Sunday, July 26, 2015

OPPORTUNITIES TO SUPPLEMENT YOUR PENSION

For many of us retirees, tightening our belts has become part and parcel of daily living. We think twice before purchasing non-essential items. Even when shopping for necessities, we have taken to comparing prices first before making a decision. Getting value for money is our shopping credo now.

It's not that we can't afford to spend, but with the implementation of GST, the weakening ringgit, and the escalating rise in the cost of living, we have to keep a careful eye on our spending. Unless we have shares that pay decent dividends, or own a small business that generates some income, we are depleting our savings as we spend. How long will our retirement funds last? Will our nest egg be sufficient to see us through the next 20 years? All it takes is just one major health crisis or a financial setback to wipe out a big chunk of our savings.

Falling back on our children for financial support is no longer an option. They have their own family and financial commitments to take care of. Consider ourselves fortunate if they don't seek support from us!

Award-winning occupational therapist Lim Hwee Er is founder of Goshen Consultancy Services

So this leaves us with no choice but to work for as long as we are able, or invest wisely to generate some extra income for rainy days and old age.

I'll leave the financial experts to advise on investments. With age working against us in the employment market, the most feasible option is probably to start a small home-based business. Below are some suggestions that require minimal start-up capital, and virtually no overheads to worry about if you operate from your home. What you must have are determination, resilience and commitment to deliver your best.

If you live in a residential neighbourhood e.g. Taman Megah, or in a condo complex e.g. Mont Kiara, you already have a pool of potential customers for the following services:

Home Tutoring and Classes
  • Home tuition - especially recommended for retired teachers. So convenient for parents looking for an experienced home tutor to coach their children in English/Bahasa, Maths and Music. There is also demand to teach Conversational English to expat wives and other adults who have a desire to improve their English.
  • Cooking classes - easy enough to conduct cooking or baking classes in your home. Or rent a multi-purpose function room in your condo block to conduct your classes.
  • Computer classes - you will be surprised how many seniors are eager to learn how to use the internet and social media. You can conduct classes for interested seniors. They bring their own laptops or tablets. 
Consider teaching seniors how to use social media either on a personal tutor basis or in a class.

Personalized services
Home Physiotherapy (Image: AsiaOne.com)
  • Physiotherapy, massage, pedicure, manicure, facials, etc. Make use of your experience in these fields. If you don't have the experience but have an interest to learn, go get the training required.
  • One of my friends conducts swim classes for seniors in their condo pool. They can choose to have one-to-one instruction, or in a group of three. 
  • Confinement ladies are earning very good money, often commanding RM8000 and above for their services for just one month of post-delivery cooking and caring for the newborn baby. In Singapore, the going rate can be as high as SGD3000!
Confinement ladies can make good money especially in Singapore (Image from The Ant Daily)

Small home-based businesses

Just as there ia a huge demand for services targeting parents with little children e.g. home child-minding, daycare centres, tuition centres, there is an even greater and more urgent demand to provide similar services for the elderly.

Start small within your condo or neighbourhood community. If you satisfy your customers, they will promote your services by word of mouth. Maintain quality control and prompt service, and you can be assured of a viable business that will contribute towards your nest egg. I know of friends who are doing splendidly operating from their home kitchen, taking orders for cakes, jams and roasted nuts.

With global ageing comes a wide and varied range of services that cater to the needs of the elderly. Opportunities are excellent for those interested in targeting this niche market:
  • Daycare centres for the elderly, There is a HUGE demand for such a service. Statistics are not available, but the number of elderly parents left alone at home is on the rise. Adult children with elderly parents would welcome such centres. Start small by taking in not more than five elderly who required minimal assistance with feeding and mobility.
  • Meal delivery to the elderly. The elderly have special dietary needs. Meal delivery would appeal to them, especially to those who find it a hassle to cook.
  • Transport-on-call. Provides an essential service for the elderly living alone who need to see the doctor or do grocery shopping. The service comes with extras, like keeping the elderly company at the hospital, or helping with the groceries.
Meal delivery at your door-step for senior citizens (Image: Internet)

If you are seeking paper qualifications or skills training for any of the above, check out what courses are offered at baking schools, IT centres, Centres for Continuing Education at local universities. MCA Wanita as well as Women's Institute of Malaysia (WIM) regularly conduct courses to equip women with skills to enable them to earn an income.

There are also free online courses that you can sign up for. All it takes is just a Google search to find out what's available, where, and when.

A baking class in session at MCA Wanita's training course for confinement nannies (Image from MCA website)

As long as you have the drive and the determination to succeed, you are never too old for an encore career, or be your own boss. Not only does working keep you mentally, physically and socially active, it helps to supplement your retirement funds. The key is to find a vocation or a business that drives you. Then it is no longer work but a passion.

