Provision of Long-Term Care and Payment Options for Elderly People Living in Kuala Lumpur and Selangor, Malaysia

Background
This dissertation attempts to assess Malaysia’s readiness to tackle the challenges associated with the provision and financing of long term care services brought about by rapid population ageing. This is done by conducting research on a sample of individual respondents and a number of care institutions from Selangor and Kuala Lumpur. The research objectives are (1) to investigate if there is appropriate placement of elderly Malaysians in nursing homes, care centres and at home; (2) to determine if the nursing home and care centre services provided meet the minimum requirements set by the authorities; and (3) to find out if elderly Malaysians who need long-term care are able to finance their long-term care needs in a sustainable manner and to gain an understanding of the payment options available for long-term care services.

Methodology
Quantitative methods were used for hypothesis testing and statistical analysis, while qualitative methods were used to study the subjective experience of long-term care services provided in nursing homes, care centres or at home, and whether participants had sufficient money to pay for long-term care services. 419 participants were interviewed.

Of these 419 participants, 154 were residents of nursing homes and 154 were provided with services from care centres. 111 were staying at home. The number of nursing homes and care centres assessed were 9 and 3 respectively.

Results
The results for research objective 1 reveal that there is inappropriate placement in relation to the actual level of care needed by elderly Malaysians in Selangor and Kuala Lumpur. Elderly persons in nursing homes and care centres have median Barthel Index scores of 35 whilst elderly living at home have a median Barthel Index score of 50. The Kruskal-Wallis H test is used to determine if there are any significant differences in the scores across the three types of care placements. There is a statistically significant difference between the Barthel Index scores of the elderly participants across the three types of placements (H(2) = 17.20, p < .001), with a mean rank of 204.44 for those in nursing homes, 187.48 for those in care centres, and 248.95 for those in home care. There is a significant difference in the Barthel Index scores between those placed in care centres (M = 36.14) and those in home care (M = 51.35) at the p<.05 significance level. There is no statistically significant difference in Barthel Index score between those placed in care centres and in nursing homes. Similarly, there is no statistically significant difference between those placed in nursing homes and those in home care. This study finds that inappropriate placement of the elderly in nursing homes stands at 29.2%, i.e. of all the nursing home residents in the study sample, 29.2% did not need to be placed in nursing homes when assessed using the Barthel Index. However, the degree of inappropriate placement is much higher for elderly research subjects in care centres and at home i.e. 89% and 70.3% respectively. Using the z-test of difference in proportion of the inappropriately placed, (i) the proportion of residents who are inappropriately placed in care centres (.89) is significantly different compared to that of residents in home care (.70), z = 3.84, p < .05, (ii) there is a significant difference in proportion of residents being inappropriate placed between care centres (.89) and nursing homes (.29), z = 10.66, p < .05 and (iii) the proportion of residents who are inappropriately placed in nursing homes (.29) is significantly different compared to that of residents in home care (0.70), z = 6.61, p < .05.

The findings for research objective 2 reveal that none of the licensed nursing homes and licensed care centres comply fully with all the minimum standard requirements of the Private Healthcare Facilities and Services Act 1998 (Act 586) and Care Centre Act 1993 (Act 506).

The results for research objective 3 support the hypothesis that elderly Malaysians who need long-term care in Kuala Lumpur and Selangor are not able to finance their long-term care needs from their own savings. For example, 75.5% of the participants (the vast majority) do not have enough savings to pay for the required services on their own when the participants were interviewed.

Conclusion
The research reveals that there is significant inappropriate placement of elderly in nursing homes and care centres. There is also significant inappropriate placement of elderly in home care. Compliance of nursing homes and care centres with all the minimum standards requirements of the Private Healthcare Facilities and Services Act 1998 (Act 586), Care Centre Act 1993 (Act 506) is also a major problem, pointing to a weak enforcement of the Acts by the regulators. Home care services in Malaysia are not regulated. The findings also reveal the continued upholding of the cultural value of filial piety – i.e. adult children (and other family members) continue to take responsibility to look after their elderly parents. However, this is due in part to the reality of the inability of elderly Malaysians to save for long-term care on their own.