PETALING JAYA: With the current shortage of maids, more people going back to their workplaces and Malaysians fast becoming an ageing society, there has been a boom in mobile applications offering home care services.
Leaning on the gig economy or e-hailing module, the service operators match the demands of caregiving with carers digitally.
The process, however, is limited by supply and demand problems related to manpower, quality and cost.
Also, there is currently no regulatory oversight to prevent abuse and avoidable risk and harm.
“In Malaysia, we have always had some form of home or mobile nursing services, and private providers have been around since the 1990s in tandem with the liberalisation of the healthcare sector,” said Assoc Prof Dr Rahimah Ibrahim, deputy director of Universiti Putra Malaysia’s Malaysian Research Institute on Ageing (MyAgeing).
“In recent years, we have seen new operating models based on the gig economy and mobile applications. The landscape is changing, but the fundamental issues remain.”
Dr Rahimah, who is also deputy president of the Gerontological Association of Malaysia, said some examples of these operators are Nurses at Home, which was established in 2005, Love on Wheels, MyFlex Health, 24 Angels Home Care and the more recent Care Concierge, Homage and Teman Malaysia.
“There is little doubt that home care services and home care services mobile applications are helpful.
“However, the gig economy and mobile applications like Grab and Food Panda are not so easily translated into other industries, as the current regulatory oversight is apparent.
“The liability and health regulatory mechanisms are unclear.
“We should encourage the development of the mobile nursing or home care industry with proper monitoring and evaluation mechanisms and financing models,” she said, adding that the industry needs to be pushed to self-regulate.
Dr Rahimah said research using data from the Household Income & Expenditure Survey 2019 showed that older households (2.7%) spent proportionately more on health than households without older persons (1.4%).
She noted that home care is here to stay, as the cost of having more nursing homes is more expensive and may not be sustainable over the long term.
“The real issue here is the quality and availability of trained carers,” she said.
“Commodification of care is inevitable, hence we must put in place proper funding and oversight mechanisms so that aged care services, whether community or home-based, are made more equitable and accessible.”
MyAgeing research officer Chai Sen Tyng agreed, saying that such care services help the elderly to remain in the community and avoid costly institutionalisation.
“However, in the absence of a federally funded mechanism or programme, we are looking at out-of-pocket expenditure and there is currently little effort on planning for a sustainable long-term care model and services in Malaysia.
“There are no data on home care and gig workers while providers are not governed under any regulations at the moment, apart from business registration.
“So we hear about consumer complaints, including the lack of transparency and standardisation in fees and services,” he said.
Quoting research, he said the number of older persons aged 60 years and above in Malaysia has shown a steady increase while household sizes are shrinking.
The older population has doubled in the last two decades from 1.45 million in 2000 to 3.44 million in 2020. Today, one out of every 10 people in Malaysia is an older person, and the aged population is expected to reach 16.3% (6.3 million) in 2040.
“The concern is not so much with the apps but regulatory oversight on the home care services to prevent abuse and avoidable risks and harm.
“We need to ensure that mobile or home care providers are properly regulated so that the right people are engaged for the right job, as healthcare risks are not properly addressed for both caregiver and clients or patients,” he said.
Chai also urged the authorities to speed up the regulations for Act 802 (Private Aged Healthcare Facilities and Service Act 2018) and ensure it includes a guideline for home-based care.
Teman Malaysia chief executive officer Nurul Ezzati Mohamed Nasir admitted that issues about the quality and availability of trained carers have been one of the challenges.
“We have a system in place when such a situation arises to get a replacement. Also, we conduct thorough screening prior to hiring anyone to be a part of the team,” she said.
Nurul Ezzati said the current home care services rates are all market-driven, as there are no regulations and fee structures.
“It’s all based on supply and demand in the market, where consumers are able to compare and choose their preferred service and price.
“It will be beneficial to have some regulations for the industry, especially in the case of injuries and accidents or deaths,” she said, adding that for now, clients are informed of and agreeable to a disclaimer within the app.