Hong Kong’s young workers hold the key to future of geriatric care
Shattering the less-than-flattering image of aged care, a younger generation of caregivers is answering an urgent need and stepping up to the challenge of working at elderly homes
Chan Cheuk-man tried many jobs after leaving school, from property management to clerical work, none of which gave him the sense of achievement he sought. The 24-year-old has now found satisfaction working as a caregiver for the elderly, but friends and family were aghast when he decided to take the job last October.
“Very few people had anything positive to say about the job. People see it as undesirable work, jobs for people who didn’t do well in school or for foreign labour,” Chan says.
“On the third day, I had to change diapers and clean up excrement. A lot of people focus on this aspect of the job and say that you’ll have to deal with the smell and the filth,” he says. “But once I actually started doing the work, I realised ... I can help an elderly person.
“It’s not like you spend the whole day changing diapers. I have to take care of the elderly residents’ spiritual needs as well, so they don’t feel lonely, unwanted or abandoned to live in a nursing home.”
The knowledge and skills he picked up have already proved useful outside his workplace. They certainly came in handy when Chan’s mother was recovering at home after eye surgery recently – and overcame her objections to his choice of career.
His familiarity with dementia also enabled him to identify the problem when he encountered an elderly man seeking directions on a street in Prince Edward. Chan got the man to call his family and arranged for them to pick him up, advising them to seek help from a doctor or social worker,
Workers such as Chan are in demand in rapidly ageing Hong Kong. And the need can only grow as the number of Hongkongers aged 65 and above is forecast to double over the next 20 years, from 1.12 million in 2015 to 2.28 million in 2034.
However, homes and institutions dealing with the elderly already have a hard time recruiting and retaining frontline staff who shoulder many demanding aspects of care.
A 2012 survey by the Hong Kong Council of Social Service, a federation of non-government agencies, found the turnover rate for personal caregivers was more than 20 per cent.
That’s not surprising as it is one of the worst paying jobs in the city. Data from the Labour and Census departments from 2015 show that frontline care workers were paid an average of HK$45 an hour and worked about 53 hours a week – typically earning less than a waiter, food processing worker, salesperson or security guard.
Addressing this manpower gap, the government introduced the HK$147 million Youth Navigation Scheme in 2013 to attract more young people to work in elderly care. Candidates accepted into the two-year programme will receive on-the-job training at a home run by one of five participating NGOs while taking courses at the Open University of Hong Kong to attain professional certification. (Fees are reimbursed after trainees have successfully completed each year’s studies).
That’s how Chan got into elderly care.
Esther Wong Chui-yan, service director at the Evangelical Lutheran Church Social Service, an NGO in the scheme, says elderly service has long suffered a bad image and there must be a shift in attitudes towards such work.
“I hope people will see that elderly work isn’t only about cleaning up poop and urine,” Wong says. “Care workers are professionals and need to be trained. I also want people to see that this is meaningful work.”
When Wong began working with the elderly in the 1990s there were many laid-off factory workers eager to take up such jobs. Now those caregivers are getting old themselves and heading for retirement.
But it’s a struggle bringing in new blood because the work is poorly paid and seen as undesirable, she says.
Lau Sau-ching, who runs the Telford Nursing Centre in Sham Shui Po, is only too aware of the sector’s workforce crisis.
Lau says he already employs five foreign workers and needs to hire three more caregivers; but there are few takers and those that do don’t stay long – a young woman who joined his centre last year left within a month because she couldn’t cope with having to feed and bathe the elderly residents.
Still, he puts out the wanted ads and takes any help he can get: “We can’t afford to choose, unless if they have mental health problems. As long as they’re willing to do the work, we’ll give them a chance.”
Lau, who turns 50 this year, says there is such a shortage that some care workers are staying in their jobs until the age of 70.
In this dire situation, Esther Wong argues that government should consider how to promote elderly services as a career option for young people. Movies or television series can do a lot to rouse interest in a particular profession, she adds: for instance, many young people went into social work in the ’80s after watching Angels and Devils, a TVB series starring Chow Yun-fat.
What’s more, the caregiver crunch will likely present even greater headaches for government administrators when the Pok Oi Hospital is completed in 2018 – the Tuen Mun facility will be the largest residential care and nursing care home in Hong Kong.
The Social Welfare Department declined to be interviewed on this matter but said they “would keep in view the response of young persons towards the [navigation] scheme and develop the promotional strategies in due course”.
Any recruitment drive, however, could face resistance from top schools.
“Some of the higher band schools don’t even allow us into their schools [to talk to students about elderly care],” Esther Wong says. “They think that Band One students should at least be social workers or managers, rather than care workers.”
Directors at Haven of Hope Christian Service and Yang Memorial Methodist Social Service, two other NGOs in the scheme, have met with similar responses from schools, though expressed more politely.
Like Esther Wong, they hope more people will come to view elderly care as meaningful work.
While many young people see elderly care as a boring job, trainee Caris Wong Sze-ting finds satisfaction from being able to help people.
The 20-year-old, who started working at an elderly home last November under the navigation scheme, decided to take up nursing after losing a beloved aunt to cancer two years ago.
“I used to live in the UK, but we all moved back to Hong Kong because of my aunt, and I stayed with her until she died,” Wong says.
She still vividly recalls their last moments together: “She collapsed in my arms, I couldn’t move, although she only weighed 43 kilograms ... then a man ran out from the hospital and called the staff to help me.
“I [used to] go to the hospital with her, saw other kinds of patients, learned the names of drugs, learned about what nurses do, and realised that I was interested and wanted to help other people. I feel like in these five years, I became especially close to my family and my aunt, and I want to use my experience to help other people.”
Diana Lee Tze-fan, a professor at Chinese University’s Nethersole School of Nursing, says Hong Kong needs more programmes where young people can learn how to take care of the health and social needs of the elderly from the start.
“We can’t wait for someone to graduate from, say, the nursing programme, and then get them to study gerontology and work at nursing homes. I want to move this forward.”
When she launched the university’s degree programme in gerontology a few years ago, Lee says, there was a lot of scepticism about whether young people would be interested in learning about care of the elderly. But now she receives up to 500 applications a year for the 28 places on the course.
“To take care of the elderly, we can’t divide their health and social needs, so we shouldn’t train a bunch of health care workers, and then a separate bunch of social workers. Anyone caring for the elderly should have both health and social knowledge and skills.”
Lee and other professionals in elderly care say devising a clear path for advancing in the field is vital to attract young recruits.
“We need career development and better working conditions for people who are just starting out,” says Grace Chan Man-yee, chief officer of elderly service at the Hong Kong Council for Social Service.
The government should offer more opportunities for professional development so young recruits know they won’t be stuck doing the menial work of a caregiver, Chan adds.
Citing examples in Japan, which also faces issues of rapid ageing, Grace Chan says the country’s clear system for professional development and career advancement means that more young people are eager to join care services.
Another approach is to set up mixed service centres that cater to children, families and seniors: such facilities have attracted a lot of new recruits in Japan, she adds.
“Young people from Japan and Hong Kong want to feel like they’re helping the community, rather than only serving people from one age group.”
This strategy requires good coordination between different agencies, but Grace Chan believes it has potential because Hong Kong is a relatively compact city and several housing estates already feature with centres where different services are grouped together.
A handful of trainees in the navigation scheme, including Chan Cheuk-man and Caris Wong, have expressed hopes to build their careers in elderly care because they find it meaningful work. Clearly, Hong Kong needs to find more people like them – and fast.