EXPORTING GRANDMA AND GRANDPA

IS GRANDMA DESTINED FOR EXPORT TO JB?
by Janice Tai, Straits Times, April 9, 2015

LAST month, The Straits Times reported on the growing number of infirm Singaporeans who have been admitted to nursing homes in Johor Baru.

I was one of the reporters involved. Back home, I had a hypothetical discussion with my grandma on considering that as one of her retirement options.

Across the Causeway, you can get a room in a bungalow for half the price here. The elderly person can tend to the spacious garden outside instead of being cooped up in an eight-bedded ward reeking of stale air, or worse, urine.

Grandma, usually cheerful and mild-mannered, snapped in Hokkien: "I'd rather jump from this building than go there."

Despite her visceral objection, the fact of the matter is that more people in Singapore will soon need to have this discussion on nursing home care for elderly family members.

Sending Grandma to JB is, of course, not the default option.

But the economic case is compelling. Cheaper land, construction and labour costs in Malaysia can halve the cost of nursing home care.

Singapore is also short of nursing home beds, with an average waiting time of several months to be placed in a nursing home. That's because many homes here have been full for years and beds are freed up only when occupants die. All 401 beds at Peacehaven nursing home, for instance, have been occupied for at least the last 10 years.

Aged sick: The new export

THE idea of sending the old and sick to low-cost neighbouring countries may attract unease, as in 2009 when then Health Minister Khaw Boon Wan suffered much flak for suggesting it as an option.

But, in fact, the idea has taken off in other developed countries, where there is a shortage of qualified nurses and facilities amid soaring costs and a rapidly greying population.

But is this arrangement what our elderly folk and their caregivers really want?

My colleague and I spoke to three old people in JB nursing homes who thought they were still in Singapore. Dementia patients make up about half the elderly residents in local nursing homes.

But senior social worker Jasmine Wong at Hua Mei Centre for Successful Ageing says that dementia patients benefit from being in familiar, not strange, surroundings: "Persons with dementia retain old memories while struggling with recent events - so being in a familiar place helps relieve their anxiety and familial visits play an important part in that assurance."

Some research links family involvement and visits to better life satisfaction and early discharge back into the community.

So while nursing homes in JB may make sense as cheaper options, they are at best a niche solution for some. For one thing, their cost is not subsidised. Even a bed in a shared home in JB costs $600 a month - beyond the reach of poorer families.

For the masses in Singapore, there is no running away from the challenge of having affordable, quality nursing homes, especially as the population ages rapidly.

The cost of care

MOST nursing home patients in Singapore pay about $450 to $500 a month for a place, after government subsidies. Nursing home fees in Singapore range from $1,200 to $3,500 a month. This is before government subsidies of between 10 per cent and 75 per cent.

Nursing home operators cite rising labour and land costs as one reason for fee revisions. Econ, for example, raised fees by 10 per cent three years ago. This year, fees went up another 10 per cent, or between $220 and $440 a month. In that same period, wages went up 16 per cent.

What can be done to keep fees low?

SINCE 2012, the Health Ministry (MOH) has operated a new Build-Own-Lease (BOL) model where it builds and owns nursing homes and leases them to operators who have to bid to run them.

This puts downward pressure on fees because affordability is a key evaluation criterion in awarding such leases. Appointed operators are held to their proposed fees for the duration of the bid.

The BOL model also helps to reduce the capital outlay for operators. However, it will apply only to most of the 19 homes coming up over the next five years. There are 66 nursing homes now.

Another way is to incentivise existing operators to keep fees down in exchange for grants. This has worked to slow down fee increases in the childcare sector, where "anchor operators" have to satisfy fee requirements in order to get grants.

New approaches to care

BEYOND cost, there is much that can be done to raise quality. Chief executive of Lien Foundation Lee Poh Wah considers the state of nursing homes here dismal. "I view most of them as cold, clinical factories housing warm bodies which are awakened, cleaned and fed on a regimented schedule. There is an institutionalised absence of life and joy."

Single rooms are the norm rather than the exception in countries such as Australia, Japan and Britain. It is the reverse here, he said, with most people housed in six-bed to eight-bed wards.

