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.

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THE LONGEST 18 DAYS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

KING DAVID'S AGEING ISSUES

As I was reading and reflecting on the issues of ageing today, I decided to take a look at some historical figures in the scripture and decided to share a short review of King David’s life.

The paragraph of the book of 1^st king vividly highlights that King David, God’s chosen man, was not spared of issues related to ageing. In the paragraph it says,

1 When King David was very old, he could not keep warm even when they put covers over him. ² So his attendants said to him, “Let us look for a young virgin to serve the king and take care of him. She can lie beside him so that our lord the king may keep warm.”

Immediately we can see that the great King David, God’s chosen king was not spared from the trials, tribulations and realities of ageing.

His great wealth and castle cannot prevent him from feeling cold. All the amenities in the castle and all the blankets cannot keep him warm. Physically, it is true that older people find it hard to keep their temperature at 37 degrees Celsius. He was subjected to the deterioration of his once mighty warrior physique.  

Although he had queens, concubines and children, none of them were there for him. One of his sons was busy trying to take over the throne by planning his own ascension together with David’s general. Prophet Nathan was busy making sure Solomon becomes the king, reminding Bathsheba about David’s promise to make Solomon king.

Everyone was busy with their own agendas and plans, so why worry about an old, weak king. Why should they worry about King David’s need for heat and warmth?

The concubines and queens will be too old to care for David and probably they are either busy shopping, having dementia or dead.

So, who has the most reasons to keep the King alive? Of course, the attendants, their livelihood depended on the welfare of the king and his family’s welfare.

David’s problem was real then as it is real now. children busy with their career, building their own wealth, family and ‘kingdom’. Nothing wrong with that because that’s what most parents hope to see their children grow to be. Giving the best education, telling them to earn foreign currencies, no need to worry about their father and mother.

This led to an industry managed by outsiders, other people and professionals. I shall not delve into this, but I must point out that what happened to King David can happen to you and I too. And most likely will. What will you do to face that day?  

MONTI IN HONG KONG CANTONESE SHOW PT 2

LET’S GO BEYOND EMPTY WORDS OF DEBATE IN AGEDCARE

In Malaysia, there is this newfound debatable topic in ageing, the key words that flowed through the debaters’ lips are professionalism, knowledge, training and guidelines.

In all these debates, many people argued from a very self-contextual point of view and not one with a wholistic view of the benefits, business or trials and tribulations of operating agedcare centres.

Doctors and nurses kept pointing out that caregivers without a medical qualification must not administer treatment nor conduct any procedures for the elderly. I agreed, to a certain extend but medical is only a part of the entire ecosystem of ageing. It is an important part but not the only ingredient.

A friend once quipped that homes with trained nurses and doctors are better. So, I candidly asked him in what ways are they better. He replied that they can deal with diseases and emergencies. Of course, I agree that having doctors and nurses is a plus, but it is not the only thing. In my 20 years of involvement in elderly care, I can tell you that there are only a few types of emergencies and diseases that we need to deal with, and I can also say that eventually, no doctors and nurses can prevent the ultimate result, death.

You see, nurses and doctors are trained to keep patients alive and heal them and statistics had shown that over 90% of hospital patients do go home alive. But the opposite is true to elderly centres, where over 90 percent will not see their own home again, alive.

The most often question I get was, “what if the residents die?” My question to them will be, “You mean they will not die if there is a doctor around?” My other question I like to ask my friends and inquirers, “Then can you explain why people died in hospitals, in the hands of doctors and nurses?” I just like to do that to see the changes in the faces of the inquirers.

I have personally watched residents catching their last breath, closed their eyes and carried their remains to the holding room or place. Over my 20 years I can definitely say that most never leave my place alive, I know it sounds like a bad line from a horror movie, but that is the truth.

I just like to point out that there are at least two differences in perspective in managing patients in hospital and managing residents in an elderly care centre.

The first is that hospitals deals more in healing and saving lives while elderly centres we deal with certain death, pain, emotional and mental deterioration.

Hospital see the patients for a few days and some a few months, while elderly centres live with the residents from a few months to as much as 15 years.

We are in the business of managing death. Our job is like a pilot. We keep the plane in the air as smoothly, as comfortably and as long as we can. But like all planes, it will eventually land, our job is not to stop the landing but to land it smoothly with as little bumps as we can.

Therefore, when I sit in conferences, meetings and discussions, hearing words without meaning like professionalism, training, knowledge and guidelines gave an empty resounding cacophony without accepting the fact that in agedcare, it is about dealing with death.

