Exploring the facet of elderly care centre in multiethnic Malaysia

Ageing population is a worldwide phenomenon, and it affects all traits of human life. The ageing population has shown an evident rise in both developing and developed countries (Burton, 2016). A report highlights that until 2050, the world population will increase from 8 to 9.6 billion, and this will post a significant challenge in the countries all across the globe (Amiri, 2018), including Malaysia. The elderly people are expected to be tripled from the year 1980 (259 million) to year 2025 (761 million); while about 72% of the entire elderly population are residing in developing countries. Malaysia, a representative of a developing country, has been estimated to have about 5% of its entire population to be 60 years of age and above by year 2030 (Department of Statistics Malaysia, 2018). Undoubtedly, the ageing is a continuous process, and another report shows that until 2030, Malaysia will be in the same line of other ageing group countries e.g. Japan, USA and China (Phua et al., 2019; Rashid and Tahir, 2015). The ageing or older age is associated with changes in physical appearance such as wrinkled skin, grey hairs and physical decline (Normala et al., 2014; Zivin et al., 2013; Noor et al., 2020), which lead to certain medical issues such as hypertension, dementia, arthritis, respiratory diseases and neurological disorders. Thus, older population needs more health-care facilities and attention, and elderly care centres are considered the key players in promoting healthy ageing among the elderly segment.

In Malaysia, the elderly care centres are categorised as public, private, non-governmental organisations (NGOs) and centres run by religious organisations and church community. The ageing population is increasing day by day with various elderly health issues, and children feel it is very challenging to take care of their elderly parents because of their busy routine and lifestyle. This led to a demand for more technological well-equipped elderly care centres in Malaysia along with the trained staff or professional care givers. Currently, about 365 registered elderly care centres are working in the main states of Malaysia, e.g. Klang Valley area, Johor and Penang (Phua et al., 2019), along with various unregistered centres scattered around the country. The estimated number implicates that Malaysia may require around 2,000 registered elderly care centre until 2030 to fulfil the requirements of the ageing population and to maintain an operational standard of elderly care centres throughout the country (Advance Care Planning, 2018). The elderly care centres’ management is trying their best to fulfil the needs of the older population. However, many milestones need to be achieved, as many centres are still not well-equipped and facing issues related to finances, technology, staffing and others. Hence, the rationale of this study is to explore the demographics disguise of elderly care centres in Malaysia to disclose the obstacles facing by these centres as the centres’ operators are the custodian for providing care, special attention and social life comfort to the older population of Malaysia.

The ageing population is rising across the globe, including Malaysia, thus, the older people are increasing in number than ever before as World Population Ageing (2019) reported that population of age 60 or above reaches to 10% of the total population in various countries, and counting them as an aged nation (Meriam Syed Akil and Abdullah, 2014; Samad and Mansor, 2017). Past research studies revealed two significant factors that involve in ageing population, namely, a decline in fertility rate and increased longevity because of improved health and medical services and increased technology and overall economic development (Forsyth and Chia, 2009; Selvaratnam et al., 2009; Ursulica, 2016). In line with longevity, Fahey (2003) stated that in more than 20 developing countries, life expectancy is about 72 years or above. From another view, an expected increase in the elderly percentage in Malaysia is from 6.3% (the year 2000) to 12.0% (4.9 million) in 2030. Even though the older population has shown an increase all across the world, the rate of change is higher in developing countries. In line with this, Keyes (2017) suggested that Malaysia, one of the developing countries in Association of Southeast Asian Nations region, is now becoming a nation progressing towards ageing; therefore, health-care needs and facilities of senior citizen are also in high demand. Research studies suggest that by the year 2025, the ageing population will reach around 1.2 billion (14% of total population), and three-quarters of the elderly population will be residing in the developing countries (King et al., 2019). Keeping in view the alarming situation of the drastic increase of the elderly population in developing countries, Malaysia needs a proper planning for maintaining a healthy environment and care facilities for the elderly. The support and care that is provided in-home to elderly seems to be unable to fulfil the sensitive requirements of old age’s chronic diseases (Soong, 2016). Subsequently, it leads to the increasing demand of elderly care centres. Table 1 shows the categorisation of registered elderly care centres in Malaysia.

