KUCHING: The mention of ‘aging’ and ‘Asia’ in the same breath tends to draw the picture of Japan, the oldest country on earth by population – which by 2020 will host 40 per cent of its adult population who will be over 60.
However, it may surprise some to learn that other Asia-Pacific countries are also host to the largest and the fastest-aging populations on earth.
By 2030, China for example will have 340 million people over 60 – this is 47 million more than the entire population of the US in the same year. China’s rapid rate of aging is matched by Korea, Hong Kong, Singapore, Taiwan, and Australia.
Apart from providing an intellectual playground for demographers and economists, the age of its population makes Asia the perfect ‘laboratory’ for developing products and services for older people.
With better living standards and modern healthcare, Malaysians are living longer than before. But comfort in old age requires more than being financially sound although having the means makes it easier.
The burgeoning number of senior citizens is expected to create a whole new market for elderly health-care and lifestyle services and facilities such as retirement homes, villages and mobile homecare, especially for those who may not have relatives around to look after them.
In Malaysia, the Ministry of Women, Family and Community Development defines those above 60 years of age as senior citizens as agreed on, subsequent to the United Nations World Assembly on Ageing 1982 in Vienna.
A country is said to have become an ageing nation when 15 per cent of the population falls into this group. Recent projections estimate Malaysia will achieve that status in 2035.
An ageing population needs better public facilities, services and social support than are currently available. Facilities and services must be easy to use, safe and convenient. These values, which are all encapsulated in the Principles of Universal Design, cover the designing of products and facilities so that they can be used by the broadest spectrum of people.
Social support like emotional and financial assistance must be easily accessible and not buried under layers of bureaucracy.
According to the Department of Statistics, there is an estimated 2.7 million senior citizens as of 2014. That is a sizeable 8.9 per cent out of the total population of 30.3 million.
The World Health Organisation also noted that the world will have more people who will live into their 80s and 90s. As they age, they lose their ability to live independently due to increasingly limited mobility, frailty or other physical or mental health problems. Many need long-term care either at their own home, in institutions or hospitals.
With families becoming smaller, the responsibility of caring for aged and ailing parents may be challenging, especially when children are working and living in another city.
This situation is made more difficult and financially demanding when both sides of the family have elderly parents requiring constant care and medical treatments or having to be put up in nursing homes.
Health care, among both providers and payers in public and private settings, is a very costly industry sector.
The Economist Intelligence Unit (EIU) estimates that global health care spending as a percentage of Gross Domestic Product (GDP) will average 10.5 per cent in 2014 (unchanged from 2013), with regional percentages of 17.4 per cent in North America, 10.7 per cent in Western Europe, eight per cent in Latin America, 6.6 per cent in Asia/ Australasia, and 6.4 per cent in the Middle East/Africa.
Deloitte noted that 2014 looks to be a positive but challenging year for the global health care sector; one in which many historic business models and operating processes will no longer suffice amid rising demand, continued cost pressures, lack of or inadequate care facilities, and rapidly evolving market conditions.
“The shared, long-term trends of an aging population and an increase in people inflicted with chronic diseases are expected to drive demand for health care services in both developed and emerging economies in 2014 and beyond,” it said in its Global Health Sector report 2014.
The global population age 60 or above has tripled over the last 50 years and is expected to more than triple again over the next half-century, to reach nearly two billion in 2050.
Improving health care access is a major goal of governments around the world, and a centerpiece of many reform efforts.
While facilitating increased health care access is an important and worthy endeavor, more people in the system means more demand for services that numerous health care systems are unable to accommodate due to workforce shortages, patient locations, and infrastructure limitations, in addition to the cost issues identified earlier.
Many countries across the globe are facing a challenge to meet their required number of health care workers, a shortage that directly affects the quality of care. Globally, the number of doctors per 1,000 population is expected to remain virtually the same between 2012 and 2015.
Bolstering the number of professional medical, nursing, and other health care professionals is not the only staffing challenge facing hospitals and health systems in 2014 and beyond.
Organisations will need to source, recruit, and retain staff, such as advanced nurse practitioners and telemedicine technicians, who are trained to meet the needs of new 21st-century health care models.
Sarawak’s initiative
Within a Malaysian context, Sarawak has taken note of this niche and made a move via a collaborative effort from Sarawak Construction Sdn Bhd and Optimum-Eden Healthcare Sdn Bhd in its project named Eden On The Park.
Eden on the Park project managing director Victor Fong in an interview with BizHive Weekly noted that the population of Malaysia above 60 years old is expected to be 10 per cent of the population by 2020. With that milestone Malaysia becomes an aging nation under the United Nation’s classification.
“Assuming that the population by then is 32 million, we will have 3.2 million people above 60.
“Right now there is no such facility in the country. In time to come, when the public accepts the concept I can see a shift to demand for integrated aged care facilities like the one that we are pioneering.
“Assuming, of the 3.2 million people and potentially, say 1.8 million potential couples or users, and only 10 per cent of them are willing to invest and shift into such facilities, we have 180,000 homes to build. This industry can be RM90 billion in value or more,” he explained.
Fong added that the industry will grow in tandem to people’s changing attitudes to such concept as for how long it takes, it would depends on how receptive people in Malaysia are. Social trends and needs will push the change in mindset.
“Right now the trend is for family units to be broken up. More young couples are shifting out to set up independent homes and many migrate to work overseas.
“Parents who are unable or reluctant to move on with their children find themselves living alone and unable to care for themselves when they aged. This is not a matter of choice. It is necessity.”
Fong noted that another reason is that the banking industry now does not easily agree to provide loans for people above 60 years. This is especially so if they are retried and have no regular income.
