Who cares? Elderly abandonment and the welfare of informal carers

Legislation to safeguard senior citizens’ rights should also be complemented by measures to ensure the welfare of informal carers.

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Published in Malay Mail, Astro Awani, The Malaysian Insight, and theSundaily, image by Malay Mail.

In an EMIR Research article entitled, “Ageing Population: Catalyst for Health Care-Social Care Nexus” (October 19, 2020), we made the case for integrating health care with social care in view of the demographic shifts. 

But there’s also a critical need for the State to extend its policy focus to the informal care sector too – not least due to the background or legacy issues of elderly abandonment. This is to ensure the preservation of our core values such as filial piety and correspondingly balance the policy orientation towards integration with the need to encourage the practice of informal caring of the elderly. 

According to a recent report from the Ministry of Women, Family, and Community Development (KPWKM), 2,144 elderly patients nationwide have been abandoned by their families in hospitals since the past four years.

The majority of the next-of-kin, i.e., close family members, who could be identified and located declined to take their elders home, citing familial conflicts and a lack of permanent guardianship, according to Minister of Women, Family, and Community Development Datuk Seri Rina Harun.

Due to changing socio-cultural attitudes and practices, there’s a critical need, therefore, for the rights, interests and welfare of the elderly and senior citizens to be enshrined in legislation – to give statutory effect for their protection. 

Towards that end, in order to safeguard and uphold filial piety and basic human rights of the elderly, the government is currently looking into the Senior Citizens Bill which is at its early stages of formulation and drafting. The draft is now being reviewed by stakeholders. 

Deputy Minister of Women, Family and Community Development Siti Zailah Mohd Yusoff was reported as saying that the Bill is scheduled to be tabled in Parliament next year.

According to veteran social activist and ex-MP Tan Sri Lee Lam Thye who’s the Chairman of the Alliance for Safe Community, the idea of a Senior Citizens Act had been mulled 10 years ago.

Its revival is a necessary feature to meet the challenges in our contemporary society where traditional values and norms are being gradually and steadily eroding – which results in the “atomisation” and “de-coupling” of the nuclear and extended families. 

Indirectly, this can threaten the social fabric of our society – leading to less cohesion and alienation. This in turn reinforces the corrosive and scarring effect of materialism and a “compartmentalised” secularism (which doesn’t overlap with religiosity so that the latter is merely an empty ritual and devoid of devotion or conviction) on the overall well-being of the individual and society. And also subversive of morally sensitive values such as empathy which is an essential ingredient of what it means to be human and humane. 

In addition to public policy and legislation (which is necessary to re-humanise our society), the government must also look into the root cause of the phenomenon of elderly neglect. 

The natural dependency due to ageing of the elderly on their children can also be exacerbated by the lack of adequate or even zero retirement funds as embodied by the Employees Provident Fund (EPF). 

Even as worryingly, a significant number of elderly people are not covered either by the Employees Provident Fund (EPF) or the government’s pension scheme in the form of KWAP, according to social security economist Dr Amjad Rabi from the University of Malaya’s Social Wellbeing Research Centre (see “Politics and Policy: Old and Out of Money”, The Edge Markets, June 4, 2020). He is quoted as saying that “[d]espite the large number of [social assistance] programmes, these arrangements [by the Social Welfare Department and other authorities such as Socso still] exclude a significant share of those who are targeted [i.e., this second group of poor elderly people]”.

Demographic shifts are also a contributing factor, whereby there are less children to support the elderly parents, for example. Dr Amjad Rabi has also highlighted that “[i]n 2000, there were 16 persons of working age to support each senior citizen in Malaysia, says Amjad in an email interview. [But in] 2020, there [were] only 10 and, by 2050, there will be only be four of them to support one elderly person”.

As a result, senior citizens are particularly susceptible and vulnerable to old-age poverty if they’re on their own, especially in relation to those who were from private sectors or self-employed. 

Last year, the EPF warned by stating that 48% of EPF members under the age of 55 have alarmingly low savings and were at risk of old-age poverty. 

Consequently, many of the elderly found themselves needing to rely substantially or wholly on their family members. However, this has a significant impact on their caregivers who are usually employed and are married with their parental responsibilities and commitments. As a result, their productivity at work can be affected or compromised, which could have an impact on their finances. 

Numerous studies have demonstrated that providing intense and continuous care for a loved one has an impact on employment or interfere with work, resulting in shortened workdays, absenteeism, poor job performance, or early retirement (see e.g., “The impacts of caregiving intensity on informal caregivers in Malaysia: findings from a national survey”, BMC Health Services Research, 2021).