Studies revealed that the registered elderly centres in Malaysia are still lagging in terms of modern set-up and technology usage (Phua et al., 2019; Noor et al., 2020). Similarly, in most of the centres, the facilities are not up to the mark and insecure because of obsolete equipment, lack of monitoring and repeated usage of installed machinery. These centres, however, are working on a sustainability basis without any profit-making, and sometimes the centres’ operators have to borrow money for the next month budget settlements, and it is becoming one of the critical reason of stress among many centre operators (Samad and Mansor, 2017; Noor et al., 2019). The Malaysian Government does provide regular monetary incentives to all centres except only to those centres that directly come under the Ministry of Women, Family and Community Development agency supervision, whereas, privately owned centres are not getting any funding from the government. Therefore, the private-owned centres have to seek external funding on their own either in the form of donations or the creation of small business to generate some regular income (Vannucci and Weinstein, 2017). Irrespective, the services provided by most elderly care centres are still not sufficient and efficient in terms of technology and health services as the standardised operational manual that can benefit all elderly care centres is also lacking in Malaysia (Leng et al., 2016; Rashid and Tahir, 2015). There is a remarkable need for well-developed strategies regarding the needs of senior citizens and facilities in elderly care centres in Malaysia, as done in other Asian countries such as Japan and Singapore, for a healthy and graceful ageing segment.

• To explore the demographics facet of elderly care centres in Malaysia.

• To determine the issues and challenges confronted by centre operators and caregivers.

• What is the current scenario of elderly care centres in Malaysia?

• What types of obstacles are confronted by centre operators and caregivers?

Qualitative methodology is considered as the best approach to discover and explore a new area-developing hypothesis (Miles and Huberman, 1994). This study is exploratory research that involves a qualitative method of data collection by using the self-administered (Bradburn et al., 2004) and open-ended questionnaire. Several researchers suggested that exploratory research is useful for defining a set of investigative questions that can be used as a guide for detailed research design (Easterby-Smith et al., 1991). The present study considers the interpretive philosophical stance as interpretivism is associated with the experience of people. This philosophy concerns about individual’s interaction with society (Creswell, 2003). The research design plays an important role and helps the researcher to answer the research question or put into entire scheme of research (Hall et al., 2016). To answer the objectives of the present research, explanatory research design is more appropriate as the study is exploratory in nature. Currently, around 365 registered ageing care centres are working in various states of Malaysia (Advance Care Planning, 2018; Phua et al., 2019). In this present study, 18 centre operators and 15 caregivers who are running the elderly care centres in several main states of Malaysia were interviewed. This number of samples is suggested by Creswell and Poth (2013) and Hall (2016). The present study adopted the purposive sampling technique to select the 18 centre operators and 15 caregivers from selected ageing care centres. The interviews were conducted in both English and Malay languages from April 2019 to December 2019. The duration of the interview lasted about 45 min to 1 h. The interview questions prepared for semi-structured interviews corresponded to two categories, namely, operators and caregiver. Operators are the entrepreneurs who run the ageing care centre as a business entity, whereas care givers are those employees working in the centres to provide services to the elderly. The interview questions were specially designed to answer the research questions and objectives pertaining to elderly care centres, as highlighted in the literature review. Bryman and Bell (2007) stated that prolong questions should not be asked, and negative question need not be included in an interview guide. Similarly, technical language needs not be used as it is essential that the participant clearly understand the meaning of the asked questions. Saldana and Omasta (2016) introduced a seven-step technique, modified from Moustakas’s (1994) method for a qualitative analysis, which adopted semi-structured questionnaires and audio-recorded interviews for data gathering. This method provides a systematic and organised way to analyse the collected data and used in various studies (Hall et al., 2016; Merriam, 2009). Below mentioned is the interview question asked from centre operators (Table 2) and centres caregivers (Table 3).

