How a discrepancy in welfare payments is thwarting care for Hong Kong's elderly in China
Mainland homes for the elderly can be good alternatives to local residences, writes Elaine Yau
The sprawling elderly centre in scenic Zhaoqing would be the envy of many in Hong Kong. With its own vegetable gardens, fish ponds and farm animals in grounds dotted with coconut palms, the place has a decidedly bucolic air.
Its ratio of 18 nursing staff to 100 residents and spacious grounds (the buildings add up to an area of 400,000 sq ft) attract retirees seeking an affordable alternative to crowded, often poorly run private care homes in Hong Kong.
Ng Yiu-kwong, 84, is among them. He moved to the 269-bed Zhaoqing Helping Hands Elderly Centre in January after suffering a fall at his home in Hong Kong. He and his wife used to share a public housing flat in Sham Shui Po. But after she died last year, he was on his own as one son was based in Zhaoqing and the other lived in Tuen Mun.
"There was no one to take care of me so I came here. I like it as there is lots of space to move around in," Ng says.
His son in Zhaoqing could visit him every week and charges were about one third of those at a private nursing home in Hong Kong - depending on the type of care required, monthly fees range from 1,800 yuan (HK$2,240) to 7,000 yuan.
On the face of it, Zhaoqing Helping Hands would be just what gerontologists envisaged when they called on the government to pursue options on the mainland as a way to cope with the shortage of affordable care places in Hong Kong.
Yet for all its attractions, just 22 of its 100 residents are Hongkongers. And herein lie the difficulties of a cross-border solution for the needs of the city's rapidly ageing population (by 2039, 28 per cent will be aged 65 or above).
Zhaoqing Helping Hands opened in 2000, boosted by a HK$90 million donation from the Hong Kong Jockey Club. It was set up primarily to serve Hongkongers, so the low residency rate runs counter to the original intention, says Colman Wong Ping-choi, who heads the Zhaoqing centre.
"In 1995, there were 24,000 people on the waiting list for a place in a subsidised elderly centre in Hong Kong. You had to wait for more than three years. Land was limited in Hong Kong and costs were higher, so we thought that going to the mainland would be a good option," says Wong.
But the discrepancy in cross-border welfare payments has discouraged many people from signing up, says Ng Hang-sau, chief executive of the Hong Kong Society for Rehabilitation, which runs an elderly centre in Yantian, Shenzhen.
Hongkongers residing on the mainland may receive the HK$1,100 monthly Old Age Allowance or HK$3,000 under the Portable Comprehensive Social Security Assistance (CSSA) Scheme. But payments from the two schemes are only about half the amount they would get in Hong Kong.
"We fought for years to have the Old Age Allowance extended to Guangdong and the extension was granted only last October," Ng says.
"The HK$2,200 Old Age Living Allowance is not available to Hong Kong residents in Guangdong. Those on the portable scheme [which covers Guangdong and Fujian provinces] get just 50 per cent to 60 per cent of the sum people on CSSA would receive in Hong Kong."
He adds: "Even with subsidies, the elderly still need to fork out several thousand dollars from their own pocket to cover their residency bills. To save money, some of our residents return to Hong Kong once they are offered a place at subsidised elderly centre."
The policy on welfare payments does not encourage less affluent Hongkongers to retire on the mainland, Ng says. Figures from the Social Welfare Department seem to back Ng's conclusion: over the past three years 1,268 people have dropped out of portable assistance scheme.
The Society for Rehabilitation's 350-bed complex in Yantian is just 15 minutes' drive from the Sha Tau Kok border crossing, compared to a four-hour ride to the Zhaoqing facility.
Perhaps because of this proximity, it has attracted more Hongkongers. At present, 76 of the 200 residents at Yantian are from Hong Kong, and Ng says they are near enough that residents requiring urgent medical treatment can be sent to the North District Hospital in 30 minutes.
"The centre has two resident doctors but for serious medical cases, we won't rely on mainland health care as Hong Kong people have concerns about the standards," she says.
Moreover, consultations with specialists in Hong Kong are subsidised - citizens pay only HK$68 for each session - while they must pay full fees on the mainland. "So we escort the elderly back to Hong Kong for specialist medical appointments," Ng says.
Such arrangements are not feasible for the Zhaoqing centre, so managers have struck an agreement with a hospital in Zhaoqing city to provide treatment for its Hong Kong residents.
Wai Suet-wing, a Helping Hands social service manager, says residents pay an insurance premium of 680 yuan each month to cover outpatient treatment at the hospital.
"This insurance does not include care requiring admission, so we escort the old folks back to Hong Kong each year to get a check-up at a public hospital for chronic illnesses like Parkinson's disease," Wai says.
Ho Ping-nam, 89, who has lived at the Zhaoqing centre for 10 years, is satisfied with the arrangement, even though he must foot his own hospital bills on the mainland.
"I have been to the hospital here four times in the past decade for chronic bronchitis. On the most recent visit, I stayed for nine days and it cost 7,000 yuan. Despite the expensive bill, I like living here," Ho says. "I have not been back to Hong Kong since coming here. My two sons in Hong Kong come to visit during Lunar New Year and other festivals."
The environment, Ho says, is much better than the cramped elderly homes he checked out in Hong Kong, where dozens of people had to share two to three washrooms.
Although private nursing homes in Hong Kong provide about 50,000 places, standards can vary enormously. Many occupy premises converted from restaurants, and are often inadequately staffed.
The poor conditions explain why there is an overall 30 per cent vacancy at the city's 565 private nursing homes while government-subsidised centres which offer far more congenial environments, are always full.
In the past five years, the wait for a subsidised place has ranged from 23 months to 35 months, and about 4,600 people die annually before they get a slot.
About 30,000 people are now on the waiting list for a subsidised residential place and, to encourage them to seek alternatives, the Social Welfare Department is launching a pilot scheme to buy residential places at the two elderly centres in Guangdong. Applicants can be placed in the homes from the third quarter of this year, a department spokesman says.
Ng says the government will pay between HK$7,100 and HK$9,600 for each Hong Kong resident under the pilot scheme. "This would cover all their costs at the Shenzhen centre, so the elderly will have greater incentives to relocate here."
"If the pilot scheme is successful, more NGOs will follow in our footsteps to establish elderly centres on the mainland," Ng says.
"When we bought land from the Shenzhen government 12 years ago [to build the facility], we didn't get a discounted land premium. But now its land policy gives preferential financial treatment to operators of elderly services."
But Elderly Commission chairman Alfred Chan Cheung-ming doubts how much cross-border schemes can alleviate Hong Kong's need for geriatric care. The 200 to 300 places offered by the two centres in Guangdong barely puts a dent in the long waiting list for subsidised places.
"No country allows welfare payments to be taken abroad as citizens will object and demand that funds should be spent locally. Hong Kong has already broken the norm by offering partial cross-border subsidies due to our close proximity to Guangdong. So a government plan to give full cross-border welfare payments is bound to run into resistance," Chan says.
"Besides, mainland authorities have yet to fully embrace the concept. Even if Hong Kong residents were fully protected by medical insurance, mainland officials still have doubts. They are worried that if nursing home residents are abandoned by relatives, they will be burdened with the responsibility of care."