PITIFUL FAMILY MEMBERS

Being in the elderly care industry for 20 years helps me to realise that the hardest people to work with are the family members, their spouses, children , relatives and so on.

There are many dynamics to their behaviours and the hassle some of them gave the care organisations and the staff.

As carers, we get blamed for injuries, bedsores, bruises, sickness and general decline of the elderlies health. We get accused quite often for being incompetent, being called stupid. Accused of stealing. Get scolding for occasional missing medication or wrong timing. Being scolded for giving the food which the family members decreed out of bound for their loved ones.

And you know what, it is ok with me and the carers because we knew one thing that the family members don't, even though they think they knew.

We know why the family members get anxious and why they behave the way they did.

There are many reasons:

1. They wanted us to do what they wanted to do. This is a case of expectations. Many family members have a mental image of what kind of care and how their loved ones are to be cared.

2. They want things to happen now. Which of course very often it does not happen that way, so they get frustrated.

3. Most are taught and educated with how problems should be solved, cause and effect. This problem this solution. But reality with elderly and care is not a straight line. This leads to frustration.

4. Their ego dented with the knowledge that with all their wealth, intelligence and knowledge they need to let a much lower qualified, lower salary individuals to care for their mother. Afterall in this society , wealth, big cars and house equals ability and success. And with all those success they cannot care for their parents.

These family members and children are the most pitiful and in need of compassion.

For the readers of this post please do not judge them but pray for them. They do live their parents or spouse.

For caregivers, please continue to love and uphold the family members, they need the care and love too.

The only way to reduce their anxieties is to be the best caregivers we can be . One who understand the elderlies, one who also understand the dynamics of family members.

May the peace of the good Lord be with us all.

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.

THE PRICE OF BEING A CAREGIVER

Want to know what is the highest price I had to pay being in the elderly care industry?

People talked about how hard the caregiver’s jobs are. That it takes a special kind of person to do it. But have you ever wondered what is the greatest price a caregiver has to pay? Oh yes, there is a price to pay for whoever chooses this industry.

There are two categories of caregivers. The first is the family members and yes, they do have to pay a price for caring for their loved ones. The second is the industry professionals, like me and the hired caregivers and nurses.

Let’s tackle the first group family and relative caregivers. There are many levels of price that they pay. Among them are giving up their jobs, careers, time and even life to care for their loved ones. Sometime ago a family 8 siblings, seven daughters and one son, came to see me about their dementia mother. They liked the place I was managing, and they wanted to check their mother in. And I said,” Wait we need to assess her over a few days to see if she is manageable type of dementia.”  As it turns out their mom was walking all the time, trying to escape and can be a bit violent. To cap it all she constantly looking for knife and scissors. 

My observation was that she has more conditions besides dementia, and I told the sisters that no home can manage her unless she has been properly evaluated by psychiatrist. I also told her that her mom’s behavior seems to indicate that she needs more that the two types of dementia medication given now. Then the daughter opened up and told me all the information she was trying to hide. According to her one sister quit her job and got depressed taking care of her mother after a few years. Then passed on to another daughter who is not married, and she got so stressed up that she just drove her mother to a cheap nursing home and left her there. All the other siblings had tried but just cannot take it.

For caregivers who are family members they may even pay the price of their own sanity. I found another solution for them but it is not a road they are prepared to travel. I told them very likely only with full medication management, in short heavily sedate her, that they can manage her. Still it is not a foolproof solution. Nobody fully understand for the mind is both a playground and a minefield.

What about industry professionals, what is the price they have to pay? Let me share with you the highest price I had to pay. I can’t be there when my father was sick, dying and died.  All because I was helping to manage and operate a new centre for a Harvest Christian Assembly church. We were short handed and we had to deal with many high care cases and worse of all I was given a ‘special church friend’ who was dying from cancer who needed super high care to manage.

Now, again as usual, (yes a double oxymoronic expression here) the family members lied about his condition saying he is okay, he can walk and eat. I was told that the tracheostomy is very easy to manage. But when I went to Klang General Hospital, the specialist told me an entirely different story. I was told he can hardly walk for his back pain was excruciating, he needed constant suction of phlegm, to be precised every hour for 24 hours. The care needed was so demanding that our staffing was simply insufficient. Not to mention that his cancer stank. The smell even drew in flies in drove. When my dad died on 16 September 2018, I cannot even go back. When my dad was sick for 3 weeks prior to his death, I could not be there. I depended on my trusted friends.

Now, I understand why my mom who was a nurse often gets condemned for not attending closed relatives’ funerals. My mom always said to my father, “cannot simply just change, there are people who are depending on me.”

But what about me?

IF ONLY I CAN SAY THESE AND GET AWAY WITH IT.

Have you ever thought of giving naughty and sometimes sarcastic replies to questions asked?

I have. There are many things I would like to say to family members if I could get away with it. 

Most elderly are checked into a care centre simply because the family members cannot manage them or care for them physically. They could be tired and feeling helpless, yet, family members never failed to surprise me with unreasonable questions.