Tables 4-7 show the profile of the operators as the research participants. The details depict that out of 18 participants, 4 belong to the age group 36–40 years, 5 belong to the age group 40–45 years, another 5 belong to the age group 25–31 years and the last 4 belong to age group 45 years and above. For the present study, 12 males and 6 females were interviewed. Regarding qualification, 12 participants have a diploma certification, 4 have a bachelor’s degree while the remaining 2 have a master’s degree. Most of the participants skewed towards Malay ethnicity (9), followed by Chinese (6), Indians (2) and (1) other nationality. Regarding year of establishment of centre, majority of the respondents (8) have been operating the centre for six to nine years, followed by five respondents who operate the centre for three to six years and four running the centre for nine years or more. Table 4 exhibits the profile of interviewed participants.

Below are Tables 5 and 6 regarding demographic details of interviewed first group of participant centre operators. The table highlights that 13 of them are running the centre as the sole owner, and 5 are running under a group partnership. In line with this, all of the centres have caregiver, cook and supporting staff. Two of the centres (O1 and O7) have about 20–25 caregivers, and all of them have at least 1 medical doctor and support staff. The strength of the female elderly is more significant in the number in each centre as compared to males. The age of the elderly in the centres skewed towards 65 years and more, in the majority of centres. The monthly expense in 7 centres (O1, O3, O4, O10, O11, O12 and O17) ranging from RM15,000–20,000, 5 centres (O2 ,O3, O6, O8 and O14) depicts monthly cost of RM20,000–40,000, whereas 6 centres (O5, O9, O13, O15, O16 and O18) incurred monthly expense of above RM40,000. The main income generation of the majority of the centres is from the customer’s service fees. Regarding donations, the majority of the centres show no support in terms of donation except (O13 and O18). A total of 13 centres (O1, O2, O3, O4, O5, O7, O8, O11, O12, O15, O16, O17 and O18) reported nil for other activities involvement. However, the other five centres are involved in renting facilities and selling consumable medical items and nonmedical services (O6, O9, O10, O13 and O14) for business survival. The service fee of all centres shows different packages depending upon the condition of elderly and services requirements, ranging from RM500 to RM6,000. The type of employment mostly skewed towards permanent and contractual. Regarding governmental support, the majority of the centres (O1, O2, O3, O4, O5, O6, O7, O8, O9, O12, O14, O15 and O18) reported that they are not receiving any government funding as they have applied for it but failed to get it. Regarding the main objective behind opening a centre, the majority of the participants stated passion, and some considered the elderly care as their responsibility. Below are the profile details of interviewed participants (Tables 5 and 6).

Table 7 above shows the profile of the second group of participants – caregivers. The details that disclose out of 15 participants, 5 belong to the age group of 25–31years, 4 belong to the age group 36–40 years and 2 belong to the age group 40–45 years, whereas another 4 belong to age group 45 onward. For the present study, five males and ten females were interviewed. Regarding qualification, nine participants have a diploma certification and six have a bachelor’s degree. The majority of the participants skewed towards Malay ethnicity (7), followed by Chinese (4), Indians (2) and (2) other nationality. Regarding year of service, five of them have been working as a caregiver for three to six years, followed by four respondents working for nine years or more, another four working less than one year and two have been working between six and nine years.

The present study adopted the qualitative research strategy; interviews were conducted with the centres’ operators and caregivers, to explore the demographics facet of Malaysian elderly care centres and issues and challenges confronted by the centre operators and caregivers. Hence, coded data from each of interviewed participant was cross-referenced with another participant to locate the similarities and dissimilarities among the participant’s views in particular. Crotty (1998) stated that the continuous comparison results in lesser number of themes for a research question. Table 8 explains the generated themes from the transcribed interview under interview questions asked to the centres’ operators.

