Living longer, but are we prepared for long-term care?
By Associate Professor Dr Mazlynda Md Yusuf and Dr Mohd Hafyzuddin Md Yusuf
A visit to the emergency department often begins with urgency, triggered by a fall, stroke, heart attack, serious infection, or another acute medical condition requiring immediate clinical intervention. In these critical moments, the healthcare team’s primary objective is to manage the acute episode, deliver immediate treatment, and, when feasible, safely discharge the patient. However, an essential clinical and social question remains: what happens after discharge?
For many individuals, leaving the hospital door does not signal a return to their previous level of independent functioning. Patients frequently require ongoing assistance with fundamental activities of daily living, such as walking, bathing, eating, or administering medication. Others depend on structured rehabilitation, skilled nursing care, mobility equipment, physical home modifications, or continuous support from informal family caregivers. This critical gap between acute clinical stabilization and sustained post-discharge functional survival defines the necessity of long-term care (LTC).
Long-term care refers broadly to ongoing assistance and support for individuals who experience difficulty living independently due to ageing, chronic illness, disability, or other health conditions. Unlike acute hospital treatment, which concentrates on resolving an immediate, short-term medical crisis, long-term care is extended in nature and may persist across months or even years. Understanding LTC as a multi-year post-acute necessity becomes critical when examined against Malaysia’s accelerating demographic projections.
Demographic reality and healthy life expectancy gaps
Data from the Department of Statistics Malaysia (DOSM) underscores the rapid momentum of this demographic shift. The proportion of the Malaysian population aged 65 and above increased from 8.0% in 2025 to 8.4% in 2026, representing approximately 2.9 million people. Simultaneously, the population aged 60 and above reached roughly 4.2 million individuals, or 12.3% of the total population. Actuarial projections indicate that Malaysia will officially transition into an ageing nation in 2036, when individuals aged 60 and above exceed 15% of the total population.
Malaysians are undeniably achieving greater longevity. According to DOSM’s latest Abridged Life Tables, an infant born in 2026 has an average life expectancy at birth of 75.5 years. From the perspective of retirement and care planning, an individual reaching age 60 in 2026 is projected to live an additional 20.2 years on average—18.9 years for males and 21.7 years for females.
However, a crucial actuarial distinction exists between total life expectancy and healthy life expectancy. World Health Organization (WHO) data for Malaysia in 2021 indicates a Healthy Life Expectancy (HALE) at birth of 63.9 years, compared to an overall life expectancy at birth of 72.8 years. Because HALE takes into account the years lived in less than full health due to disease or injury, this statistical gap reveals a significant morbidity gap of 8.9 years spent in compromised health. Extended life expectancy without a parallel expansion in HALE results in a prolonged period of functional dependency, directly challenging healthcare risk models and the solvency assumptions of traditional retirement annuities. Consequently, population planning must evolve beyond asking, “How long might I live?” to confront the more crucial question: “How many of those years might I need assistance to live independently?”
The multi-dimensional burden: financial, practical, and familial
Consider the post-acute trajectory of an elderly patient presenting to the emergency department following a fall. While the acute physical injury may be successfully treated, the patient’s ongoing recovery extends far beyond the hospital ward. Post-discharge management frequently requires ongoing physiotherapy, home nursing services, specialized mobility equipment, adapted transportation, daily personal care assistance, or structural home modifications.
These long-term requirements impose direct financial liabilities and generate substantial indirect economic consequences for families. Spouses, adult daughters, or sons frequently adjust their professional obligations by reducing working hours, taking extended leave, or exiting the labor force entirely to serve as primary informal caregivers. The true financial footprint of long-term care extends well beyond immediate medical bills, directly eroding household earning capacity and workforce productivity.
Despite these catastrophic financial risks, traditional retirement planning relies heavily on income replacement models that assume static post-retirement consumption for basic living expenses—such as food, housing, daily overhead, and basic acute healthcare. Actuarially, long-term care does not follow a predictable, linear spending pattern; instead, it introduces asymmetric, catastrophic expenditure spikes in late life that can rapidly liquidate accumulated retirement reserves. Long-term care can no longer be treated as a peripheral contingency, but must be established as a distinct, dedicated pillar of retirement financial security.
Strategic preparation and national imperative
Effective preparation for long-term care does not require predicting exact individual health trajectories. Rather, it demands systematic risk recognition and the pre-emptive alignment of multi-layered support frameworks prior to a health crisis. Essential pillars for long-term care readiness encompass personal liquid savings, tailored insurance or takaful protection mechanisms where appropriate, family financial resources, structured government support programs, and community-based care networks.
When an unexpected medical emergency occurs, families are forced into immediate clinical decisions. However, the overarching challenge extends beyond acute hospitalization costs: the immediate inquiry, “Can we afford today’s hospital treatment?” must be paired with the crucial long-term reality, “If the patient returns home but needs care for the next three, five or ten years, who will provide that care and how will we finance it?”
As Malaysia transitions toward an ageing society, funding for long-term care costs must be integrated into the core national conversation surrounding retirement policy, healthcare system sustainability, and social security infrastructure. Extended life expectancy is a major developmental achievement; ensuring that these added years are lived with physical dignity, structured support, and financial resilience represents an urgent national imperative.
Associate Professor Dr Mazlynda Md Yusuf is an Actuarial Science and Risk Management Lecturer at Universiti Sains Islam Malaysia (USIM), and Dr Mohd Hafyzuddin Md Yusuf, is a Consultant Emergency Physician and Medical Lecturer at Universiti Malaya.