Developers find it hard to sell to this group of people hence the lack of interest.
To clarify, Eden On The Park is the first integrated senior lifestyle and care residence resort facility in Malaysia.
It is the leading integrated senior lifestyle brand developed on the 3R concept – rest, recreation and rejuvenation and built around the 5S principles of security, safety, support, service and sustainability.
The integrated senior lifestyle and care residence resort are based on proven models in Australian and New Zealand which is designed to make sure that every citizen can contribute as much as possible toward their cost of care, depending on their individual income and assets.
This means that residents pay only what they can afford, and the commonwealth government pays what a resident cannot.
An Australian statutory authority, the Productivity Commission, conducted a review of aged care commencing in 2010 and reporting in 2011 which concluded that approximately 80 per cent of care for older Australians is informal care provided by family, friends and neighbours.
Around a million people received government-subsidised aged care services, most of these receiving low-level community care support, with 160,000 people in permanent residential care.
Following the design which avoiding the mistakes, the facilities at Eden on the Park are designed to be age-friendly with amenities to encourage community living and social interaction for the active and healthy while also providing specialist nursing care for those who need it in an adjacent property within the same neighborhood.
The project boasts of 104 luxury apartments with 14 units of exclusive single storey villas for active senior living.
A separate care residence is also available with 72 suite rooms with a capacity of 143 beds for assisted living and acute care.
Fong further enthused that correct branding is vital to alter existing mind-sets and kick-start the industry locally, hence introducing the ‘3R’ concept of ‘rest-recreation-rejuvenation’ for the project.
Adjusting products and services to accommodate the changing physiological needs of the aging consumer is a challenge for virtually every company.
The intricacies of physiological aging will affect a company’s distribution infrastructure, retail environments, support services, and communications, as well as product design.
The entire customer journey must be adapted to accommodate the changing needs of older consumers. If companies want to succeed in this older world, they need to become age-friendly.
“We believe that state-of-the-art security systems and a design which is aged-friendly, easily accessible and able to respond to emergency situation is key.
“Our project will not only provide social support, but also have in place programs to encourage interaction and activity participation.
“Residents have the freedom of being as active or inactive as they want to be.”
“Cleaning and maintenance service is optional to allow for dispensing with the need for domestic helpers while the unique care and on-line medical record keeping systems allow residents the peace of mind that care is readily accessible if required,” he added.
For the financial aspect of things, company chairman John Chin observed that thanks to the miracle of modern medicine, most people now live a relatively long life and are experiencing that savings alone is not enough to sustain them for the rest of their lives.
“Eden on the Park’s unique financial architecture helps to address this issue as it enables the residents a carefree existence without the worry of long term maintenance commitments,” Chin highlighted.
Fong enthused that Eden-on-the-Park is developed in line with the needs of Malaysia’s aging society.
The Government of Malaysia too has place priority for aged care under its Economic Transformation Plan and as one of the National Key Result Areas (NKEAs). Because of Eden’s initiative and being first on the block the company was on 26th June, 2014 awarded a pioneer status by the Prime Minister’s Department as an Entry Point Project (ERR 17-Retirement Village). Various tax incentives were provided to encourage the growth of the industry.
This initiative could also be expanded into a medical tourism sub-sector as global medical tourism market that is seeing particularly rapid growth in Southeast Asia.
US-based industry resource Patients Beyond Borders estimates the world market is expanding by 25 per cent per year, and reached US$55 billion with 11 million medical tourists in 2013 and with that, Southeast Asian players like Malaysia, Singapore and Thailand are aggressively promoting treatments at up to 80 per cent cheaper compared to developed nations.
Malaysia’s market has nearly doubled since 2010, reaching 770,000 patients and US$200 million in revenue last year, according to government figures.
Frost and Sullivan in a recent statement noted that Malaysia has successfully attracted 19,488 retirees from 120 countries to settle in the country since 2002.
It is estimated that the market worth of the Aged Care industry in Malaysia by 2020 will be US$1.4 billion.
The form of elderly care provided varies greatly among countries and is changing rapidly. Even within the same country, regional differences exist with respect to the care for the elderly.
However, it has been observed that the global elderly population consume the most health expenditures out of any other age group, an observation that shows worldwide eldercare may be very similar.
We must also account for an increasingly large proportion of global elderly, especially in developing nations, as continued pressure is put on limiting fertility and decreasing family size.
Traditionally, elderly care has been the responsibility of family members and was provided within the extended family home. Increasingly in modern societies, state or charitable institutions are now providing elderly care. The reasons for this change include decreasing family size, the greater life expectancy of elderly people, the geographical dispersion of families, and the tendency for women to be educated and work outside the home.
“In trying to understand how we as a nation can better deal with managing care for the aging, we should appreciate how developed nations cope,” said Dato’ Sri Idris Jala, CEO of Pemandu and Minister in the Prime Minister’s Department in his website.
“Japan’s population will fall by a third in 2060, with nearly 40 per cent being above 65 years of age. Lifespans tend to be longer for developed societies with access to medical technology and high standards of medical care – in Japan’s case, their life expectancy is about 83 years.
“As we approach high income, developed nation status, we are heading in a similar direction. The average life expectancy for a Malaysian in 1957 was just 56 years. Now it is at 75 years. By 2020, the number of Malaysians aged 60 and above is expected to hit 4.46 million up from the current 2.32 million.”
As aging is inevitable, one should always view the silver lining in the landscape. The increase in the aging community has opened up an avenue for the local economy and with Sarawak embarking on this pioneer project it is no doubt an idea worth taking.