Malaysia – Resources to support community and institutional Long-Term Care responses to COVID-19

LTCcovid Country Profile – Printable Version

1.01. Population size and ageing context

The population of Malaysia is roughly 32.4 million (World Bank). Since 2014, the share of the population over age 65 has been increasing; it went from 5.6% in 2014 to 7% in 2020. Malaysia therefore faces the prospect of an aging population; this may happen by 2030 (Statista).

The National Policy Order for Older Persons (2011) defines an older person in Malaysia as someone aged 60 years or older (Hasmuk et al., 2020).

References:

Hasmuk K, Sallehuddin H, Tan MP, Cheah WK, Rahimah I, Chai ST (2020) The Long-Term Care COVID-19 Situation in Malaysia available at LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 2 October 2020.

Update for: Malaysia Last updated: February 16th, 2022 Contributors: Daisy Pharoah |

1.04. Approach to care provision, including sector of ownership

The long-term care (LTC) system in Malaysia is fragmented; this comes as a result of separate health and social care systems, as well as a divide between publicly and privately funded care. Malaysia has focused on family and community provided car; the result of this is that the burden of care tends to call on female members of the population (both in terms of formal and informal care providers. It is estimated that Malaysia’s LTC system serves only about 1% of the total population (Hasmuk et al., 2020).

For those who are terminally ill, Malaysia has 2 government-run homes and 15 government-run residential homes; there are an additional 320 registered LTC facilities, all of which are registered (as of 2020) under the Private Healthcare Facilities Act (2018). It is estimated that over a thousand care homes in Malaysia remain unregistered. There are also some facilities that are operated by non-governmental organisations (NGOs), but these generally lack the resources to care for those with nursing-level care needs and are primarily residential homes. The majority of nursing homes are privately run, and there has recently been an emergency of privately-run day-care facilities. However, the majority of LTC in Malaysia is provided at home, often through domestic workers who are hired through agencies from the Philippines, Cambodia, Sri Lanka, and Indonesia. This home care is generally unregulated, and is not mentioned in the new Private Aged Care Facilities Act (Hasmuk et al., 2020).

References:

Update for: Malaysia Last updated: February 16th, 2022

2.01. Impact of the COVID-19 pandemic on the country (total population)

The first COVID-19 case in Malaysia was reported on 24^th January 2020, and the number of cases began to increase two months later, in March (Jamaluddin et al., 2022). As of February 2022, the total number of COVID-19 cases in Malaysia is just under 3.1 million, and there have been 32,180 deaths. The greatest increase in the number of cases was seen in the second half of 2021, with the peak in infections seen in August 2021 (as a result of the Delta variant) (source: Worldometres).

Since the end of August 2021, the majority of deaths have been in the over 60 age-group (source: Malaysia MOH). Between 24 February and 14 September 2021, the median age of people who died from COVID-19 was 61 years old, and most deaths occurred in the 60-69 age group. Higher mortality rates were observed in the population who were unvaccinated (Abdul Taib et al., 2022).

Although the pandemic affected all of Malaysian society, vulnerable communities and low-income groups were affected in particular. It is thought that just over half a million households that were in the middle 40% income group fell to the bottom 40% group as a result of the pandemic (source: Yeo, 2021).

References:

Abdul Taib, N. A., Baha Raja, D., Teo, A. K. J., Kamarulzaman, A., William, T., HS, A. S., Mokhtar, S. A., Ting, C. Y., Yap, W. A., Kim, M. C. Y., & Edwin Amir, L. (2022). Characterisation of COVID-19 deaths by vaccination types and status in Malaysia between February and September 2021. The Lancet Regional Health – Western Pacific, 18, 100354. https://doi.org/10.1016/J.LANWPC.2021.100354/ATTACHMENT/96E09F81-FB57-495F-9CE7-DFDA52281B3C/MMC1.DOCX

Jamaluddin, F., Sheikh Dawood, S. R., Ramli, M. W., & Mohd Som, S. H. (2022). Bouncing back from the pandemic? A psychosocial analysis of older adults in urban areas of Malaysia. Http://Www.Editorialmanager.Com/Cogenthumanities, 9(1). https://doi.org/10.1080/23311983.2021.1996045

Update for: Malaysia Last updated: February 16th, 2022 Contributors: Daisy Pharoah |

2.05. Impacts of the pandemic on the health and wellbeing of people who use Long-Term Care

A survey of 224 older people living in nursing homes in Malaysia during June to August 2020 found that the majority of respondents were severely depressed and one third reported mild to moderate anxiety and very low social support. Having lived in the nursing home for over a year, not having a hobby and low social support were associated with depression. The authors comment that these rates of depression and anxiety are expected to be higher than before the pandemic (Nair et al., 2021).

References:

Nair P, Gill JS, Sulaiman AH, Koh OH, Francis B. Mental Health Correlates Among Older Persons Residing in Malaysian Nursing Homes During the COVID-19 Pandemic. Asia Pac J Public Health. 2021 Nov;33(8):940-944. https://doi.org/10.1177/10105395211032094

Update for: Malaysia Last updated: January 14th, 2022

3.01. Brief summary of the overall pandemic response (not specific to Long-Term Care)

A comprehensive preparedness plan was developed by the Ministry of Health (MOH) in Malaysia during the very early days of the pandemic; before the first case in the nation had been identified. The main components of this plan included screening at ports of entry, designating hospitals and clinics as either treatment or sampling centres, and empowering the public health surveillance system (Hashim et al., 2021).

