Retiring to the mainland is losing its lustre for Hong Kong seniors
Tens of thousands have retired to the mainland for a better life; costly health care and limited benefits are driving many back
Woodlands and farm plots span the 27 hectares of Kornlake Villa Resort, a retirement community in the town of Zhangmutou near Dongguan. The resort is one of the many luxury estates built here in the 1990s to attract Hongkongers. There is space to farm, to garden, to dance and to practise calligraphy.
Despite the beauty and sense of community, Father Joe, a retired Anglican priest, left to return to Hong Kong in July.
Joe is one of tens of thousands of Hong Kong seniors who moved to the mainland in recent years seeking a better life in retirement than one in congested and expensive Hong Kong. But he and a growing number of seniors are coming home, unable to access affordable Western medical care or government subsidies on the mainland.
"I couldn't imagine how I would be transferred across the border when I needed urgent treatment, not to say when [dealing with] my dead body," said Joe. He suffers multiple ailments - coronary heart disease, kidney failure and mild depression. He asked that his full name be withheld to protect his privacy.
The number of Hong Kong elderly at Kornlake has dropped from 300 in 2008 to 103 today, the resort's chairman said. Some of those died there, but many left for Hong Kong to access better and less expensive health care.
Thus, there's a conundrum for the Hong Kong government. The number of Hong Kong residents aged 65 or older is projected to grow by 161 per cent - from 980,000 in 2012 to 2.56 million in 2041. As more than 30,000 people aged 65 and up await nursing home beds, Hong Kong needs to handle a fast greying population.
The government's steering committee on population policy is expected to develop policy recommendations later this year. One suggestion likely to be raised: encourage people to retire on the mainland.
But as Joe and others have discovered, that's not so easy, as when retirees leave Hong Kong they also leave behind many of the benefits the city grants its seniors. Hong Kong citizens living on the mainland receive only limited financial benefits from the city and no medical benefits from either the city or the mainland. They are referred to as "the marginalised" in a mainland retirement study released by Hong Kong's Central Policy Unit in July.
Encouraging Hong Kong's elderly to move to the mainland is "an option, given the scarce land resources in Hong Kong", said Alfred Chan Cheung-ming, a gerontologist who chairs the Elderly Commission.
However, there are problems. "Supporting measures are lacking. Can older people receive medical services on the mainland at Hong Kong prices? Which authority should handle their bodies when they pass away?"
About 110,000 Hong Kong retirees have moved to the mainland, according to 2011 estimates by the Census and Statistics Department, the most recent available. The department believes the real number could be higher because the survey did not take account of residents who had sold their properties in Hong Kong or did not stay for long periods in the city.
No reliable data exists as to how many seniors have returned to Hong Kong. The Social Welfare Department says that the number of elderly taking part in the city's 'portable' social security scheme - which offers monthly payments to those living in Guangdong and Fujian - has dropped by a third, from 2,985 in 2009-10 to 2,096 in 2013-14. To rejoin Hong Kong's social security scheme, a senior must have been resident in the city for the previous two years - about 110 seniors rejoin successfully each year.
Seniors are returning because of two problems that have yet to be addressed - access to health care and rising inflation on the mainland.
Retirees who move to the mainland are deprived of the affordable care that is readily available in Hong Kong public hospitals. Neither do they qualify for a HK$2,500 annual voucher made available to Hong Kong citizens aged 70 or above for primary care service from their private doctors. On the mainland, these seniors must pay even for ambulance rides in emergencies.
"To me, encouraging people to retire on the mainland is not the right direction. A gallstones check in a hospital, plus medication to ease my pain has cost me HK$3,000," Joe said. "But it would cost only a few hundred dollars in Hong Kong."
Born in Hunan province and raised in Hong Kong, Joe decided to move to the mainland eight years ago when his wife died and his two adult sons moved overseas. Before moving to the village, he lived in a nursing home operated by a Hong Kong charity group, Helping Hand, in Zhaoqing for about a year.
"The nursing home was too remote. It took me seven hours to visit Hong Kong," said Joe, sitting by the lake after dinner.
The village in Zhangmutou had Chinese medicine practitioners, but Joe said he preferred Western medicine. "The acupuncture treatment never works on me," he said.
A few years ago Joe would return to the city to receive regular medical check-ups at hospitals and a clinic.
"But my legs are too weak to go through immigration now. I have to walk with a cane."
Inflation on the mainland is another factor driving the elderly back to Hong Kong.
One hundred Hong Kong dollars is worth just 80 yuan today, compared with 140 yuan in the 1990s.
