Worrying Trend: At Least 2 Elderly Patients Are Abandoned At Government Hospitals Monthly

Unable to recall his name or produce an ID, Ah Chong*, a 70-year-old man with dementia, was admitted to Hospital Kuala Lumpur (HKL) after concerned neighbours intervened. The hospital’s Social Work Department used his fingerprints to trace his family, but his children, once located, refused to take him in. Consequently, Ah Chong was placed in a welfare home, where two of his children now visit him occasionally^[1].

Ah Chong’s case isn’t isolated; it reflects a troubling trend at HKL. Last year, the hospital recorded 358 cases of elderly patient abandonment, with 166 cases reported by May 2024^[1]. Typically, at least two elderly patients are abandoned at the hospital monthly, spiking numbers during festive seasons like Hari Raya and Chinese New Year.

According to the Women, Family and Community Development Ministry (KPWKM), in 2022, 2,144 elderly patients were abandoned within four years (2018-2022) in hospitals nationwide^[2]. 

50% Of Abandoned Patients Are Over 60yo

Shima*, a former registered nurse at HKL, shared her encounters with abandoned elderly hospital patients. Over her years of service, she witnessed firsthand the distressing situations these vulnerable individuals face^[3]. Many arrived without anyone to care for them, their frail bodies and confused minds left to navigate the daunting hospital environment alone.

There was this one elderly male patient I had who was lucid but too weak to move.  His wife had passed and he had one son who was married and spent all his money on his wife. When the father was hospitalised, he just left him there. The patient didn’t seem too bitter and just told me he thought his son was stupid. He didn’t seem like someone who would raise a bad son. – Shima*, a former registered nurse at HKL^[3]

According to HKL’s data, 50% of patient abandonment cases involve elderly individuals over 60 years old, with 90% claiming they have no family. This year alone, HKL received 166 cases: 139 men and 27 women. The majority were of Chinese ethnicity (66), followed by Indians (51) and Malays (43).

However, not all elderly patients are abandoned by “anak derhaka” (ungrateful children). Some are brought in by concerned passersby or neighbours, as they are homeless or “kutu rayau” (vagrants).

In most cases, these patients are admitted by passers-by and were often sent to HKL by ambulance. When it is time for them to be discharged, they tell us that they have no relatives. – Zulhan Ambi, HKL Social Work Department chief^[1]

Norzila Hasan, a senior official in HKL’s Medical Social Work Department, explains that abandoned patients are typically elderly or mentally ill^[4]. Many are homeless, while others have been disowned following family feuds, divorces, or due to issues like HIV and drug abuse. 

Persuading families to reclaim their relatives is often hindered by rough histories involving domestic violence, gambling, and addiction.

I remember one case where a patient came to our nurses’ counter and told us to only call her if her father is dead. It looked like she didn’t have a good relationship with her father. Who knows what her father had done before.– Shima*, a former registered nurse at HKL^[3]

It’s easy to blame a lack of filial piety for the abandonment of elderly patients in hospitals, especially when next-of-kin provides false information or blocks the hospital’s number. However, the reasons are often multifactorial.

Some are from poverty-stricken families living in People’s Housing Projects (PPR) who cannot care for an ill and elderly person. Adults work long hours to make ends meet and cannot tend to the seniors and take care of their children at the same time. –  Muhammad Syafiq Mohiadin, Persatuan Kebajikan Mahmudah Malaysia secretary^[1]

Echoing these sentiments, The Malaysia Healthy Ageing Society (MHAS) suggested that the Social Welfare Department should closely examine the reasons behind elderly abandonment, noting that factors like dementia, psychiatric conditions, financial difficulties, and caregiver stress often complicate elder care^[2].

The Cost Of Caregiving 

With the rise of the sandwich generation, the pressure on adult children has intensified. Caught between raising their own children and caring for ageing parents – the dual responsibilities place them in precarious positions. Sometimes, they may feel forced to make a difficult decision. 

In 2000, there were 16 persons of working age to support each senior citizen in Malaysia. In 2020, there [were] only 10 and, by 2050, there will be only be four of them to support one elderly person. – Dr Amjad Rabi, social economist^[5]

For Cassandra Michelle Paujik, who has prioritised her finances to care for her mother, a cancer survivor, and her late father, who had Parkinson’s disease – most of her earnings had been channelled to the upkeep of her ailing parents. 

