Hong Kong faces challenge ensuring the elderly feel right at home

Hong Kong faces a massive challenge if it is serious about giving its growing legions of senior citizens the quality care that they deserve

PUBLISHED : Monday, 24 February, 2014, 4:45am
UPDATED : Monday, 24 February, 2014, 5:26am

With his liver and heart ailing and suffering from dementia, Star Ng's father needed special care.

The health needs of the once outgoing primary school teacher had overwhelmed his family.

They put him in a nursing home, where he saw out the last two years of his life.

Home-based services might have eased his life - and that of his relatives. But they could not afford to hire two round-the-clock nurses.

"It was sad to see a respectable man like my father living in a nursing home. But it was inevitable because we had limited choices," Ng said.

Now she worries about her mother, who is in her 70s and lives alone.

A gray tsunami is washing over Hong Kong - and it's triggering a flood of problems.

Elderly people's housing and welfare needs are becoming more pressing. The number of people over 65 will double to 2.16 million within 20 years, accounting for a quarter of the population. They will represent a third of the city by 2041.

This is leading to long waits for services. Last month, nearly 30,000 people were waiting for subsidised nursing units. The average wait is 35 months, up from 30 months in 2003. About 5,000 elderly people die every year while waiting for a subsidised nursing unit.

All the while, more residents are demanding a pension scheme that would give them greater security in their retirement.

The government and its advisers on demographics released a report for public consultation last September outlining the challenges ahead and floating possible solutions.

Suggestions largely focused on expanding the workforce. They included raising the retirement age, encouraging housewives and retirees to return to work, helping new immigrants integrate into the community, strengthening vocational training for youngsters, attracting overseas talent, importing low-skilled labour, encouraging more births, and encouraging the elderly to retire on the mainland.

The report drew harsh criticism during the subsequent consultation that ended yesterday. Gerontologists said the report did not address inadequacies in housing and pensions and the possible impact on public finances.

"The issues of elderly accommodation and retirement security are basic when we look at population policy," said Nelson Chow Wing-sun, chair professor at the University of Hong Kong's Department of Social Work and Social Administration. "I can't visualise what Hong Kong will be like in 30 years."

Chow said ignoring such issues would invite inconsistent policies. "For example, how can the government encourage parents to give birth when the Housing and Transport Bureau said most flats built in the next decade would be as small as 300 square feet"? he said.

Finding land to build more public rental and subsidised flats has become a priority of Chief Executive Leung Chun-ying.

A source close to housing chief Anthony Cheung Bing-leung said giving land to the Housing Society - the only developer of homes for seniors - to build accommodation equipped with medical facilities and nursing staff was no longer a priority.

Two housing estates for seniors in Kowloon Bay and Tseung Kwan O provide just 576 homes. They are leased for HK$260,000 to HK$590,000 for the lives of the tenants and the society's spokesman said the turnover rate was lower than expected.

Ten years ago, only 65 per cent of the tenants were over 70, and 17 per cent were over 80. Today, 90 per cent are over 70 and 47 per cent over 80, he said. About 500 people are on the waiting list.

New homes for seniors slated for North Point and Sau Kei Wan target those in the wealthier classes.

The housing shortage has made retiring on the mainland, especially in Guangdong province, an option. But gerontologist Alfred Chan Cheung-ming, who chairs the Elderly Commission, said he doubted this was a real option.

"Future retirees are baby boomers who are comparatively better-educated and well-off. They will want to live where medical services and the legal system are up to international standards," he said.

Chan said food and goods would cost more on the mainland in five to 10 years, given the rapid economic growth. Referring to Hongkongers, he said: "Those retiring soon should be given a choice to stay in their beloved city."

Some retirees go to Guangdong but don't end up staying.

The mainland branch of the Federation of Trade Unions said about 200 disaffected elderly people a year returned to Hong Kong.

For those who opt to stay in Hong Kong, the shortage of well-equipped homes for seniors and affordable nursing places means many need help from personal carers if they stay in their homes.

Kwong Wing-tai, 65, one of a concerned group of citizens from Tseung Kwan O, said frail people who did not yet need a wheelchair had to wait up to two years to get subsidised meals delivered to their homes.

"If their neighbours can't buy them take-away meals, they usually have instant noodles or biscuits as they can't cook their own meals," Kwong said. "Some organisations only provide meals on alternative days, either lunch or dinner.

"These people contributed to the city's growth but aren't treated as a human beings," he lamented.

Wong Yun-tat, a social worker with the Neighbourhood and Worker's Service Centre, said only 60 service teams - each with a social worker, personal care worker and driver - were available to serve the elderly in the entire city, despite the changing demographics.

"Some organisations have stopped accepting new applications. They just can't cope with the surge in demand," he said.

Official statistics show that subsidised home care services - which include delivering meals and accompanying clients to medical appointments - covered 23,400 elderly people in 2012, while just 2,600 obtained services at day care centres.

Wong said this was just a drop in the ocean compared with the more than 700,000 elderly people who needed help.

"Many of them would not need to go to nursing homes if personal care workers could serve them at home," he said.

"The service programmes were devised to prevent the health of the elderly from getting worse. Now, only those getting worse can get the service more quickly."

Neither the Food and Health Bureau or the Social Welfare Department would give an estimate of how many elderly people with chronic diseases needed personal care services.

For Ng, who is worried about her mother, the ideal option would be for her to spend her last years in a village where daily and health care services would be at her doorstep.

It would also offer classes and volunteer opportunities. Those flats would be subsidised and resold when the person died.

"I hope the government will consider my suggestion," Ng said.

She thinks often about her father's situation.

"I always think spending the last years at home is best," Ng said. "Our family members could have seen him together, visited him more often and had somewhere to sit down and talk to him."

The family's angst was made even worse when her father fled the nursing about 10 times as his dementia progressed.

Cities in Florida in the US and Canberra in Australia offer possible models for retirement villages.

Senior homes range from cottages to suburban apartments, offering health monitoring and special teams of caregivers to look after those with dementia. The villages have club houses where residents can watch movies and do aerobics and activities include gardening.

Social work professor Chow said building such retirement villages was not impossible. "In Canberra near homes for the elderly, the traffic lights are set to give them more time to cross," he said. "In the end, it should be about people's quality of life."