This article first appeared in The Edge Malaysia Weekly on February 8, 2021 - February 14, 2021

HANDLING the challenges of an ageing society will strain the nation’s resources as the number of elderly people in the country rises rapidly, population data shows.

Estimations by the United Nations indicate that Malaysia will be an aged nation within a generation, with 17% of the people aged at least 80 by 2045.

In the light of this trend, the care economy, which includes care for the elderly, has huge potential, says Social Wellbeing Research Centre (SWRC) director Datuk Emeritus Professor Norma Mansor.

“Demand for care is only likely to increase as the population grows older, making the need for public investment in quality care jobs and services, combined with inclusive social protection systems, ever more urgent to meet future demands,” she says in an email interview with The Edge.

The need to prioritise investment in the care economy was signalled in a 2018 International Labour Organization report, which said current deficits in care work and its quality will create a severe and unsustainable global care crisis.

The much-needed solutions to improve the care economy for the elderly cover a range of sectors, from services to employment policy to financial protection and the application of technology, says Norma in the interview to explain the implications of the Malaysia Ageing and Retirement Survey (MARS) Wave 1 report, which was launched last month.

This will require attention to areas such as measures to professionalise social care, prolong working life and facilitate community living and the participation of older adults in society. Alongside these adjustments, steps must be taken to develop meaningful social insurance for old age and retirement. In addition, in this age of technological solutions, digitalisation of processes to manage adult dependency will need to be adopted.

The survey was conducted by SWRC in 2018/19 to obtain nationwide longitudinal micro-level data relating to ageing and retirement. Longitudinal surveys involve data collection over a span of time to permit analysis of changes at the individual level.

The research involved personal interviews of more than 5,600 people aged 40 and above on vital issues that affect their lives. The components include family relationships, connectedness and support, work and employment, income and expenditure, savings and assets, retirement and social participation, health and healthcare utilisation, and cognition and psychosocial well-being.

The MARS is part of the Gateway to Global Aging platform and is Malaysia’s first-ever globally comparable survey data with other leading family studies in the US, Europe and Japan.

Interestingly, the findings show a gap between the reported physical and social well-being of the respondents and indicators of health and family support. This is seen, for example, in the incidence of non-communicable diseases among the respondents and their preference that support for parents be made mandatory.

Generally, half the respondents rate their health as good and almost 90% lead a meaningful life, the survey shows. Yet, a significant portion is prone to undiagnosed hypertension. While 36.5% had been diagnosed with the disease by doctors, of the remainder, 44.3% were found to have a high blood pressure measurement during the survey.

“Lack of awareness is a major obstacle to successfully reducing hypertension at the population level,” says Norma.

That points to additional pressure on the public health system to screen the target group for non-communicable diseases and promote preventive health strategies. One way to lighten the burden on government health facilities is to involve community organisations in these efforts. However, this route has its limitations.

Such initiatives might not lead to an improvement if those diagnosed with hypertension do not take follow-up action, says Norma.

People might not act on advice to seek treatment at a healthcare facility or change their diet or exercise habits, she notes. Even those who start treatment might not stick to it or seek recommended follow-up care.

“There is a need to realise a whole-of-society approach to health and active ageing — steering public-private-community partnership in the pursuit of health and active ageing as integral to well-being. There are a few overarching themes: empowerment, education, engagement, participation in policy and commitment,” says Norma.

To advance this holistic goal, SWRC advocates a self-care approach so that people take responsibility for their own health and well-being. This is one of six areas covered by the recommendations in the survey report: self-care, family, seniors@work, ageing in place, community and education (see “Recommendations” above).

Further, the survey results raise a red flag about financial support for the elderly. Two-way financial and non-financial transfers are prevalent, with six out of 10 receiving money from their children (RM150 a month on average) and five out of 10 giving financial support to their children (RM100 a month on average).

“MARS data suggests that while half of the respondents received financial support from their children, the average sum received monthly is low,” Norma observes.

“Given Malaysia’s ageing trend, it is crucial to extend old age allowances (Bantuan Orang Tua). One approach that can be undertaken is for the government to consider providing social assistance in the form of cash and in-kind transfers to all citizens upon reaching a certain age, say, 70 and older.

“Another proposal is the formation of a Social Solidarity Fund. The strong should support the weak, and the able must undertake the responsibility for the less able or disabled. Community members and the private sector could make contributions in supporting the fund,” she says.

An integrated support system is crucial to address the issues of an ageing population, especially for the underserved segments of society.

“For the urban poor and people in remote areas, strategic interventions to strengthen the operationalisation and engagements in health management between public health service providers, local authorities and civil society organisations including community leaders, academic institutions, NGOs, private sector entities and philanthropic foundations to promote health talks and periodic check-ups to the people in the local communities are key,” says Norma.

At the global level, an intersectoral, interdepartmental approach to governance is already being adopted in regions that are ahead of us in the ageing curve.

Working with Society has become an important strategy for the World Health Organization (WHO) European Region, says Norma. This is seen in Health 2020, the new European policy for health and well-being for the 21st century.

Some countries have gone ahead to introduce laws that require adult children to support their parents.

Singapore implemented the Maintenance of Parents Act of 1995, which details the monthly allowance or lump sum to be paid by adult children to their parents. Although the Act did not specify a penalty for non-compliance, a national survey of senior citizens in 2011 found that over 70% reported that cash transfers from children are their biggest source of income, says Norma.

In the US, adult children are required to financially support their parents in need of expenses such as medical care and basic needs, in which the law varies from state to state.

“It is also interesting to learn from Germany and Japan that have mandated kinship responsibility as part of the elderly care provision. It is commonly defined as ‘the full-time care, nurturing and protection of an older person by relatives, members of their tribe or clan, stepchildren or other adults who have a family relationship to the older person’,” she says.

Keeping seniors active and at work is an important aspect of healthy ageing.

Measures to encourage older workers to continue to work after retirement include:

The government has taken notable steps to promote employment and productivity of older people.

Budget 2021, announced last November, is deemed kinder towards senior citizens, says Norma. Among incentives introduced are:

In addition, aid measures announced last month by the government under the Permai Assistance Package to ensure economic resilience during the Covid-19 pandemic will contribute to the people’s well-being.

These measures include additional incentives for the vulnerable groups and informal workers who are dependent on daily wages, says Norma. Foreign-owned companies with 75% Malaysian workers have been given access to the Danajamin Prihatin Guarantee Scheme for raising working capital.

Welfare assistance provided by the Social Welfare Department (JKM) under Budget 2021 has been increased with effect from January 2021 to RM2.2 billion and will benefit more than 400,000 recipients.

The JKM will also implement a food basket programme to provide essential food items for eligible households.

“One concern remains for Malaysia — a sizeable proportion of our older population is in the informal sector with no social protection, the so-called ‘missing middle’, hence requiring intervention by the government,” says Norma.

“SWRC lauds efforts to make it mandatory to contribute to social protection for those who can afford it, and for the government to contribute on behalf of the low-­income group.”

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