FONG MUNTOH ON AGEING IN MALAYSIA: THE 4 PILLARS IN AGED CARE MANAGEMENT

FONG MUNTOH ON AGEING IN MALAYSIA: THE 4 PILLARS IN AGED CARE MANAGEMENT: 15 years ago I saw how Living trust worked to support an expatriate from Netherlands living in our Elderly care centre in the former hom...

THE 4 PILLARS IN AGED CARE MANAGEMENT

15 years ago I saw how Living trust worked to support an expatriate from Netherlands living in our Elderly care centre in the former homes that I managed.

Our centre only have to send our invoices to Netherlands and the resident's fee will be paid online. When additional medical costs were incurred we just sent the total bill to Netherlands and it will be reimbursed.

I thought that was great, and that was why I propagate the idea of 4 pillars of ageing which my friend used to start a company to provide swupport for total aged care management.

How does a total aged care management system works?

It goes like this, the 4 pillars are Care Centre Operations, Administration of Care Management, Trustee and Funds Management.

These four pillars are to help the elderly answer a few important questions.

Q 1. I have no other relatives, there is only me and and my wife, who will take care of anyone of us if one of us die first?

Q 2. Whom can i trust among my relatives and friends to help managed my funds when I am mentally incapacitated?

Q 3. What will happen to my funds and money after i am gone?

All these are real issues which I have given consultancy to. I believe organisations of reputes and with good ethos should consider setting these four pillars to help their community. We do not have to worry about the rich, they have their plans and people and corporate bodies to managed their lives and funds. It is the middle income with not enough clout to access such set ups.

The first pillar, which is the care centres will provide the care required by elderly.

The second pillar is the administrator of care centres, which function as a quality control and assessor of care centres and advise the elderly or the trustee board.

The third pillar, which is the trustee’s job is to ensure the funds are well managed and to ensure that the funds can last the lifetime of the elderly.

The fund management shall be provided by financial institutions, which can be a bank or any other financial institutions job is to ensure the funds grow at an acceptable rate.

I will talk more on this later.

AUTUMN IS GOLDEN

AUTUMN IS GOLDEN AND BEAUTIFUL

I named my agedcare academy Autumn and many asked why autumn, it sounds like winter is coming and nothing to look forward to. I told them it is because to live is to acknowledge the truth and that death is not a bad thing but something to embrace for what is life if there is no death. I borrow a beautiful passage on autumn from a friend's posting , I do not know where it is from but it is beautiful.

Signing MOA with Open University Malaysia's Professor Dr Richard Ng

There comes a time in our lives when the innocence of spring is a memory and the exuberance of summer a song whose echoes faintly remain in the air, when, as we look out on life, the problem is not how to grow but how to live truly, not how to strive and labour but how to enjoy the precious moments we have, not how to squander our energy but how to conserve it in preparation for the coming winter. A sense of having arrived somewhere, of having settled and found out what we want. A sense of having achieved something also, precious little compared with its past exuberance, but still something, like an autumn forest shorn of its summer glory but retaining such of it as will endure.

I like spring, but it is too young. I like summer, but it is too proud. So I like best of all autumn, because its leaves are a little yellow, its tone mellower, its colours richer, and it is tinged a little with sorrow and a premonition of death. Its golden richness speaks not of the innocence of spring, nor of the power of summer, but of the mellowness and kindly wisdom of approaching age. It knows the limitations and its richness of experience emerges a symphony of colours, richer than all, its green speaking of life and strength, its orange speaking of golden content and its purple of resignation and death. And the moon shines over it, and its brow seems white with reflections, but when the setting sun touches it with an evening glow, it can still laugh cheerily.

HOME ENQUIRERS SELDOM TELL THE FULL STORY

One of the most common statements by enquirers to the care centres where I was and is now is;

"Oh my mom/dad can fully take care of themselves, they can feed themselves, shower themselves and feed themselves and they do not need much help."  

Yeah right.... In fact this statements raised my antenna every time they say it.

I mean if an elderly person who is independent , why then do their children want to explore the possibilities of sending them to a elderly home. Why must the children subject their elderly parents with the feeling of rejection, neglect and unwantedness? Make no sense to me and make no sense to a cow either.

I have many such enquiries and discovered during interview and assessment that their parents are suffering from alzheimer and dementia in general and need medication. Very often the missing information is that my parents do not sleep at night and walk from room to room, perfect for security guard job. They did not tell you that their parents are violent at home and beat their loved ones. One such experience crossed my path recently. I had a 91 years old lady with serious dementia and when she goes off the rail she will disturb everyone, she will scold everyone in typical flowery chinese language bringing up other peoples parents, family, organs and ancestors, in short swearing all the the way. She can even beat up people with the strength and power of Ip Man with he r walking stick. Two of our strongest ladies can't hold her back.

Another common enquiry with insufficient information is this;

" Oh my mom/dad is on wheel chair and JUST  need some basic day to day care like shower and daily care. Very easy to take care."

This could mean many things. The parents could be big in size or tall or hard to carry or handle. They could be suffering from arthritis and body is painful from top to bottom or they have bedsores that need serious managing and care. Sometimes they did not tell me that their parents are about to die. There are children or their spouses who do not want their parents or father in law and mother in law to die in their house. 

Generally many people are desperate to get rid of their parents from their home, and I do not mean it in a bad way. Many children or carers are just desperate for help in this area of care. They are tired, they are arguing with their brothers and sisters and whom their beloved parents loved more. They are fighting to see who should pay what. They are fighting with their spouses.