To bring back the "home" aspect in the nursing home, the Lien Foundation is setting up a new $15 million building for elderly dementia patients next year.

Besides having single or twin rooms with en-suite toilets, the home will feature a rooftop garden, hair salon and grocery store. Residents can engage in social and recreational activities whenever they wish instead of adhering to fixed schedules.

More operators could develop care models that create homely environments where residents can choose their own schedules, not adhere strictly to regimented ones.

The time is right for a revolution in nursing home care.

One area crying out for a change is facilities for dementia patients. One in 10 of the older adults already has the brain disorder. But many nursing homes here are not purpose-built for them and they can often be seen wandering aimlessly along the corridors.

With a spike in the number of nursing homes, there should also be a way to assess the quality of homes, and publish these ratings, as the United States does.

Already, Singapore is one of the fastest-ageing countries in the world. As of last June, there were more than 430,000 people in Singapore aged 65 and above. That is a whopping 100,000 more elderly folk than just four years earlier.

The numbers are likely to rise to nearly one million by 2030.

It is clearly not feasible to think about exporting Singapore's elderly en masse to low-cost neighbouring towns.

In the end, sending Grandma to JB is not the best solution to the issue of providing aged care.

jantai@sph.com.sg

(The full article is available only to subscribers of Straits Times. Get a copy today or subscribe.)

TIME WE HAD A SENIOR PRIVILEGE CARD

For Malaysians living in Malaysia, the Goods and Services Tax (GST) comes into effect today - 1 April 2015. This is not an April Fool joke. It's for real. Nothing can be harsher than the reality of struggling with limited financial resources to maintain the same lifestyle. It does not help that we also have a weak ringgit. A double whammy indeed for everyone, especially for retirees and pensioners. They will have to tighten their belts a notch or two.

The time is certainly right for the introduction of a senior privilege card. Senior citizens in countries like Australia and the USA have been using such cards for years. About time seniors in Malaysia had one too, and SeniorsAloud will continue to push for it.

The opportunity finally came in Oct 2014 when SeniorsAloud received an invitation to participate in the Social Impact Innovation Challenge, organized by Agensi Inovasi Malaysia (AIM), in the Prime Minister's Department.

Our team members Kamil and Lily attended a one-day workshop as part of the challenge. We were taught how to pitch ideas. We brainstormed a few potential ones and finally decided on a senior discount or privilege card as our entry in the Elderly Care category. We were told that the 12 finalists would receive RM50,000 plus RM25,000 seed money to kick-start their projects.

We worked hard and came up with a slide presentation which we had to submit to AIM through their crowd-sourcing platform Ureka. Before the deadline came up, we were informed that there was no need to submit the slides. A brief write-up about the project would suffice. To cut the story short, our entry was approved. But we never got the chance to move on to the next round where we could pitch our senior privilege card to the selection panel.

Anyway, rather than see our efforts go to waste, we are happy to share the slides here. We welcome feedback, if any.

Setting the context - why the need for a senior privilege card

We figured we would target the middle class as it was affected the most by the rising cost of living. The lower income groups were eligible for welfare packages and subsidies, but the middle class fell outside the ambit of government aid. 

Self-explanatory.

Presenting our objectives. Noble indeed, but perhaps too ambitious?

Identifying the groups that would benefit from a senior discount card. We imagined the long queues waiting to apply for our card, much like lining up to get the Rabbit card for seniors to travel on public transport at 50% off the regular fare.

Some of the many benefits cardholders would enjoy.

As an added bonus for cardholders, we would include free transportation to hospitals by volunteer drivers who would regard this as contributing to the community. Seniors helping seniors.

Phase One: How it works. Such services are already in operation overseas.

Two models to choose from should the project receive the green light. You will be surprised to know how difficult it is for an elderly person to visit the hospital on her own for a check-up or for treatment.

Ok, a little self-promotion here is necessary if you want to sell an idea or business proposition. Our Unique Selling Points.

Wouldn't you want to own one, and not leave home without it?