In March 2020, when the first community case was identified and cases in Malaysia subsequently began to increase, the Malaysian government introduced the Movement Control Order (MCO) in an attempt to mitigate spread of the virus. This order was extended and/or amended several times (e.g., the Recovery Movement Control Order) in the following months, until June 2021 when the National Recovery Plan (NRP) – a four-phase plan to steer the nation out of the pandemic – was put into effect (Jamaluddin et al., 2022). The MCOs involved the closing of local or community borders and strict enforcement of the prohibition of movement between areas, and its initial implementation was followed by a drop in the number of daily cases reported within two weeks (Ang et al., 2021).

Malaysia achieved successful delivery of medical services and COVID-19-related physical and digital infrastructure (such as mobile apps for track-and-trace) through a centralised coordination council which was made up of multiple ministries, to whom the Ministry of Health provided advice and updates on the pandemic, and collaborations with the general public, NGOs, and other states. Aside from the various national lockdowns, Malaysia adopted a targeted screening approach to monitor individuals who had been identified as high-risk (such as those who had travelled), and had hospital and non-hospital quarantine systems to manage active COVID-19 cases. These were organised according to the disease severity and risk of infection (Ang et al., 2021). The MOH distributed the National Guidelines on COVID-19 Management (aimed at assisting frontline staff and also available online) in every step of their management of COVID-19 cases. These guidelines were continuously updated throughout the trajectory of the pandemic (Hashim et al., 2021).

References:

Ang ZY, Cheah KY, Shakirah MS, Fun WH, Anis-Syakira J, Kong YL, Sararaks S. Malaysia’s Health Systems Response to COVID-19. Int J Environ Res Public Health. 2021 Oct 22;18(21):11109. doi: 10.3390/ijerph182111109. PMID: 34769629; PMCID: PMC8583455.

Hashim, J. H., Adman, M. A., Hashim, Z., Mohd Radi, M. F., & Kwan, S. C. (2021). COVID-19 Epidemic in Malaysia: Epidemic Progression, Challenges, and Response. Frontiers in Public Health, 9, 247. https://doi.org/10.3389/FPUBH.2021.560592/BIBTEX

Update for: Malaysia Last updated: February 17th, 2022 Contributors: Daisy Pharoah |

3.02.02. Measures to improve coordination between Health and Social Care in response to the pandemic

Throughout the pandemic, officials from the Department of Social Welfare and Ministry of Health have worked closely with academic, civil society groups, and care home representatives have worked together closely together to facilitate good care (Hasmuk et al., 2020).

References:

Update for: Malaysia Last updated: February 17th, 2022

3.07.03. Visiting and unpaid carer policies in care homes

In July 2021 the country was under its third lockdown. Intensive care units were full for the first time ever. The only visitors to care homes at the time were the vaccination teams. No other visitors were allowed and there were no plans to revise the ‘no visitor’ policy in Malaysian care homes.

Source: https://ltccovid.org/2021/08/05/current-situation-in-relation-to-visiting-in-care-homes-and-outings-for-residents-ltccovid-international-overviews-of-long-term-care-policies-and-practices-in-relation-to-covid-19/

Update for: Malaysia Last updated: September 8th, 2021

3.11. Vaccination policies for people using and providing Long-Term Care

Vaccination overview

Vaccines were rolled out during the Ministry of Health’s National COVID-19 Immunization Plan; a framework describing three phases with an aim to vaccinate 80% of the population and achieve herd immunity by February 2022. In the first phase of vaccination, priority was given to frontline staff, followed by vulnerable and high-risk groups – including elderly people (Hashim et al., 2021).

Vaccination rollout in care homes and the LTC community

Information on the vaccination rollout in Malaysia has not been made publicly available. Due to the delay in vaccination at care homes, most care home residents had received their vaccines through a separate individual vaccination route through vaccination centres, facilitated either by family members or care home staff. It is impossible to tell, therefore, how many care home residents eventually had been vaccinated as these would not be recorded as care home residents. The vaccination rate is high in Malaysia with 97.6% of all its adult population reported to be fully vaccinated by 28 December 2021.

Booster/third doses:

As care homes were not prioritized for initial vaccines, the policy of only boosting at 6 months meant that care homes residents who received vaccines at their homes would not yet be due their booster shots (as of December 2021). However, the many who took matters into their own hands and received their vaccines through individual efforts during Phase 2 of the national vaccination programme in May and June 2021 would now have been offered their booster shots. Empirical reports have suggested poorer uptake for booster shots.

Impact of the COVID-19 vaccination on care home infections and deaths:

There is no available data on the impact of the vaccination on care home infections and deaths. Although the number of deaths from care homes have almost certainly seen a significant reduction since August 2021 (when the number of cases nationally also started coming down), this has been largely attributed to high vaccination uptake. The initial delay in vaccine roll out was attributed to a lack of vaccine availability.

Policy in relation to mandatory vaccination for LTC Staff and visitors to care homes

There is no mandatory vaccination policy for users or providers of LTC. However, there is a mandatory vaccination policy for civil servants, with those who do not comply being asked to resign from their posts. With this severe policy, it is likely that care home owners and managers are likely to have a similar approach to their staff.

With thanks to Professor Tan Maw Pin

References:

Update for: Malaysia Last updated: February 17th, 2022