Not too long ago, a couple and their niece were desperate to get better care for their brother of the man and father of the niece. They told me oh his condition is very easy to manage and to care for. His condition actually needs a good nursing care and trained nurses are the best to manage his condition. I just had to reject their application to our home. 

There is no end to desperate children in desperate situation till they are will to say what is necessary to get a care centre to accept them.

I hope I can live long enough to build an eco system to help more children with elderly parents to care for their parents in their home.

HOME CARE VERSUS HOME CARE

I am playing with words here. I am referring to the choice of choosing sending your ageing parents to a home or centre to be cared for or employing care givers to go to your home to care for your ageing parents.

I received a call one day, just like any normal day I get many calls asking for help and suggestions on how to take care of their parents. It was from an Indian male professional, race is added in not as a racist comments but to emphasize the ageing parent issues are not a problem for a particular race or nationality. Just so happened this happened to be an Indian man. I get calls like this from all races.

This man told me that he has problem with getting reliable maid to care for his father. They all ran away after two to three months.

I said, "Wait, let me guess. "Your maid worked 24/7 without rest right?"

He replied, "Yes"

I said, "Brother with working conditions  like that even I want to run away."

It is very common to get family members turning to  cheap maids to care for their ageing parents. They treat them like a maid and expect them behave like a care giver. The rationale in the mind of many family members who hired care givers was,"After my mom or dad slept, they have time to do other things." Very often, family members try to fill up the leisure hours of the caregiver.


Important note: Caregiver is not a maid, their job is to care, they are entitled to their rest. If they don't rest they cannot do their job.

So let care givers be care givers, if you think paying a maid RM1,200 to care for your parents and to do house work is what you wanted them to do, good luck to you .


So when do one decides on care at a elderly home or care in their own home? In Malaysia it is usually when it is medically impossible and physically draining and financially limitations do Malaysians send their parents to an elderly home.

If one can afford RM4,500 monthly then they can choose having caregivers caring for their parents at their own home.

Sending ones parents to a elderly home is a traumatic experience with a few psychological and emotional consequences. The elderly will feel abandonment and rejection, while the children will fell useless for not able to care for their parents themselves.

Whichever options appear, one can only take it one step at a time.

I NEED POSITIVE AFFIRMATION FROM PEOPLE I HELPED

Without sounding like a glory hunter, I must confess that I too need some positive affirmation from people whom I have helped. Sometimes in my journey to help others, I always wonder if my suggestions had helped them in anyway.

Recently a lady name Miss Tan called me. She got my number from a cousin who was a former colleague of my cousin. Her situation was that her father was very ill and many of his organs were failing and needed a home with proper medical care. She had searched high and low but found none as she also wanted a single room as her father also had weak immune system and will get flu quite easily.

She contacted me and I found another wonderful friend who managed a successful nurse company with over 600  nurses. My friend sacrificed a double room to make it single for Miss Tan and gaver her a very big discount.

Later Miss Tan called me and asked me , " How did you get the special deal for me? I contacted this company (my friend) and they cannot accommodate me?"  I replied, "My friend and I went go back a long way."  Miss Tan was happy and I will share screenshots of our conversation.

This was the first communication between Miss Tan's cousin and myself.

This message from Miss Tan and Wai Teck is her cousin, and he was my cousin's ex colleague. Never mind the tongue twister.

My reply to Miss Tan

After visiting Miss Tan's dad, My friend who owned the centre took me for a free lunch.

About a month later mid July 2018

This was our final communication.

It was a happy sad ending for Miss Tan, Happy that her dad no longer suffered. Sad that he was gone. To all those who had passed my way, may God bless you and your family and thank you for your encouragements through social media or otherwise. Your encouragements gave me strength to carry on.

EPILOGUE - MANAGING YOUR ELDERLY PARENTS

Further to my posting early in the morning of 25 July 2018 i received the foolowing updates from my friend's son.

Here are the updates:

[09:30, 7/26/2018] Ray: Wah...you featured our story in your blog! FYI, my dad couldn't do the procedure after consulting 3 specialists. The soft bone between his vertebrae are already quite worn out and the procedure (called Neucloplasty) is basically removing part of the soft bone. The only available procedure is to inject steroids into his back (like epidural) which is not necessarily successful but may offer temporary relief. In any case, we checked him into the nursing home almost 3 weeks ago. We got him a single room as they didn't recommend sharing because of my dad's psoriasis which may scare the other patient. A few positives can be experienced by my dad after only one week: 1. His back pain practically stopped! This is possibly due to the proper handling of him at the home. He was indeed very pleased with this development as this is a great improvement to his quality of life. 2. As his pain reduced significantly and proper moisturizing of this skin, his psoriasis improved significantly as well. Another positive outcome for him.

[09:36, 7/26/2018] Ray: I will be back to Ipoh this weekend to visit him and I hope to see that his skin condition to return to normal. One issue which needs more attention is his bedsore. They are changing his diapers 6 times daily as opposed to 3 times daily when he was at home. We are paying extra for the nurses to tend to his bedsore. I believe my dad is quite comfortable in the home (if not quite happy) as he has most of his leisure items with him such as his smartphone, iPad and computer (which I got a new one for him). I would like to thank you for your invaluable advice and we are now managing this 1 week at a time. Hopefully we can then move to 1 month at a time in due course. Shall keep you updated! Cheers!👍🙏

[09:43, 7/26/2018] Muntohfong: Good to hear bro.  Your story that I shared touched  many people and will help many.

[09:45, 7/26/2018] Ray: You may update your blog with the recent development. Hopefully, others will find it useful. Once again, thanks a million! Take care!

[09:46, 7/26/2018] Muntohfong: Yes Raymond your dad's life is still helping others in his last journey.