The Health | November , 2020

relationship between healthcare and social care with the purpose of joining and melding these two policy issues together . This is to create an integrated nexus in view of our ageing population .

Healthcare and social care are typically regarded as two distinct or even separate policy issues . Healthcare could simply be defined as “ the provision of services involving care and treatment of patients ”. Social care relates specifically to the provision of care especially for the elderly .

According to the World Health Organization ( WHO ), a nation can be considered as ageing if seven per cent of the population is 65 years and above . A United Nations ( UN ) definition has it at the 15 per cent threshold of senior citizens aged 65 years old and above . On the other hand , based on the definition made by the World Assembly on Ageing 1982 in Vienna , an old person is someone who is 60 years and above .

Figures by the Department of Statistics Malaysia ( DOSM ) indicated that there was seven per cent of old people , i . e . aged 65 years and above in 2019 , rising to 14 per cent by 2045 .

We have to start preparing now for the future as our country ’ s aged population will further increase in tandem with the declining birth rate .

For the record , our total fertility rate ( TFR ) stood at 1.8 in 2019 . To drop below

By Jason Loh

2 simply means that we are not replacing ourselves fast enough relative to the current population size .

To begin with , there is a need for a White Paper on our ageing population .

Following this , there should be a national and strategic policy framework .

Such a policy framework sets the future direction of the country in tackling the challenges of an ageing society . It would entail looking at healthcare and social care for the elderly from a holistic perspective .

Or there could be a policy framework specifically on social care – with the view of integration with healthcare as the next step .

A seamless and open-ended relationship

Moving forward , would there be trade-offs in such a relationship of “ equal parity ” analogous to the “ parity of esteem ” from the UK ’ s Department of Health and Social Care with respect to the link between physical and mental health ?

Furthermore , whilst there might be fiscal sustainability , could this actually or possibly result in healthcare suffering from under-funding or under-resourcing ? This is assuming that by default that the shift is towards social care – as people live longer lives ?

Addressing these challenges in synergising healthcare and social care requires a seamless and open-ended relationship . Healthcare cannot be seen to be “ cut off ” or isolated from social care – as if that the latter is merely an afterthought , especially to be left to private responsibility and burden with some help from the State . As it is , at present , our healthcare and social care systems go separate ways . So , how to bring the two together ? Well , one idea which we could explore is a pilot scheme where care homes could be located next to hospital ( s ). Now in Malaysia , there is also talk about self-sustainable townships catering to the grey or retiree population . For example , the case has been intriguingly and meticulously laid out in an article published by the Edge Market titled , “ Framework for Sustainable Retirement Villages in Malaysia ” ( Dec 17 , 2018 ).

These townships catering to the needs of the aged should include a cluster of healthcare facilities such as hospitals with state-of-the-art facilities .

In fact , we already have the first integrated seniors ’ lifestyle and care residence resort in the country , based in Kuching . The development provides senior citizens with resort-style living in luxury apartment suites and bungalow villas with aged care facilities right next to them .

Furthermore , social care training should be increasingly integrated into medical and nursing training . This arrangement will obviate a dichotomous approach and promote a holistic framework .

It cannot be emphasised enough that from a practical viewpoint , both overlap and under certain circumstances , are virtually indistinguishable .

Paradigm shift needed

A good example would be Alzheimer ’ s disease which is a form of dementia . As a neurological or degenerative brain condition , it comes under the healthcare category of geriatrics .

But we know that Alzheimer ’ s also requires social care outside of the hospital . And integration will provide better support in terms of data collection and collation for medical monitoring and diagnosis .

This will also allow for a more efficient and effective allocation and distribution of resources .

In addition , the digitalisation of healthcare will also be enhanced . This is because real-time data , signs / signals and information derived under social care can be fed into healthcare as part of an early warning system ( EWS ).

For example , an elderly suffering advanced stages of Parkinson ’ s disease , which requires social care , could well exhibit signs of other complications . These complications could be severe constipation or gastro-intestinal problems that require medical or healthcare attention . We , therefore , need a paradigm shift . There must come a time in which digitalisation of healthcare is regarded as seamlessly and continuously linked to social care . And the time is now . In conclusion , we can ’ t afford to leave social care to “ develop ” independently of healthcare if we wish to also ensure the sustainability of future spending and investments . It makes sense to combine the two together for more effective allocation of resources .

That said , the question is , therefore , not – “ If it ain ’ t broken , why fix it ” but “ How do we make the most with what we have ”? — The Health

Jason Loh Seong Wei is Head of Social , Law & Human Rights at EMIR Research , an independent think tank focussed on strategic policy recommendations based on rigorous research .