The Hong Kong government has some schemes to ensure the elderly living on the mainland receive some money.
It introduced a one-off arrangement last October that granted seniors living in Guangdong an allowance of HK$1,180 without requiring that they return to Hong Kong each year. But the arrangement will expire next month.
After that, seniors must live in Hong Kong continuously for one year before they can apply.
The Old Age Living Allowance scheme was set up to give financial assistance to those receiving less than HK$7,090 per month and holding assets valued at less than HK$201,000. But elderly people living on the mainland don't qualify.
Joe said residents in the village did not worry about food costs, as they were offered four meals a day at about HK$1,000 per month. Yet, he could feel the impact of inflation. "We have fewer choices and ingredients in our dishes," he said. "There was a time they put eggs in nine meals in a week. I eventually wrote to the managers and asked them to be more considerate of elderly people."
Moving into Kornlake costs about HK$500,000 for a single person to stay in a bedroom of about 240 sq ft until death. A monthly rental costs about HK$3,000, with dining and care services costing an extra HK$1,700.
Kornlake, now owned by a state-owned company, Guanghong Holdings, plans to upgrade its services and expand the village - from 300 to 1,000 flats - as part of a 5 billion yuan property development plan, according to the resort's chairman, Xu Lei.
The village will become a 24-hour care centre serving older people living nearby who suffer from chronic diseases and aren't able to care for themselves. That should help single children, who, because of the state's one-child policy, sometimes need to support six elderly people - two parents, two in-laws and two grandparents.
The expansion will open the village to mainlanders. "We would love to serve more Hongkongers, but the fact is that the number of residents is dropping," Xu said
"Some have passed away. Some have returned to Hong Kong for better and cheaper medical services," he said.
Guangdong provincial government figures show that citizens aged 60 or over numbered about 11 million, about 12 per cent of the Guangdong population in 2012. The percentage is expected to grow by three per cent each year. Yet the number of nursing places made available by public and private institutions accounts for just 1.5 per cent of its senior population, lagging behind the national average of about 2 per cent.
Xu said the Hong Kong administration should provide medical insurance for elderly residents so they could visit local hospitals and clinics delivering medicine on the mainland.
Similar recommendations were suggested in a survey commissioned by the Hong Kong government's Central Policy Unit, which was carried out by Sun Yat-sen University in Guangzhou in 2011.
The survey recommended increasing the old age allowance and pegging it to the mainland inflation rate, providing free transportation and overhauling the distribution of portable social security assistance.
A spokeswoman for the Food and Health Bureau said Hong Kong was considering allowing the elderly on the mainland to use a health care voucher to pay for services at a Shenzhen hospital that was established by the University of Hong Kong.
A spokeswoman for the Labour and Welfare Bureau said the government had strengthened support for the elderly on the mainland by paying organisations for services and selling them to seniors at more affordable prices at two mainland nursing homes in Shenzhen and Zhaoqing.
The two homes, run by NGOs, offer in-house medical consultation and transportation services for those who need follow-up treatment at the North District Hospital in Sheung Shui, Hong Kong.
But Professor Nelson Chow Wing-sun, chair of social work and social administration at the University of Hong Kong, said placing people in nursing homes was less desirable than housing them in communities for retirees.
He questioned why the Hong Kong government did not allocate land for building retirement villages. "To old people, family reunion is precious," he said.
The Elderly Commission's Professor Alfred Chan said medical services should be improved as soon as possible. "It would require better and more frequent communication between the two governments," he said. Parents whose adult children had moved away accounted for more than 20 per cent of the city's senior population, he said.
"Very often, old couples are forced to live in different nursing homes because of an acute shortage of places," he said.
Having returned to Hong Kong, Joe lives in a nursing home, in a smaller room than his bedroom in Kornlake. He will share that with a roommate. Yet, it is his preferred option at his age.
"We are emotionally attached to Hong Kong," he said. "Why can't we stay in the city and be taken care of?"
Lending a helping hand
Recommendations to help Hong Kong's growing senior population better navigate retirement:
- Increase the amount of "old-age allowance" by pegging it to the mainland inflation rate
- Convince mainland authorities to provide free public transportation and affordable medical services to Hong Kong retirees
- Require the Hong Kong government to provide frequent transportation so the elderly on the mainland can cross the border for Hong Kong medical services
- Remove the restriction that seniors applying for portable social security assistance must return to Hong Kong and stay for two years
- Build retirement villages in Hong Kong instead of on the mainland
Sources: Study by Hong Kong government's Central Policy Unit and Professor Nelson Chow Wing-sun