Recently at a Rancangan Malaysia Kedua Belas meeting or twelfth Malaysian plan, it was revealed that there are over 1627 elderly care centres in Malaysia, but according to the Welfare website there are only 382 registered centre in the list and I know for a fact that about another 100 in the process of application. So, what happened to the 1100 that are not registered with the Welfare department, are they illegal?

There are many reasons why they are not registered, in fact, there are too many to be listed in this blog here. But, let me share with you just one reason why they are not registered as several of them are good homes and I knew a few of them. They do not wish to be part of the system and be judged by professionals with their own set of knowledge, context and guidelines. They just want to serve quietly, providing the level of care needed for the price affordable to their selected target market.

Professionals from both private and public sectors are generally quick to judge but offer no solutions. If ever there are solutions, it is to close the centres down. Effectively denying the needy, both residents and family members of the only affordable solution in a location and community that serve their needs.

If ever all the 1100 centres are closed, there will be over 20,000 elderly residents displaced without any solutions in sight.

In my battle to make this industry better, I can only do one thing at a time, make sure I give my best and be professional, design systems and operations to make sure what I do is the best. I tried not to judge other centres, if ever I have to, I will help them to be better. I urge readers of this message to start giving your best and help out with centres without judging them but with love and understanding that all centres do their best in the only way they can, with the knowledge they have and against unfriendly guidelines that focus on correctness of rules and self-justifications by little napoleons in the each location.

If it is within my capability, I would like to propose to the Ministry to offer a general conditional amnesty to all centres, so that they can operate above board. I would like to see that to happen so that we can take a step by step help to make the ageing industry much better.

Let us not stop at empty meaningless superlative words, but take action in your location and in your community.

NO BEDS AT ACCIDENT & EMERGENCY AT PPUM

Let me start by saying that PPUM ((Pusat Perubatan Universiti Malaya) did not do anything wrong, their A & E was packed.

On Tuesday at 11.30 pm I received a call from my nurse that one resident was having difficulty breathing.

The vitals showed her SPO was low. My nurse had administered oxygen for her but the resident still have difficulty breathing. After discussion with my nurses we decided to admit her. Following our procedure we called a private ambulance , which usually is faster than calling 999 because they don’t ask too many questions and transfer the call.

Ambulance came at 12.30am and two of my nurses who had already packed all the essential items and documents for admission went on the ambulance to accompany the resident to hospital. On arrival at PPUM 5 minutes later, the person in charge at PPUM A & E (Accident and Emergency) told my nurses that there was no bed available.

We immediately diverted her to Assunta Hospital, a private hospital, A & E. At Assunta, the medical team stabilized her condition and did some diagnostic tests. My nurse informed me that everything was fine.  But I told her to call me back later, because I knew it is not over yet.  Remember I said Assunta is a private hospital? Well this was where I expected problems to arise.

A little bit more about the resident, she was single and the person caring for her financially is her 70-year-old sister who lives in Kuching. Her niece was fast asleep and her phone was off.

At 1.45 am, my nurse called the sister in Kuching and the Kuching sister called me in return.  The problem was Assunta told my nurse that the resident must be admitted in high care unit. But first we must pay a deposit of RM5,000. Now I must point out Assunta did nothing wrong here because this is the procedure at a private hospital.

So, her Kuching sister panicked and called me to help, now I live in Klang and I don’t like the idea of driving to Assunta to sort things out. So, what shall we do? How shall we solve this problem? Shall we transfer the resident to General Hospital KL? But it was too far. Here is the good news. I had the experience of managing a 24-hospital admission call centre for 12 years besides managing nursing homes and 10 clinics. 

I asked the nurse to let me talk to the admission unit and I asked the person one question, “Can we do online transfer to Assunta?”  He said ,”yes.”  Great . The next question is , “If we transfer the money to you will definitely admit her?”  He replied, “Yes.”

So that was done. The resident was admitted and I told the sister in Kuching, “not to worry, we have sorted the issue and now she is now admitted.” A side noe here, the sister in Kuching did not know that we can do online instant transfer, she relied on her accounts staff.

Government hospitals running out of beds is a possibility. After all, most people try to get the best care at the lowest possible cost or no cost at all. Private hospitals need deposit that’s a reality.

My key message is that we need to prepare in terms of finance and the people who can manage odd situations. It was a good thing that this resident is staying at our place with me and team who can deal with this situation or else it will be a long Tuesday night.