Pertaining to Q1 regarding any challenging situation while managing the centre, majority of the operators explained about staffing, funding and government support, and these findings are in line with previous findings (Meriam Syed Akil and Abdullah, 2014; Noor et al., 2020; Samad and Mansor, 2017). The feedbacks from the participants are stated below:

Concerning to Q2 regarding the solution of issues and problems related to managerial practices. The participants revealed about training and counselling, loans from friend and family circle and marketing, as agreed by previous studies (Ariffin et al., 2017; Lam et al., 2018; Sharpe, 2011). One of the feedbacks from participant O6 is listed below:

Regarding Q3, type of marketing communication strategy adopted by the respondents are door to door counselling, Facebook, orientation session and the website, and these are in line with previous research studies (Noor et al., 2020; Tohit, 2012). Below is one of the feedbacks from participant O3:

Concerning to Q4 regarding how to tackle the financial problems, majority of the respondents revealed about small business, acceptance of donation (staple food and other items), funding from private sectors, followed by a request of government funding, which are also highlighted in several previous research studies (Meriam Syed Akil and Abdullah, 2014; Sharpe, 2011; Noor et al., 2019):

About Q5 regarding experience in managing the centre, majority of the participants considered it as challenging, and this finding is in line with previous research studies (Meriam Syed Akil and Abdullah, 2014; Rashid and Tahir, 2015; Beard, 2016). Some of the feedbacks from the participants are stated below:

Table 9 demonstrates the generated themes from the transcribed interview under interview questions asked from centre caregivers.

Regarding Q1, the main reason(s) for taking up this position in this centre, the participants revealed about passion, part-time job, elderly care and no job as the reasons which are in line with previous research studies (Abudu-Birresborn et al., 2019; Minton and Batten, 2016; Rejeh et al., 2010):

In relation to Q2 about the major challenges caregivers face while dealing with the elderly, majority of respondents explained about aggressive patients, memory issues specifically dementia patients, full of stress environment, weak and improper management policies, long duty hours and lack of knowledge on elderly care. These findings are in tandem with past literature (Rejeh et al., 2010; Smeulers et al., 2014; Wang et al., 2018):

Relating to Q3 about dealing with challenges of staff and management, the participants mentioned lack of privacy, tough schedule, management favouritism, communication gap, peer conflicts and less experienced staff and administration, which accede with past literature (Aghabarary and Nayeri, 2016; Rostami et al., 2019):

Regarding Q4 on the suggestions to improve the centre’s leadership, management and operations, the participants stated that there should be proper policies, weekly meeting with staff, proper handing over and specialised knowledge of elderly care, which is badly needed in the centre, and these are in line with past research studies (Smeulers et al., 2014; Abudu-Birresborn et al., 2019):

While keeping in view the challenges faced by centre operators and caregivers in elderly care centres in Malaysia at present, the following implications have been proposed to mediate the challenges and obstacles which caregivers and centres’ operators are facing in elderly care centres:

• Government support in the form of funding is mandatory to all elderly care centres irrespective of public, private and centres that come under religious organisations. These centres are facing severe financial constraints because of the unavailability of funds and always encounter delay in elderly fees submission from elderly families. The annual funding from the government will help the centres to cut their operational cost to some extent.

• The licensing procedure should be streamlined with one window operation where officials should guide the operators regarding terms and conditions on the issuance and renewal of licenses. The proper licensing procedure may help to formalise the economy and secure the businesses.

• There is a need for a central geriatric training centre under the Ministry of Health and the elderly care centre’s staff training must be considered mandatory from the geriatric training centre. It will minimise the issue of less-trained staff. The staff training is very crucial as currently many staffs are immature and lack in patience and empathy, which is considered as the core element to be an aged care staff along with effective communication skills and positive attitude.

• The centres’ operators need to attend training programs to improve their leadership skills and also refine their administrative skills. Thus, developing good leadership skills may benefit the whole centre. Management, finance and marketing pieces of training may help the entrepreneurs to re-strategise the original business process, time management, networking and strategic thinking.

• Management must follow the performance-based measures and avoid favouritism, and must communicate with staff frequently as well as praise them often. This practice will motivate the staff. The centres’ operators must create a professional environment free from any kind of unfair treatment.

• The operational policies need to be revised containing the standard operating procedures, the hierarchy of organisation along with emergency procedures. It is imperative to have proper standard operating procedures (SOPs) of the centre, as it will help the staff to perform daily operations effectively. The SOP is a valuable business tool as it demonstrates the correct way to carry out an activity with a direction and proper guidance.