I’ve seen prices range from RM40 to RM50 for a pack of adult diapers. Yes, there are cheaper options. But when it comes to something as important as my parents’ comfort and well-being, I always try to go for the best quality. – Cassandra Michelle Paujik, an employee at a financial institution^[6] 

Lester Calvin Miol, a general manager, faces a similar challenge as the sole caregiver for his mother with Alzheimer’s. Balancing her care with his own household’s needs, he hires help and uses a care centre on weekends, which costs up to RM9,000 a month. 

When my mother’s condition advanced, we brought in hired help to assist with her care. Now, over the weekends, she stays in a care centre. This gives our family some breathing space, as I have to consider my young daughter’s mental health too.  – Lester Calvin Miol, a general manager^[6]

Despite government aids like Bantuan Orang Tua (BOT), Bantuan Rakyat 1Malaysia (BR1M), and Rahmah aid schemes, support for a changing demographic remains inadequate. 

Many elderly individuals, lacking sufficient retirement funds and often not covered by Employee Provide Fund (EPF) or Kumpulan Wang Amanah Persaraan (KWAP), rely heavily on their children^[5]. 

This in turn affects caregiving duties, the National Health and Morbidity Survey of 2019 revealed that 65.5% of informal caregivers primarily rely on family support, with sporadic external assistance from the state^[5].

There’s No Place Like Home 

Hospitals face persistent high demand for beds, with many patients awaiting admission and medical attention, creating pressure for healthcare workers to vacate beds quickly. At HKL, staff go the extra mile. The Medical Social Work Department works tirelessly to locate the families of abandoned elderly patients. 

When patients like Ah Chong* lack identification, their thumbprints are sent to the National Registration Department to find their families. Social workers then visit, counsel, and persuade families to take them back home.

We visit the family and discuss our findings with various hospital experts, including nurses, pharmacists, dieticians, and medical specialists, to create a care plan. Usually, family members are willing to take back the patients once they understand our care plan. – Norzila Hasan, a senior official in HKL’s Medical Social Work Department^[4]

When families refuse to care for elderly patients, HKL arranges family conferences to highlight available support systems. Norzila emphasises HKL’s goal: preventing elderly patients from going to welfare homes, believing that a familiar environment with loved ones is more beneficial than institutional care.

It’s just that there tends to be less love and care in such institutions. It’s always better for their families to take care of them. There’s no place like home. – Norzila Hasan, a senior official in HKL’s Medical Social Work Department^[4]

However, some stories end tragically, as some elderly pass away during the process. Others spend their remaining days in welfare homes, hoping for occasional visits from their children or next of kin. 

In 2022, 1,230 individuals or their family members who could not be traced were placed in the custody of welfare institutions^[2].

Most welfare homes do not accept patients who have no next of kin. When no one wants to care for these seniors, officers will get relatives’ consent for the patient to be accepted into a welfare home. – Zulhan Ambi, HKL Social Work Department chief^[1]

Malaysia’s Response To Elderly Patient Abandonment 

In response to the increasing cases of elderly patient abandonment, the government established shelters such as Rumah Seri Kenangan and Rumah Ehsan. 

Rumah Seri Kenangan caters to elderly individuals over 60 who lack financial means, heirs, or permanent residence, are free from infectious diseases, and can care for themselves. Meanwhile, Rumah Ehsan provides long-term care for bedridden elderly individuals who are sick and without heirs^[7].

However, many welfare homes are hesitant to admit bedridden elderly individuals due to the intensive care they require. 

At Pusat Jagaan Mahmudah Malaysia, a facility supported by public generosity, they provide refuge for residents aged between 38 and 90 years old. The home receives daily calls from hospitals seeking care for abandoned elderly patients.

They are mostly people with disabilities, single and without next of kin, or are ill and in need of medical attention as well as being bedridden. Most of them have non-communicable diseases and need regular medical check-up. – Muhammad Syafiq Mohiadin, Persatuan Kebajikan Mahmudah Malaysia^[1]

Directly sending ailing parents to old folks’ homes carries a stigma, implying a lack of care and appreciation towards parents. The proposed legislation aimed at protecting the elderly appears to be a double-edged sword.

In a statement, Social Welfare Department Director-General Norazman Othman remarked, “Currently, there are no legal provisions allowing for action against families who abandon their parents and other elders. It is time that such laws are enacted to protect these people.”^[7]

To address this, the government is advancing the Senior Citizens Bill, initially considered more than a decade ago. 