The National Health and Morbidity Survey 2019 has shown that 54.1% of caregivers for high-intensity care are (either fully or partially) employed and 68.5% are married. 

It is also crucial to note that 45.9% of the caregivers are from low-income families. This might correspond to the affordability of formal service institutions for elderly care being inaccessible to the group.   

In caring for the elderly, these informal caregivers frequently disregard their own needs. Considerable research conducted in Malaysia have revealed that these difficulties include not only financial insecurity, conflict of family obligations, distraction from workplace responsibilities but also health issues. Ironically, many of these caregivers end up by neglecting the seniors because they are so stressed out and couldn’t cope with the pressure anymore.

Presently, there are only two main sources of financial assistance for the elderly – one direct and the other indirect by policy design, respectively i.e., the Bantuan Orang Tua (BOT) scheme administered by KPWKM and Bantuan Rakyat 1Malaysia (BR1M). 

Within the last decade, both BOT and BR1M have been expanded significantly (akin to “automatic stabilisers” as representing the financial outlay of the government which increases the deficit and as a kind of a “reverse” fiscal drag) to meet the huge pressure for old age protection.

The BOT programme increased 4.2 times from 2008 to 2016 and covered 133,352 old age recipients as per the KPWKM data for 2017 shows.

The country’s ageing population and demographic shifts represents a huge indicator and signal to the government in the pursuit of its deficit reduction and fiscal consolidation commitment (in that it’s simply unrealistic to aim for “too low” a figure as EMIR Research has consistently cautioned before). 

At the same time, monetary policy will also have to definitively take note vis-à-vis the overnight policy rate (OPR). In other words, what constitutes policy normalisation will have to re-defined and re-configured. 

A recent Khazanah Research Institute (KRI) study has estimated that 60.3% of senior citizens are in the B40 group. However, since there’s no legal or statutory and, therefore, formal recognition for caregivers, they’re not given the necessary resources and support system to discharge their responsibilities and commitment on a sustainable basis.

According to the National Health and Morbidity Survey 2019, the majority of informal caregivers in Malaysia (65.5%) received their primary support from family members, with only sporadic assistance from outside, i.e., the State. 

Prominent constitutional expert and jurist Professor Datuk Dr Shad Saleem Faruqi has suggested that the government must make it mandatory for children to take care of their parents. He made reference to Singapore’s Maintenance of Parents Act (1995) and said that Malaysia ought to follow suit.

However, making it a legal or statutory duty for children to look after their parents is perhaps not yet a viable solution. 

Professor Datuk Dr Shad Saleem Faruqi suggested that Malaysians ought to be able to take unpaid time off to care for their ill or infirmed spouse, child, or parent(s). In addition, flexible working hours or arrangements which are already in place due to the impact of the pandemic such as working from home (WFH) and hybrid schemes sould be readily explored.

A study done in Australia and the UK show that taking unpaid leave has a greater impact on working hours leave and productivity rates than having flexible working hours when caring for the elderly.

Other than requiring children to look after their parents, Professor Datuk Dr Shad Saleem Faruqi argued that carers also need to be protected by legislation precisely because they are under-appreciated and not recognised as such. According to him, encouraging caring as a new (and emerging) profession is critical.

Malaysia should look to other countries (other than Singapore) as part of the currently on-going formulation (which includes consultation) process for the Senior Citizen’s Bill. 

In Belgium, for example, informal carers have been legally recognised by the government since 2019. Thus, they could enjoy protection and receive support from the State. Those who are registered as informal carers are able to reduce their working time and are protected against dismissal from work. 

The government should introduce a carer’s allowance like in the UK. The carer’s allowance offers financial assistance to informal caregivers, who need not be connected to the elderly person as long as their salary is below as certain amount.

In France, informal carers have the option to reduce their working hours as well as enjoy a medium-term paid-leave benefit (in the form of a compensation for up to three months). 

Denmark has an Act on Employees’ Entitlement to Absence from Work for Special Family Reasons (2006).  Employees have the statutory right to a paid leave with no fixed time limit for the care of a someone close dying – subject to eligibility conditions which could be modified in our context, including the minimum amount of payment or wage conditions. Socso can be a co-payer. 

In summary, creating legislation to safeguard senior citizens’ (basic) rights should also be complemented and supplemented by the policy focus and relevant measures to ensure the welfare and financial situation of informal carers.

Jason Loh and Nik Nurdiana Zulkifli are part of the research team of EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.

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