I know they are desperate and sometimes exasperated because they can do nothing much to care for their parents, I understand this, but I feel that sometimes the most important person in a care centre, which is the carers were being unfairly treated. 

I do not belief that customer is always right when they start scolding and use abusive and condescending tone towards the carers. Personally, I have been askeddesperate  questions that I have decided to give a tongue in cheek answers to in this posting, which you will never hear me telling the family members.

Desperate question or DQ: Why my aunt/mother/father who can walk in the previous home, but now she hardly walks?

Tongue in cheek answers or TICA: Oh that’s because your aunt is getting older weaker. They have good days and bad days as they aged.

DQ : But that cannot be, your place is advertised to be so much better, it looks nicer than the other place.

TICA:  Probably the other place is an Olympic training centre for the seniors preparing the elderly for marathon or the 25km walk event. We are just a professional daily assisted living centre.

DQ : She couldn't walk maybe because you all don't help them to walk?

TICA : Er, where were you when we helped your mom to walk? What kind of children you are? You should quit your job and sit in our centre to see us when we exercise her.

DQ : Why my mom looks older now compare from last visit last year (children living in uk) ?

TICA : We call this ageing, you will get there too if you stop asking question like this.

DQ : Why is it that my father is eating less?

TICA : Food he likes doctor won’t let them eat, food they don’t like you kept giving to make sure he stay healthy to live a longer miserable live.

DQ : Why is it that the staff sits around doing nothing?

TICA : It is call lunch break.

DQ : You must force my mom to walk, she always complaint about leg being painful. She always pretends.

TICA : You called your mom a liar, may she is lying about her age too. Please take her to nursery school.

DQ : I saw your staff using wheelchair the other day, why don’t they listen to our simple instructions?

TICA : Because your mom complaint her leg is painful and we do not know that she can pretend and lie. Obviously ou are the only one who can take care of your mom, would uou like me to tell our manager to prepare the refund cheque?

DEATH - PEACEFUL AND BEAUTIFUL?

Here is a story of death and how it can be peaceful and beautiful thing.

Visited my late Father in Law's grave this morning. He passed away on 24th Dec 2011.
Sitting on the side of his grave stone it helps me to reflect that definitely all things will come to an end.
Our earthly revelry, sorrow, sufferings, anger and hate all will end.
Lying before me are people who were once well known, rich, successful and arrogant together with the humble, poor, destitute and down trodden.
All will end.
What's left are memories.t

Over the years I have seen many deaths; closed the eyes of a few; carried the remains of a few. Many people struggled to come to terms with their mortality. This story is not one of recovery but about the last journey of a lady named Grace who showed me how death can be peaceful and beautiful.

I met Grace somewhere in August 2019, she was in her 60s and suffering from stage four cancer of the lung. I assessed her in PPUM at the cancer ward. She was located next to the nurses’ station, which meant that she was critical and may go anytime.  Yet, when I spoke with her in PPUM I did not see death in her eyes but peace and full of cheer and life. I thought her visitors and relatives were the one dying, they looked so grimed.

Our conversation was fun and candid and she went straight to the question, “ Do you accept one who is about to die and could die anytime?” I thought that was pretty direct. and I replied, “Yes we do, because I have seen staged four recovered before, you may live longer than you think.”
She checked in a week later in one of the room with all the essential trappings. Oxygen concentrator, oxygen tank, morphine and the works.  She received many visitors daily and we even had a birthday party for her in the centre.
She had good days when she could sit up and chat with visitors and me. There were days when she almost departed. But in all the days she spent preparing for her eventual reunion with God. She prepared what to say and to give to each one of her friends and relatives. She even prepared something for each and every caregivers, nurses and myself. All these given to us by her niece after her death about 2 months later at her request, in her own home.

She was peaceful and happy till the end and this helped me to reflect the reason why her death was so peaceful and beautiful.

The reason was that her life was not her own to live but for others. She spent days in our place preparing all her luggages for departure.  It was death waiting at her door that gave her the life that she lived towards the end. When we got news of her death, me and our staff cried and when we receive each an angpau with our names on it, we were flabbergasted and lost for words. We asked, “How can someone who is going to die spent time  preparing angpaus for each for each of us with our name on it!?

It was because she did not live for herself and through her death we saw whom she lived for.

Share this with your friends to encourage them.

HEALED IN 21 DAYS, NOT 180 DAYS

This is one among my favourite stories It is about a 75 year man who is a bit of a rascal and fun-loving character. His name is Bernard.

Do share if this story inspires and edify you.

Late last year he came to my centre with a serious spine injury and operation wounds. While in hospital he fell in the bathroom after the operation and was lying in the bathroom for 2 hours until his wife/girlfriend went inside the toilet and found him there. The bathroom incident happened when his wife/girlfriend, depends with whom you ask, went to get some stuff from the private hospital stores. Bernard went into the toilet to pee and he fell, aggravating his post operation wounds.