In 2022, efforts are underway to formulate and review this bill with stakeholders, expected to be presented to Parliament in 2024. Among the proposals discussed in Parliament is the possibility of salary deductions for children found neglecting their filial responsibilities^[7].

KPWKM welcomes the proposal to introduce a law that mandates salary deductions for children who send their parents to care centres or nursing homes if the children are capable but do not fulfil their responsibilities. – Aiman Athirah Sabu Deputy Minister of Women, Family and Community Development (KPWKM)^[8]

Reflecting the same view, Professor Datuk Dr. Shad Saleem Faruqi, a constitutional expert and jurist, proposed adopting measures similar to Singapore’s Maintenance of Parents Act, making it mandatory for children to care for their parents^[5]. 

He also suggested introducing unpaid leave for caregivers and promoting flexible working arrangements. Drawing inspiration from European nations, he advocated for legislation that recognises and supports informal caregivers^[5].

At the same time, the proliferation of senior living centres in Malaysia reflects the changing realities of the country and its economy. Rather than signalling waning filial piety, it highlights how younger generations are often not around to care for their parents due to migration and their parents’ increasing self-reliance. These services, regrettably, are currently at a premium price. 

The seeds were already there but MCO accelerated the growth because you suddenly had so many people unable to return to care for their parents and older relatives. – Elizabeth Gimbad, anthropologist^[8]

On the government end, KPWKM is ramping up efforts to ease the caregiving burden often borne by women with plans to establish elderly care centres in government facilities next year, offering caregiving services at a minimal rate. Additionally, the ministry already operates Senior Citizens Activity Centres (PAWE) and Senior Citizens Care Units (UPWE), which provide community activities and transport services for the elderly needing medical attention. 

Meanwhile, Masoc Care, founded by Dr Melody Ang and a group of young professionals, is tackling Malaysia’s senior care challenges head-on. Inspired by Japan’s effective senior care model, the organisation advocates for enhanced caregiver training and youth engagement. Youths are involved in a variety of training programs to enhance seniors’ quality of life and offer programs not only for career seekers but also for family members seeking basic caregiving skills.

The old cannot take care of the old. The young need to do it and, as young people, we want to advocate for this. – Dr Melody Ang, founder of Masoc Care^[9]

Other than equipping ourselves with caregiving knowledge, the following are changemakers who are working to cater to the elderly who would benefit from having volunteers or donations. 

• Rumah Kasih, is a charity home that tends to the abandoned elderly. The home offers shelter, and medical treatments and provides necessary assistance to senior citizens. 
• Kechara Soup Kitchen is a not-for-profit organisation tending to the marginalised, their work consists of reuniting homeless senior citizens with their families. The organisation also strives to provide a better quality of life by providing food, medical treatment and clothes. 
• Pertubuhan Kebajikan Warga Emas Sungai Chua, is a welfare home established in 2021 catering to the elderly with families that are unable to support them due to financial constraints. 
• Rumah Charis offers a place where the elderly, who may be homeless or in need, can find a secure environment and improve their quality of life.

*Not their real names as names have been modified to protect their privacy and identity. not real names 

Explore our sources: 

1. Sri Priya, S. (2024). Patient abandonment on the rise. The Star. Link 
2. Yeo, B. (2022). The plight of elderly abandoned in hospitals: Where do we go from here, Malaysia? Focus Malaysia. Link 
3. Mohanakrishnan, A. (2023). More work for MoH nurses as families abandon elderly in public hospitals. The Vibes. Link 
4. Tan, T. (2016). How HKL deals with abandoned patients. Free Malaysia Today. Link 
5. Loh, J. & Zulkifli, N.N. (2022). Who cares? Elderly abandonment and the welfare of informal carers ― Jason Loh and Nik Nurdiana Zulkifli. Malay Mail. Link 
6. Yahoo! Malaysia. (2024). Growing old in Malaysia can be very costly; The high cost of ageing in the country. Link 
7. Nair, T. (2023). Call for law against abandonment of elderly. The Sun. Link 
8. Code Blue. (2023). Proposed Senior Citizens Bill May Impose Penalties For Sending Elderly Parents To Care Homes. Link 
9. Soo,W.J. (2024). Senior living centres symptom of Malaysia’s cultural and economic shift, anthropologist says. Malay Mail. Link 
10. Indramalar, S. (2024). Why these youngsters are making senior care their business. The Star. Link