To be sure, we already have tons of discount cards, privilege cards and membership cards. But one specially for seniors? Some companies have been issuing such cards to seniors as part of their customer service. But how useful are the cards?

I have a privilege card from a pharmacy that is valid till 2017. I hardly ever use it. Why?

• There are simply too many terms and conditions governing the use of the card.
• The discount is small - usually 10%. 
• The discount is applicable for a very limited range of items. 
• It is valid only at outlets operated by the issuing company.

In other words, there is no ONE card that offers seniors a decent discount across a broad range of goods and services.

Isn't it time we had ONE?

IPOH MALI - IPOH, HERE WE COME!

On Wednesday 4 March, 13 members from our SeniorsAloud community boarded the 6am train for a day-trip to Ipoh. For many of us it was a long overdue visit. While some of us took the opportunity to revisit the town, others were eager to take videos of the trip and apply what they had learned from Alan Chai's video-making workshop held last February. As for me, I wanted to try out the electric train service, and also find out more about Green Acres in Meru, touted as Malaysia's premier retirement village.

For those who were unable to join us, here's a pictorial account of our Ipoh trip.

 Time to catch up on sleep - most of us were up at 4.00am to make sure we were at KL Sentral by 5.30am. Getting there at that hour proved to be a challenge. Fortunately everyone made it on time. 

We left at 6am sharp and arrived at Ipoh railway station at 8.20am. Right across from the station was the Town Hall. The two buiildings are part of the Heritage Trail which takes visitors around the older part of the town. I love the architecture of these old buildings built during the colonial era of our country's history.

We were prepared to spend the morning exploring old Ipoh on foot, and were pleasantly surprised on arrival to find a coach and three lovely ladies waiting for us. They turned out to be our hosts cum guides Siew Leng, Mandy and Becky. 

First stop was breakfast at one of Ipoh's popular coffee shops. Every which way you look, you will see a kopitiam. Ipoh is truly the home of Malaysian coffee.

Coffee and toast done and served the old-fashioned way - what a hearty breakfast to start us off on our discovery tour of Ipoh. Despite the huge crowd, service was fast. 

After breakfast, we dropped by at this mom and pop shop across the road. It sold all kinds of preserved delicacies, including a baby shark (see top right corner)! The Chinese will eat almost anything if you tell them it's good for their health.

Outside the Hakka Miners Club with retired Commander Ian Anderson (back row). With 26 years of Ipoh residence under his belt, he is the definitive source of information on the history of the town, and of the Hakka community in particular. We were so lucky to have him as our guide for the hour-long visit which proved to be an eye-opener for many of us.

Ipoh owes much of its early development to these pioneer tin miners from the Hakka comunnity. Photos like these and other items from the colonial era have been lovingly preserved or replicated, thanks to the efforts of dedicated Ipoh residents like Anderson.

Not too sure how present-day Hakkas will view this association with the Jews. But no one can deny their pioneering spirit. 

Listening to Anderson brought back memories of our high school days when we learned so much about the tin-mining industry from our Geography and History textbooks. Today Geography is no longer taught in schools, and History isn't what it used to be. Sad.

The Hakka Miners Club was exclusive to men. The only women allowed on the premises were songstresses or hostesses. The wax figures depict a typical scene at the club during its heydays

Anderson explaining the Four Evils of the early Chinese in Malaya - Opium, Gambling, Prostitution and Triads. A negative association that still persists today albeit to a much lesser extent.

What an opium den looked like. As a little girl growing up in the early 1950s, I recall seeing scenes like this one in the back rooms of the coffee shop near my house. It was common too to see prostitutes waiting for patrons in the back alleys of my hometown.

Another discovery for me - many of my favorite foods like lei cha are of Hakka origin. 

Group photo taken at the banquet table. Laid out are crockery and utensils used in the old days. On the extreme right are our friendly guides who took such good care of us seniors. Admission to the Hakka Miners Club is free, but visitors are encouraged to donate 'generously' as it costs RM5000 monthly to maintain the club.

Next up on our itinerary was a presentation on Green Acres, Malaysia's premier retirement village due for completion (phase 1) in 2017. We were very impressed with the facilities listed, and eager to know more. I hope to visit the show unit when it is ready in a couple of months, and share my impressions on this blog. So expect more about Green Acres soon.