He tried to reach the bathroom’s call bell, but some smart Alex tied up the long wire that allows it to dangle all the way to inches off the floor on the handrail. Making it out of reach for him as he could not stand he lied on the floor. The wife/girlfriend came back a few minutes later not realizing that he had fell, thinking that he had been wheeled for more test. After almost an hour watching the tv she went to the toilet and found him there. Oh, they actually had to break the toilet door to get in.

On reaching our centre somewhere on the first week of October 2019, he could hardly walk, sit or talk much and suffering from excruciating pain.

Physio and acupuncture was arranged for him daily and within days he could talk, sit and stand. That’s when the fun start and his wife/girlfriend pusing kepala(shook her head). He started calling all his friends, all loud rascally, fun-loving professionals who visited him. Follow by bunch after bunch of gorgeous women although in their 60s and still hot coming to visit him in droves.  Bernard told me loudly these are my girlfriends. I told him you want to die talking like this. Bernard happily replied, I have gone through worse.

Within the second week he went to his home one day with his wife/girlfriend and came back to our centre in a big black Porsche Cayenne, and he went out every day. And on the 21^st day of October I wanted to kick him out, albeit jokingly, and he said, “Never mind paid one month might as well enjoy peace and quiet here.”

Here I must point out the the key things that helped in his recovery.

The first is that Bernard is generally a happy man and was an active man. He has lots of friends and he was not afraid to be vulnerable in front of them. He did not ask for pity, In fact, the rascal (in a nice way) took advantage of his droves of girlfriends with his conditions. Of course, the other is the support from his wife/girlfriend was tremendous. The wife/girlfriend was so supportive in spite of her recent trauma of losing her 40 year old daughter to cancer. The wife/girlfriend teared when she shared this and asked why her daughter being young did not fight on. But that did not stop her being a cheerful soul.

Being in the care industry allows me to meet many people whose life inspired me and helped me to look beyond myself. It helped me to realise that there is nothing wrong with being sick or need help. Being vulnerable is not a weakness but a strength that I can draw on.

Oh Bernard left me with a beautiful video saying thank you to everyone and I do believe in miracles.

AMAZING STAGE FOUR CANCER RECOVERY!!

I promised to share heartwarming stories of carers ad family members. I am sharing another wonderful story. People talked about miracles and in my years in elderly care I have seen many miraculous healings, I believe they were all divine and peppered with lots of love and care by the care givers and the family members.

January 2019, two brother and sister came to see me regarding their younger sister, Rosie, who was suffering from stage four cancer. A former teacher, she was not married and live alone in an apartment in Klang. Her chemo treatment left her breathless, tired and weak. As she was living alone, she could not get her own food, she could starve in her own home.

On the 3^rd day of Chinese New Year 2019 me and two caregivers, David and Rishu went to this Rosie’s apartment in Klang. When I saw her, she was bald, tired, weak and could hardly walk, but she was smiling and what a wonderful smile she has. We wheeled her into my faithful Toyota Unser and took her to the centre which, I helped a church to organized.

We put her in a single room, but unknown to her that room was also known as the holding room. It was meant for residents who need critical care. It is located near the kitchen and easy access to a back door for the purpose of easy moving out in case of emergency or death. Yes, I expected her to ‘go’ within a month or two.

Rosie was a happy soul inspite of her pain and conditions. There was a slight stench of cancer that was oozing out. If one never smells death, well visiting a cancer ward and taking a deep breath will show you what death smells like.

She continued her chemotherapy while with us. We fed her and my care team gave her love and jokes. One of my night shift care givers shared with her the gospel and prayed for her. She became more cheerful. Four months into her stay she accepted Jesus as her Lord and Saviour. Pastor Alan Tan or Harvest Christian Assmebly came to baptized her. Her conditions continued to improve. By October 2019, she was proclaimed clear of stage four cancer and she could walk, her hair grew and in November 2019 she went home, walking out happily with the same big smile I first saw on her face. Of course, the cancer can return, but until then she is well now.

I have seen miraculous healing, not like those of magic abracadabra stuff but one of love and care and how the power of the Spirit in ones’ life could change and heal. For how long,  I do not know, but for now I know she is well. Met her again during Christmas and her hair was much longer, she gained some weight. Dressed in a pretty white with floral pink dress, she greeted me with a big smile and cheerful voice.

At this point some may expect me to sell some supplements or the scret of miraculous healing and say, "Follow Jesus and you will be healed." No my friend nothing like that, I am just sharing what I experienced and saw. Perhaps if you want to know the secret it is probably an amazing potion call Love.

All I can say is thank you God and thank you for the caregivers’ hard work, care and love and her family members who supported her through out her journey of recovery. Never forget the joy of my day’s work.

Share this with your friends and encourage them to serve in care community.  Miracles do happen, people will die but your love and care will forever be carved into the hearts of those whose paths you cross.

Go beyond the sad and miserable face and conditions and dive deep into the lives of those who cross your path. Inside a plain cover book are pages of stories, funny stories, heartwarming stories and do not be afraid to be vulnerable. Never let what others are doing affect our value and importance in a world so short of love.

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.