Updated country report: The Long-Term Care COVID-19 situation in Malaysia

Kejal Hasmuk, Department of Medicine, University of Malaya Medical Centre; Hakimah Sallehuddin, Universiti Putra Malaysia (UPM); Maw Pin Tan, Faculty of Medicine, University of Malaya, Kuala Lumpur; Wee Kooi Cheah, Taiping Hospital, Ipoh; Rahimah Ibrahim, Malaysian Research Institute on Ageing (MyAgeing), UPM; Sen Tyng Chai, MyAgeing, UPM

Last updated: 2nd October

The full report is available here:

The social care policy for Malaysia has lagged behind the country’s development since independence, leading to unregulated care homes and home care providers now providing the bulk of long-term care in Malaysia. Apart from a small number of outbreaks, Malaysia’s experience with care homes during COVID-19 has been surprisingly positive. Both the Social Welfare and Health sectors willingly worked with lobby groups and NGOs to protect care homes very early on the second wave which started on 10 May 2020. The desire to ‘do well’ in terms of COVID-19 control and the feeling of solidary and good will that emerged during this pandemic, had led to surprisingly positive responses and support to provide for those more vulnerable to COVID-19. The mini outbreak almost provided the ideal springboard to sound the alarm and sparked a series of responses which finally led to mass testing of care home staff and residents.

While many other countries, particularly in Europe and North America, struggled with unimaginable death tolls, Malaysian officials, healthcare providers and care homes watched in horror and moved to rectify any deficiencies in our system to avoid our care homes becoming the source of the next wave. This crisis, therefore, perversely opened up many opportunities for society to right many wrongs in their previous persecutory stances on care homes. Care homes prior to COVID-19 were shunned by society, received no financial subsidies from the government, whose policy it was to ensure that adult children remembered their obligation to their older parents to provide for them in their old age [19].

With widespread testing now a reality, the next challenge is to ensure the delivery of PPE to care homes throughout the country regardless of legal status. It remains unclear who will pay for the PPE, which is expensive, and therefore not generally affordable to care homes nor to the adult children to have to pay for care home bills, which average RM3000 per calendar month, whereby the average household income for Malaysian is RM6,000 per calendar month.

The interim recommendations development group through MyAgeing, UPM, is expected to obtain funding from the World Health Organization to facilitate coordinated efforts to train care home staff on infection control and supply of PPEs to these facilities.  There is also an effort to conduct harmonized studies to gain insights on behaviour of older adults during the COVID-19 pandemic as well as promoting greater awareness in the situation among community-living older persons.

Key points from the report:

• Malaysia has ten federal-funded homes for older people and two homes for people who are chronically ill in Peninsular Malaysia, five state-funded homes for older people in East Malaysia, and a number of Islamic care homes operated and/or supported by State religious authorities.
• There are about 320 residential aged care facilities registered under the Department of Social Welfare (Act 506) and 26 nursing homes registered under the Ministry of Health (Act 586). The number of unregistered facilities numbers from 700 to over 1000, depending on estimation method and definition used.
• Community and home-based long-term care are currently unregulated in Malaysia.
• Department of Social Welfare and Ministry of Health (MOH) officials work closely with academics, care home representatives and civil society groups to reach out to care home providers.
• Malaysia has adopted a mass-testing strategy for all registered and unregistered care homes since April 2020. The nation-wide care home screening has halted since 31^st July 2020 with the last report of total 16 425 screened (staff and residents), 47 detected positive (0.3%) of which 36 (76.6%) were asymptomatic.
• Previously, two older persons clusters have been reported (and closed) which involved at least two care homes in Klang and Petaling Jaya, resulting in 36 infections and five deaths. A further care home cluster (now closed) had emerged on 22 June, with eight cases involving both residents and staff. There have been no new deaths reported involving this cluster. Another nursing home cluster (now closed) had reported one death and eight other cases involving staff and residents. As such, a total of 4 known care homes have had cases detected/clusters. However, within the nationwide mass screening that detected another 47 cases, the number of care homes affected is not known.
• As part of “soft landing” and mitigation plans, Malaysia moved from Movement Control Order (18^th March 2020 – 3^rd May 2020) to Conditional Movement Control Order (CMCO) (4^th May – 9^th June 2020) to Recovery Movement Control Order (RMCO) (10^th June 2020- supposedly 31^st August 2020, but was later extended till 31^st December 2020). To date (2^nd October), there are 24 active clusters, none of them involving care homes. The last reported care home cluster ended on 18^th July 2020. That cluster involved 8 individuals (staff and residents), with no deaths.
• With the RMCO being implemented, many care homes have now moved towards taking in new residents and people discharged from hospitals – a much needed move to sustain the care homes. With the guidelines adopted by MOH, every patient discharged to a care home would first be tested for COVID. In addition, most nursing homes have also adapted to the best of their ability and capacity the Interim Recommendations to practice standard infection control measures for new residents admitted to care homes, especially those with respiratory symptoms.
• Care homes lack basic PPE and have difficulty observing physical distancing within their confined spaces.
• The industry body proposed a ‘No visitors’ policy and care homes are discouraged from admitting any new residents.
• Care home residents with suspected COVID-19 will be admitted to COVID hospitals, with all other residents admitted for isolation and testing if necessary. 
• The MOH have also recently mandated that older persons to be discharged to an care facility to be tested for COVID-19.