By Dr Thomas S.K. Tang
Managing Director, KLCSI
Malaysia has an ageing problem. Compared to European countries which took 100 years to double their populations aged 65 and above, Malaysia will take only 23 years to double from 7% in 2020 to 14% in 2043. This is a reflection of longer life expectancy, good public healthcare and smaller families – all robust signs of a developed society. The downside is that we do not have much time to prepare for a new set of issues that come with ageing.
What are the challenges that an ageing population brings?
Firstly care and attention of the elderly will be critical. The old are more prone to chronic diseases, sleep disruption, psychological problems and cognitive decline. Healthcare models will have to be reconfigured to cater for the aged who have spent a lifetime of modern living with all the associated stresses.
Housing will another challenge as homes designed for the young and active slowly become difficult for the elderly to cope with. Whilst ageing in one’s own place is undeniably the best approach for a greying population, the practicalities of navigating stairs and squat latrines become physically insurmountable as one ages. Moving to aged care homes is a possibility but not everyone can afford the high end comfortable places instead ending up in homes of a basic nature at prices they – or their offspring – can just manage. There are many other problems but the immediate one that springs to mind is degeneration both physically and psychologically. Even with extended retirement ages, there will come a time when we all cease working and attempt to maintain a level of activity in our lives to keep ourselves occupied.
The converse is rapid deterioration when retirement is epitomized by emptiness and boredom. Much of our social stimulation is triggered by human company. Deprived of the latter, it is easy to see how decrepitude becomes synonymous with being abandoned or ignored. A simple solution to the challenges represented above is to promote more intergenerational living.
Houses are expensive at the best of times so an affordable housing model for the young could be to share living quarters with the elderly. This occurs anyway as children age and they cannot afford means of renting or owning their own homes so they spend their adulthood living with ageing parents. In Japan, 40% of older people live with their adult offspring and over 17% live with their grandchildren in contrast to the UK where less than 10% of those aged 70 and over live with their adult offspring and around 2% live in multigenerational households with offspring and grandchildren. Does this mean Asian families are more amenable to this idea?
Non-familial models also exist. Home sharing is where an older person offers accommodation to a younger person at a reduced rate in exchange for some support with basic tasks such as shopping or gardening. Co-housing is the development of private households with shared facilities that invoke a sense of community.
But, other than family ties, it would be justified to say that the intergenerational housing model has not taken root in any large measure in Malaysia. This is possibly due to the unpopular notion of having to share facilities with strangers, and elderly ones to boot. But the benefits exist – older people can benefit from reduced levels of loneliness and isolation and increased levels of civic participation, while younger generations can also gain in similar ways and through the provision of affordable housing.
In an interesting experiment in Alicante, Spain, using an ingenious blend of subsidized public rental housing, grants and low interest mortgage loans, a government agency set up over 200 affordable, intergenerational housing units in central urban areas.
Residents included low-income older persons over the age of 65 and low-income young people under the age of 35 in a ratio of 80:20 respectively. In the selection process, priority was given to those more advanced in age and with the greatest socio-economic disadvantage while young people were chosen based not just on low income but also on motivation, empathy and suitability to work in social programmes.
On the basis of a ‘good neighbor agreement’, each young person had responsibility for four older people in the building. Feedback from the elders included an increase in well- being, independence – but not loneliness – a decent home life with a family-like environment and a wide range of activities within reach. For the young people, in addition to accessing high-quality housing at affordable rental rates, they reported knowledge gaining and the opportunity to nurture real relationships of friendship with the older persons they assisted. Key to all this was the application of self-managed activities like dancing and gardening to promote social integration and the creation of a ‘big family’ environment, which ended up more valued than the accommodation itself.
Applying the intergenerational model to a Malaysian city like Kuala Lumpur can be done but the following challenges must be borne in mind:
- Establishing a relationship between generations can be fraught if individuals do not want to share.
- Ability to find the right young people with the appropriate skills and aptitude can be difficult not only due to cultural and religious differences but also social upbringing and behaviour.
- The right activities must be designed to involve the elderly in a Malaysian context.
Lastly the financing of such housing is complicated due to the lack of government resources always a challenge) as well as inadequate savings from the elderly to sustain their twilight years. Some of the latter could be addressed by imposing responsibility on the children of elderly to provide funding through a ‘parents tax’, a sort of inverted responsibility model where children have an obligation for their parents. But for singletons who chose not to have offspring, this is one more gap in resources to add to the financial challenges already encountered.
A starting point for this new radical thinking would be to test an intergenerational community care centre where grandparents mingle with youth and toddlers. Japan has demonstrated that that this arrangement actually works well with the elders being stimulated by the presence of young people around them. Providing facilities such as IT and urban gardens can form the right platforms for interaction and intergenerational learning– in some cases reverse mentoring from young to old can be just as effective as the conventional vice versa transfer of knowledge and experience from old to young. Such building facilities can further be a show case for assistive technologies, green practices and innovative care models.
The time is right to adopt this model as it tackles the dual problems of affordability and active ageing. This is how to make the golden years our best years.
This paper was prepared for and presented at the Healthcare Forum (organised by the Asia Strategy Leadership Institute) in March 2016 by Dr Thomas Tang, Managing Director of KLCSI (www.klcsi.com).