Lunch time. How could we say no to an invitation to sample Ipoh's famous chicken rice and bean sprouts?

For dessert, we had tau-fu-fa from Funny Mountain Soya Bean stall. Their soy bean curd is billed as 'the best in the world' according to the signboard. My verdict? The smoothest soya bean curd I've ever tasted.

Who could resist fried ice cream? A must-try if you are visiting Ipoh. Comes in the usual flavors. 

Spotted these ladies enjoying ice balls at Plan B. During my school days, these ice balls were very popular especially on hot days. Sucking these ice balls was more fun than licking ice lollies. My classmates and I would throw the last bit of our ice balls at each other! 

The last part of our itinerary was the Heritage Trail. Thanks to 'Uncle Looi', the coach driver, we were able to do some sightseeing of the old town in the air-con comfort of the coach.

One of the murals that caught my camera's eye. I have been told that this 'old man sipping coffee' is Mr Lim from Ipoh, and the painting is done by Lithuanian artist, Ernest Zacharevic, who also painted the now famous Penang street murals. Apparently he has been told by Ipoh City Council to alter the image as it resembles former Malayan Communist Party leader Chin Peng.

I couldn't leave Ipoh without a shot of this building. Old Town White Coffee has elevated Ipoh to its current position as one of the top coffee brands in the country.

This young lady was posing for a photo with the sign "We are young". We decided to join her as 'we are young too!'

Back at the railway station to catch the 4pm train home, but not before collecting our orders of salted chicken and kaya puffs - simply the best we have tasted.

After returning to KL and while googling for more info about Ipoh, I stumbled upon this Malay Mail article about Commander Ian Anderson. It was published a few days prior to our visit. We had a local celebrity as our guide at the Hakka Miners Club!  

A big THANK YOU for hosting our group in Ipoh. 

Some tips for those planning a day trip to Ipoh by train. 

Normal fare is RM35. Senior citizens pay only RM22 (one way). For group travel, the tour leader/organizer must provide a photocopy of each of the participant's IC (MyKad) as proof of age (60 and above) to enjoy discounted fare.

The first train of the day departs at 6am. The ticket counter only opens at 7am. But don't worry, tickets can be purchased on the train itself. An attendant will come around to check tickets as well as sell tickets. Do take note that public transport services (bus and LRT) begin at 6am. So you will have to figure out how to get to KL Sentral at that early hour.

The best coach is Coach C - the buffet coach. You can have early breakfast on the train. Ask for seats facing the direction of your destination.  Toilet facilities are available on every coach. The journey takes two and a half hours each way. Although the train makes several stops along the route, each one is only for a minute or two. The ride is very smooth and pleasant. I highly recommend going to Ipoh by train if you don't want the hassle of driving all the way.

Lat, Malaysia's favorite cartoonist, hails from Ipoh. Do get a copy of his books about his growing up years in Ipoh. You will enjoy reminiscing about life in the good old days in small towns across the country.

TENANTS FROM HEAVEN, TENANTS FROM HELL

Count yourself one in a million if you have a tenant who leaves your property in better condition than when he first moved in with his family. My daughter had one such heaven-sent tenant a few years ago. The rest were from hell or some place close to it. The latter can literally drive you up the wall - whatever is left of it.

Some tenants who leave with a grudge are capable of wrecking your property out of spite. One of my friends had her kitchen walls smeared with faeces by the tenant who also left her with a stack of unpaid utility bills. (Photo: Daily Telegraph)

Heaven-sent tenants in my book are those that:

• pay the rent on time
• help to maintain your property in good condition
• pay out of their pockets for extra fittings
• handle minor repairs on their own 
• seldom hassle you with endless complaints 
• do not make unreasonable demands 
• do not sub-let your apartment
• do not use your property for purposes other than as a residence

When it comes to finding good tenants, it boils down to how desperate the owner is to rent out his property. I once had a peek through the open front door of my neighbour's apartment as I passed by. It looked as if it had been bombed or hit by a wrecking ball. The plaster on the walls was peeling, the doors of the kitchen cabinets looked about to fall off their hinges, and the living room sofa should have been thrown out in the garbage dump long ago. And the floor? It was covered with layers of grime and rubbish.

