Kuo Chih-chiang is delighted with his new home, a 100-sq-ft flat in a Tai Wo Hau public housing estate in Kwai Tsing. There's just room for a bed, table and a television, but the 66-year-old says it's a vast improvement on the 50-sq-ft rooftop cubicle he had in Tsuen Wan.
He's lucky social workers from a community group found him and arranged for his resettlement, Kuo says. 'I didn't know where to seek help. I had no idea about what services were available.'
The former security guard has lived alone since he separated from his wife more than 30 years ago, and didn't have friends or family he could turn to for help. 'I don't have friends and I don't like mingling with other people,' Kuo says. 'We don't have common topics. They don't understand me.'
The latest government statistics in 2006 show that 11.6 per cent of Hong Kong's population above the age of 65 - 98,829 people - live alone. But Kuo is among the senior citizens whom welfare workers describe as the 'hidden' elderly: typically impoverished old people who have become socially isolated and are unable to obtain community support or don't understand how the welfare system works.
The hidden elderly made headlines last year when Tsang Wing-on, a 78-year-old living alone, started sleeping in the streets because he could not stand the heat in his rented cubicle in Cheung Sha Wan. He became so desperate he staged a robbery at a convenience store in order to be sent to jail where he would be housed and fed. A subsequent investigation found Tsang had stopped receiving social security payments because he had not responded to letters from the Social Welfare Department.
Elderly Commission vice-chairman Alfred Chan Cheung-ming attributes such cases partly to the social stigma associated with being dependent.
'Many of our older generation aren't used to seeking help from others. They prefer to rely on themselves,' he says. 'Then there are those who suffer from mental conditions such as depression and dementia that may keep them away from the community.'
Mental health problems are common among the 'hidden' elderly, says Joanne Chung Wai-yee, a professor of nursing at Polytechnic University. She leads a mobile team of health workers who have been providing free screening and monitoring services to isolated elderly in Kwun Tong and Sham Shui Po.
The team, which includes nurses, nutritionists, Chinese medicine practitioners and psychologists, treats people identified from door-to-door visits by district community workers. 'Many 'hidden' elders have low self-esteem and lose interest in activities,' says Chung. 'They lack the motivation to seek help even when they need it and many are unaware of their problems.'
A survey of 1,500 people over 65 by Chinese University found that 450 respondents who lived alone had more complaints of fatigue, insomnia, dizziness and pain than those who did not live alone.
Kuo used to earn some money by collecting cartons in Tsuen Wan for recycling but his failing memory now deters him from going out.
'I'm so afraid I'll get lost,' he says. Even a 10-minute walk to the nearby centre for the elderly can take him an hour. He drinks to cope with his sense of listlessness since being laid off, a habit that may aggravate his complaint of occasional rapid heartbeat. But Kuo says: 'I'm so bored. There's nothing I can do at home except drink.'
To help reclusive elderly such as Kuo, the government plans to spend HK$38 million on enhancing outreach services at 156 community and neighbourhood centres for the elderly. The need for services may rise because of Hong Kong's rapidly ageing population; about 12.7 per cent of the population is 65 or older and this is projected to rise to 26 per cent in 2036.
Since January, social workers from district centres have been trying to identify and reach out to reclusive elderly at public housing blocks and haunts such as recycling plants and bakeries, but it's hard work. 'You need a lot of patience to develop rapport with a withdrawn elderly person,' says Polly Seto Man-yee, a social worker with the Hong Kong Society for the Aged. 'Many refuse to talk about their personal problems. They lose trust in people because they don't get along well with their families.'
For instance, Seto has yet to persuade an 83-year-old woman with failing sight and hearing to open her door to home visitors. 'I've put a note on her door to tell her I want to help,' she says. 'There's no feedback from her yet, but I hope one day she'll open up.'
But there have been heartening results. Tin Shui Wai social worker Kwong Po-sze recalls how she and a colleague were able to encourage a reclusive 70-year-old woman to become a volunteer at a neighbourhood elderly centre.
'Sometimes all they need is a friendly greeting as an ice-breaker,' Kwong says. 'It's also good to empower them so they know they're not alone and their contribution is acknowledged.'
The Elderly Commission has also just launched a pilot scheme to widen neighbourhood networks to reach out to isolated elderly people. NGOs collaborate with residents' organisations, schools or the commercial sector to train volunteers to organise activities for the elderly and visits to those living alone. It's important to recreate the lost community networks that traditionally sustained the elderly, says Alfred Chan.
'Many isolated elderly people could have services of friends [and volunteers] reaching their homes,' he says. 'Many would welcome friendly visits and telephone calls. So neighbours, friends and students should be sensitised to the needs of these elderly and perhaps pay a visit to their elderly friends next door.'
Lam Bo, a sprightly 82-year-old from Tin Shui Wai, appreciates the idea. Such social support would help the many old people who don't know how to book appointments on the telephone, says the former street vendor. 'That's why we queue up at the health-care centres in the early morning,' he says. 'But very often we go there to find all the quotas have been used up.'
The shortage of medical services is the biggest problem for the elderly living alone in Tin Shui Wai, Lam says. His grown-up children have their own lives so his neighbours have become his biggest source of help and support.
Widowed former factory worker Lau Yuet-ha couldn't agree more. The 76-year-old, who is still frail after an operation for colon cancer last month, is grateful to neighbours who have accompanied her on her visits to the doctor. 'It's true that good neighbours are more helpful than distant relatives,' she says.