• Elderly families’ cooperation is highly needed for the smooth functioning of these centres as most of the centre complained about the delay in fee submission and non-cooperative behaviour in terms of the frequent visit to their parents. The centre can only provide health supports to their parent, but the elderly still rely on families for emotional support. The families should cooperate in this regard as centre and elderly families may work together to save the ageing population from mental disorders, stress and trauma and make them ageing gracefully.

The resource-based view (RBV) theory has become a dominant theoretical foundation in strategic management (Newbert, 2019; Stieglitz and Heine, 2007) and has been applied to strategic marketing as well (Morgan et al., 2006; Zahay and Peltier, 2008; Voola and O’Cass, 2010). According to Barney et al. (2011), the RBV originated from the work of the economist named Penrose (1959), who argued that “services yielded by resources are a function of the way in which they are used – exactly the same resource when used for different purposes or in different ways and combined with different types or amounts of other resources provides a different service or set of services”. Penrose’s (1959) arguments suggest that the uniqueness of an organisation is based on how the organisation combines its resources and capabilities. This theory attempts to answer the following question: what types of organisational capabilities lead to a sustainable competitive advantage (Vora et al., 2012). RBV explains how a firm attains a sustainable competitive advantage and superior performance. This theory provides that firms can perform effectively and attain the competitive advantage if they have better resources and have the abilities to use them to exploit the opportunities and outperform the competitors (Voola and O’Cass, 2010). Resources are not only considered as the internal production capabilities of the firms, but also serve as the abilities of the firm to get adjusted according to the environment. Resources may include the managerial capabilities to learn developing new resources or strategies to respond effectively to the external environment to attain a competitive advantage and superior performance (Ferna and Romero-martı, 2010). The RBV theory describes that firms have a bundle of resources that possess certain specific characteristics that have the potential to provide a sustainable competitive advantage. Thus, more excellent managerial abilities and skills are required to deploy these resources that collectively produce better performance and returns (Mahoney, 1995). The ability of the firm to understand the market and response to market changes not only ensure the firm’s survival in the competitive environment but also enhances the firm’s performance. The core competencies of the firm may include risk-taking attitude and learning of new ideas for overcoming the external pressure. For attaining the superior firm performance, a certain amount of competence is required (Lumpkin and Dess, 1996). Based on the premises, the overall capabilities of the firm to develop internal resources by developing new strategies implement strategic orientations and continuously enhance the innovative capabilities of the firm, to respond to the external environment’s demands that are the key to sustainable competitive advantage. Thus, the operator and caregiver, both are considered as strong pillars for smooth running of elderly care centres. As in year 2005, 7% of the elderly population aged 60 years, which is expected to be doubled or 14% by the year 2028. This situation is alarming and requires awareness in place of infrastructure and various facilities to look after the older population of Malaysia.

Elderly people are not considered prior in international policy development since ages. In recent years, because of drastic demographic changes in various countries worldwide, older people become significant in development agendas. This leads towards a new prototype of research on elderly care centre. In this regard, governments all across the world start to engage in the development of policies, to meet up the challenges faced in handling the ageing population, in both health and infrastructure matters. Noteworthy, the ageing population is a global phenomenon and has an impact (direct or indirect) on all human life traits. Hence, developed and developing countries must see the issue of ageing scientifically. Elderly home or old homes strategy plays a vital role to look after the Malaysian aged population in a more systematic order. Hence, a better support system for the elderly population in the form of well-equipped elderly care centres is needed. As the elderly population facilitated the nation in their prime and now, it is a compulsion on society to provide them proper care, attention and help. The present study reveals the demographic disguise of elderly care centres in Malaysia and challenges which caregivers and operators are facing while managing these centres. This study will help the policymakers to formulate specific strategies for elderly care centres, keeping in view the challenges confronted by front line custodians of ageing industry such as operators and caregivers. This practice will lead to active and graceful ageing in Malaysia. As this study is limited to 28 centres and involved the entrepreneurs (male and female), future studies may be conducted to add more centres throughout Malaysia and comparison of centres run by male and female entrepreneurs from different ethnicities can be done to get a holistic view of obstacles confronted by male and female entrepreneurs in ageing care centres.