Spotting me at the door, my neighbour invited me in to survey the horror. I guess she wanted to share her shock with someone else, who could also bear witness to the total destruction done. The toilets were filthy and unusable. The mattresses in the bedrooms were grossly stained and the curtains were actually pieces of sarong strung up together. The whole apartment was left in a state resembling this one in the video below.



What kind of tenants would leave their rented premises in such a deplorable condition? For my neighbour, the answer is one word - students. Foreign students. Foreign male students. All 12 of them splitting the rent for a 3-room apartment meant for a small family of five or six. Such massive damage cannot be attributed solely to a lack of responsibilty. Often when tenants leave on a sour note after receiving an eviction notice, they feel they have a right to settle a score. What better way to express this than to leave behind broken furniture and missing fixtures? Also months of unpaid rent and utility bills amounting to thousands of dollars. And don't forget the cost of repairing the damage which could easily run into tens of thousands of dollars. All very painful for the owner indeed.

But I also wonder why my neighbour rented out her apartment to these students in the first place. She was not in dire financial straits. As owners, the onus is on us to choose our tenants carefully, and have them sign a tenancy agreement to safeguard our property. Without such a document, owners are at the mercy of these tenants from hell. Even with the document, there is no guarantee the tenant will honour the terms. Any legal action taken against the tenant can take ages and incur more expenses for the owner. In the end, the tenant gets away scot-free, taking along with him pilfered items from the apartment.

Discarded cupboard left in the common stairway. Unsightly.

What about the common areas like the compound, garbage dumps and stairways? Tenants use these facilities all the time, yet few observe basic rules of cleanliness and good neighbourliness. The prevailing attitude is one of 'it's not my property, so why should I care?' I suspect some owner-residents are just as guilty. Take a look at what my camera captured:

Flat tyres No road tax. No registration plate. Definitely an abandoned car. Just one of a few occupying space in the parking lot.

Fencing being put to 'good' use. Why waste money on a clothes dryer when sunshine is free? That seems to be the rationale behind this tenant's idea of sun-drying his laundry.

A typical example of laziness. Much more convenient to just leave the garbage bags under the bushes than walk all the way to the nearest garbage dump. Maybe a kind resident will take care of it?

When it comes to poor maintenance of common areas, both owner-residents and tenants share equal blame. One of the biggest challenges of property management companies is the collection of maintenance fees and sinking fund. There is often not enough money collected to pay for improved security, better landscaping and more efficient garbage disposal. But there will always be some residents who refuse to pay. They complain that maintenance is not satisfacory, so why should they pay. It's the old which comes first syndrome.

There is nothing much the management can do except to send reminder after reminder to errant residents to settle their outstanding payments. Don't even think about refusing them entry into the compound, or cutting off their water and electricity supply - the management has no power to do so. The only way to recover these debts is to wait till such a time as when the owner wants to sell his property. The sale cannot be finalized until all outstanding debts are paid in full. But what if the owner has no intention of ever selling his property? He can continue to live in his apartment till he kicks the bucket, without ever having to pay any maintenance fee.

This is why there has been a call for a Tenancy Act to protect property owners.

Don't for one moment think that only owners of low-cost and medium-cost apartments are cursed with such abominable tenants. Owners of bungalows and up-market condominium apartments face a different set of problems. Their tenants think that paying thousands of dollars in monthly rental entitles them to make unreasonable demands like asking for high-end bedroom sets, expensive furnishings and fittings, and brand new electrical appliances. You will be surprised how much damage their children and pet dogs can cause to your property. Such tenants can give you severe heartburn and ulcers, and shorten your life span.

Having heard horror stories about tenants from hell, and having personally witnessed the extensive damage my neighbour's tenant left behind in her apartment, I have sworn never to rent out my apartment to anyone. I would rather keep it as a guest house for relatives and friends who are visiting and need a place to stay.

Do read this article on the same topic

What to do when you meet tenants from hell