Wednesday, July 15, 2015

SHALL WE SEND MOM TO A PRIVATE HOSPITAL OR A GOVT HOSPITAL?

When an elderly parent has a bad fall and requires immediate medical attention, what do you do?

Call for an ambulance.

"Which hospital to send her?"

You have little time to think of comparative costs, hospital's reputation, doctors on your contact list. etcetera. There is even less time to consult family members.

So if you have an elderly parent living with you, it's advisable to do some homework and be prepared in the event she has to be admitted to the hospital immediately. Here are some factors that will help you decide where to send her, namely;
  • costs - how much can you pay? What's your max?
  • location - is the hospital close enough for daily visits?
  • reputation - what have you heard about the medical expertise and nursing care?
  • services - how efficient and integrated are the services?
  • facilities - do the facilities meet your expectations of comfort, care and convenience?
Still applicable by and large for public hospitals, but for private hospitals, the fees have skyrocketed. (Sourced from Astro Awani)

Surgery and hospital stay at a private hospital can swallow up a sizable portion of your retirement savings. If your elderly parents are in their 80s and 90s, they probably have no medical insurance. If you can afford it, or if your siblings are prepared to share the hefty bill, then by all means, opt for a private hospital.

Otherwise, go with a government hospital. Whether they work in a private hospital or a government one, all medical doctors are commited to the Hippocratic Oath to treat, mend and heal patients entrusted to their care. Even in teaching hospitals, senior surgeons and professors are there to supervise and step in when the situation calls for their intervention. So there is really no need for concern in this aspect.

The modern version still maintains the essence of the original

If there is any difference, it is arguably in the quality of nursing care. Private hospital nurses are at your beck and call. They cater to your every need or demand. They have better bedside manners, are more gentle and patient, and make an attempt to get to know you as an individual. But it will cost you. Nothing is complimentary. Every service or item, no matter how small, is chargeable.

Contrast that with the nurses in government hospitals, or at least in the one where my mom was admitted. The nurses behaved as if they were doing my mom a favour rather than providing a service. A couple of times my mom was busy with visitors and missed the diaper change when the nurses made their rounds. She had to wait till the next round which was hours away. When I asked for her diaper to be changed, the nurses showed their annoyance. On one occasion when I approached the nurse to change the bedsheet as my mom had wet it, she handed me a fresh bedsheet, expecting me to do it all by myself!
These are 2009 prices. Expect to pay much more now with GST. See below for current fees.

Government hospitals are heavily subsidized, so charges are a whole lot lower. For comparison, in March 2011, when my mom was discharged after 15 days in a private hospital for hip surgery and angioplasty, the bill came to a whopping RM45,532.90. This excludes the charges for rehabilitation and medicine. The itemised bill came to several pages!

Compare this with the costs incurred for my mom's recent 9-day stay in the orthopedic ward of a government teaching hospital. Irrespective of room-type, patients were charged RM70 a day. This covered breakfast, lunch, tea-time and dinner. You could select your meal from the daily menu. X-rays cost RM85 each, physiotherapy sessions RM20 each and doctor's (intern) consultation was Rm15. Add RM2120 for the PFNA device, and another couple of hundred for diapers, medicine, rubber gloves and other essential items, the grand total came to just under RM5000.

An amendment to the 13th Schedule of the Private Healthcare Facilities and Services Act 1998 passed in Dec 2013 allows doctors in private clinics and hospitals to raise their fees. But as the official receipt above shows, some specialists can charge as much as RM340 or more for consultation and medicine.

The majority of middle income wage earners can't afford the high cost of sending a loved one to a private hospital. They will have to opt for a public hospital and bear with the less than satisfactory nursing care, basic facilities, and long queues for consultation and for medicine.

(On a separate note, if you are unable to stay in the hospital ward with your loved one for the entire period, you can hire the services of a part-time nurse. Charges are RM12 an hour at the hospital, and RM15 an hour for home care. The minimum is 12 hours to make it worth their while.)

Some conclusions:

  • Invest in medical insurance for yourself and your family if you haven't done so yet. Pensioners and their spouse enjoy free medical treatment and hospitalization, or pay only a nominal fee.
  • When you do your retirement planning, remember to factor in medical expenses for your elderly parents. Most financial planners don't mention this crucial allocation.
  • How much you can afford to pay is more important than showing how filial you are. Filial piety is not measured in monetary terms. Your mom will recover from hip surgery whether it is done in a private hospital or a government hospital.
  • Find out what you have to do to prevent falls in the elderly. My mom fell not once but several times, including two falls that required surgery and hospitalization. The first time she slipped and fell outside the bathroom. The second time she fell from her bed. Just bear in mind that despite the closest supervision and best preventive measures, accidents can and do happen. We can only reduce the risks.
  • Take care of your health. Keep fit. Eat sensibly. No awareness campaign is as powerful as the harsh reality of seeing patients in ICU with tubes inserted in their body after heart surgery. Equally heartbreaking is to hear the cries and moans of the patients in the orthopedic ward after amputation. An elderly patient in the room next to my mom's lost both legs and an arm because of diabetes. The government's anti-smoking campaign requiring all cigarette packs to carry images of lung cancer has met with limited success. To quit, smokers need to face harsh reality, not 2D images, campaigns or exhortations.
For a list of private hospitals, click on this link: http://new.medicine.com.my/private/hospitals/

For a list of government hospitals, click on this link: http://new.medicine.com.my/government/hospitals/

Wednesday, July 1, 2015

OH NO! MOM FELL - AGAIN...

Mom before she was
admitted to UMMC
The call came early on Saturday 20 June, at 7.27am to be precise. "Mom fell and fractured her left leg." Oh no, not again! The last time I received a similar call was in March 2011 when she slipped and fell at home. She broke her hip then, and had major surgery followed by months of rehabilitation. It was a traumatic experience both for her and for me as her primary caregiver. I had prayed that we would never have to go through the painful ordeal again. ("Mom Fell And Broke Her Right Hip")

Alas, with that phone call from my brother, it was deja vu all over again.

I cancelled all my appointments in Singapore for the following week, and took the earliest available flight back to Kuala Lumpur. It was straight from KLIA2 to UMMC (Universiti Malaya Medical Centre) with my luggage and all.

Before surgery - Mom's left leg all wrapped up and weighted down to keep it straight and raised. Even so, she was able to kick away the pillow and roll over on her left side. Surely that must have hurt?

The PFNA Asia (also known as PFNA II)
Mom had been rushed to emergency at UMMC, and subsequently admitted to the orthopedic ward. X-rays showed she had sustained a fracture to the femur near the hip joint. She had fallen from her bed to the floor in the nursing home. Due to her age (mom is 89), that minor fall was enough to cause a fracture. The doctors said she would require surgery, and gave me a number to contact to order (and pay in advance) a device called 'proximal femoral nail antirotation' or PFNA.

Surgery was scheduled for the afternoon of Monday 22 June. Unfortunately, just before she was wheeled into the operating theatre (OT) final tests showed her blood pressure was way too high to risk going ahead with the surgery. The doctors decided to postpone it to the morning of Wednesday 24 June.

During the intervening days, the nurses administered medicine to lower mom's BP to an acceptable level for surgery to proceed on Wednesday. When mom was wheeled out hours later from the OT, her eyes were wide open and she was alert. I noticed she wasn't on a drip. The instant she saw me, she called my name and insisted I accompany her back to the ward.

Obviously the surgery was a success. Post-surgery, however, was an entirely different story.

The two incisions where the PFNA device was inserted.

Caring for an elderly with dementia is vastly different from caring for one without. Dementia patients especially those recovering from surgery require supervision 24/7. My mom has dementia and this complicated matters tremendously. Her inability to understand and remember instructions made her most uncooperative to the point of being unintentionally rebellious. She couldn't fathom the need to have tubes, needles and bandages on her body, and was in the habit of removing them repeatedly, much to the frustration of the nurses and doctors. 

She kept demanding help to get up and use the toilet. When reminded that she had diapers on, she insisted she didn't want to soil her pants. This was what upset her most - the loss of dignity and privacy at having to rely on others to change her diapers. She would scream, curse and swear at anyone, including the nurses, who didn't give in to her demands. 

Before surgery (left) and after (right)

She couldn't recall that she had just had lunch or dinner, and demanded to be fed again. It was a challenge watching over her 24/7 to make sure she didn't try and get up, or remove the bandages/plasters/diapers. I had to resort to the services of a private nurse to relieve me on three occasions so I could get some rest. I was also lucky to have my sister-in-law come by on Saturday 27 June, so I could attend a workshop on 'Essentials of Dementia Care' organized by Alzheimer's Disease Foundation Malaysia (ADFM).

On Sunday 28 June at 4pm, Mom was discharged from UMMC. That day was also my birthday. Indeed it was the second time I was spending my birthday in hospital,  Only this time I was not the patient.

Mom with my bro Henry at her new nursing home in PJ
Right now Mom seems to have settled in nicely at this nursing home in Petaling Jaya, one of the very few that accept post-surgery admissions.

This is only the beginning of the road to recovery for Mom. She is one tough cookie. I am sure she will bounce back and be on her feet in no time.

(This post was written to share with family members and also with carers who may be going through a similar experience with their loved ones. More posts to follow...)