators i was always intrigued with the Doctors Hypocritical oath and the nurses' Nightingale oath. So i starting searching for a care givers oath and i found it. except for the first oath, all the rest i took it from a carer's website but i have modified it a little to suit the elderly care industry.

THE  CAREGIVER’S OATH

1) I will care for each elderly person as my parent and their children become my brothers and sisters and we are one big extended family.

2) I understand that I can’t care for anyone else if I don’t also care for myself. I will keep an image in my mind of putting the oxygen mask on myself first.

3) I will remember that the only person I can change is myself. I cannot change the person under my care who is ill, nor their family members.

4) I will find opportunities to laugh, daily. These might come in movies, jokes, television, or with friends who can see the humor in my situation and remind me to do the same.

5) I will get away from my caregiving duties on a regular basis, even if it is just to walk around the block. But I will also find ways to have lunch with a friend, go to a movie, window shop, breathe in fresh air, watch the sunset, or have an ice cream.

6) I will visit a support group, either online (at caregiver.org) or in person in my community, so that I know that I am not alone. If a support group isn’t right for me, I will find a friend to talk to, call my family consultant, or attend a workshop.

7) I will learn as much as I can about the person under my care’s illness so I can better care for him or her with understanding. I will learn techniques that will make caregiving easier for both of us.
8) I will say “yes” when people offer to help from colleagues, other residents and family members. When there are not offers, I will ask for help, even though it might be hard to do so.

9) I will use community resources—such as college , NGOs, government and elderly support groups and volunteer —to help make my caregiving duties easier.

10) I will find something I really like to do and make sure I find time to do it on a regular basis. Just because I am a caregiver doesn’t mean I have to give up everything that is meaningful to me. I will read, knit, garden, scrapbook, cook or any hobbies for a designated period of time every week.
11) I will remember that I am loved and appreciated, even when the person I am caring for can’t tell me that.

12) I will honor the nurturing, responsibility, caring, and support that I provide to those under my care as a gift I give.

MISSION ACCOMPLISHED

On 1 April 2019 I was appointed home director of The Mansion, Jalan Gasing. The conversation with the CEO was clear and that is  to achieve 35 residents by end June 2019 or else I go, fair. At the time of appointment, The Mansion has 28 residents, so 7 was not a tall order.

By 1 July, I achieved full house with 44 residents at an average of RM5.5k per residents. The full house status was maintained till today March 2020. 

Most important of all I promised the Management that within 6 months I will build a team that can run without me. That's what I do I duplicate myself.

That too is accomplished.

Then when The Mansion Sri Aman started In October, I went over to be part of the set up team. I brought along two staff whom I have hired  groomed to supervise. 

Within the first month, October, we had 4 residents which immediately made us operationally sustainable.

We were operationally sustainable from October till we hit full house of 23 residents in February 2020, slightly less than 5 months. And oh at a fee of RM6, 500 per residents

Likewise as I pen this end of contract message I am sure both the team that I had groomed can manage The Mansion effectively and efficiently.

Of course, the pandemic is a different ball game all together.

Effectively on 17 March I am to let the management take back both centres. This is normal to ensure smooth transition.

So while the pandemonium is going around I was rewarded  my full final fee, 14 days transitional days off and no worries of this Covid Lockdown issues.

My success at the Mansion is definitely not about me alone but about the team and people I worked with. Yes I am good at building teams that last, but it  depends on the materials and people I got. All my success I give glory to God who took me through this and many other journeys over the years.

To the team I built and come to love as friends and family, may you grow and prosper in all you do.

To the management, thank you for the opportunity to make something good, great.

Till we meet again.

Muntoh

Former Home Director of The Mansion

STOP JUDGING, STOP CONDEMNING

I read with amusement and sadness many comments from the netizens condemning those who travelled back to their kampung inspite of the current restricted movement exercise. There are people posting pasar pagi selling things and people still go there inspite of council officer giving warning.

Let's break it down here. many who migrate back home the last few days did it not because it is a holiday, well perhaps a little break for them. The reality is most workers from others states who worked in KL live in small poky flats or only one small room and some even share it with friends. With this lock down and no work, no entertainment, and many things that they cannot do means they will be lock in a small poky room smelling their own fart.

Most of the rented areas that they can afford are dirty, traffic congested and smelly.

They cannot even go to the park in Kuala Lumpur, so sad. I would have thought that open air and sunlight is a good prevention idea.

For those who had condemned and made fun of these groups going home, think twice most of them are not as lucky and blessed like of of us living here. We are commenting in the comfort of our home and air con. Going home means more space for them. Yes there is a risk of transmission, but staying back also face a risk of depression.

My nephew is staying in a rented room of only 6ft x 6ft, if he wasn't busy at work that's what he live in.

Before we call them stupid, ignorant and bodoh, please lah Malaysians show some compassion.

What about those opening for business, opening their nasi lemak stalls and what not. do not many of them do not have a credit card, or sufficient reserves to last two weeks. They need food, I hope that is not too much to ask. So they need to make a choice between penniless and coronavirus. They are stuck with Hobson's choice. Don't do business, die, do business may die. You tell me what would you choose for them.

Looking at myself, at least I have wifi, a comfortable 1500sf terrace house with two airconed rooms. there are many who are not living so comfortably.

Therefore, before we comment and condemn, go a layer deeper.

Shallow thinking is seeping through fear of coronavirus or that virus. Yes the virus can be deadly, so is hunger and no money for medical bill.

Maybe this group is ignorant, but aren't we all at many times and instances.

The fear is not the virus but DEATH, that's what this is about because it can affect comfortable people like you and I, rich and affluent. The rich can actually die too, all is fair in the death and taxes as the saying goes.

What if we die, but hey as an insurance friend of mine once said , there are two ways we die, failure of organs or accident.

So can we between life now and death then spare a moment to say a kind word like, yes have a safe journey home. Pray for their safety. Wish time joy and beautiful moments with their old parents and old friends. See you in 14 days. May the peace of God/Allah/Buddha and what not be with you.

My Malaysia now do not need condemnation and judgements, we need love, kind words, caring thoughts and positive action.

Peace.