Who cares about the carers?
HONG Kong women are becoming caught in the ''caring trap'', endangering their own health in the struggle to look after the handicapped, elderly and small children at home, without adequate support from family or community services, new research has found.
Community care, harnessing family responsibility backed up by formal and informal support, is seen as the best way of looking after the disabled and frail and is a cornerstone of the Government's welfare policy.
But new studies show that it is women who disproportionately shoulder responsibility for such caring.
The strain on these women is so great that close to 40 per cent of those looking after the disabled and nearly a third of those caring for the elderly are at risk of falling prey to mental illness, according to a study by a working group for the Hong Kong Council of Social Service, chaired by Thomas Mulvey.
The study was presented to last week's International Conference on Family and Community Care, hosted by the council. Other papers said the Government should no longer take it for granted that women should shoulder this burden and called for a policy to support caregivers in particular and for a family policy in general.
''Community care in Hong Kong is mostly family care, and that generally means care by women. Informal support is limited,'' says the council's report.
Dr Raymond Ngan and Dr Joseph Kwok, senior lecturers in the Department of Applied Social Studies, reported that women family caregivers were victimised in the ''caring trap''. Services to help those looking after others and suffering a great deal of stress themselves were virtually non-existent.
The lecturers are calling for a Bill of Caregivers Rights, including their right to more supportive services such as home care and respite, to decide whether to continue their own work or not, to financial and community support and to be consulted on services provided. They would also like a caregivers' association to be formed.
''When will Hong Kong have a comprehensive policy, which among others, will ensure that service providers make practical support for carers a high priority?'' they said. ''Support for families in need is considered grossly inadequate, particularly when parents of children with mental retardation are growing old, and both need care. This also applies to ageing spouse caregivers of frail Chinese old people.'' Dr Ngan said that home care was largely confined to the provision of meals. It did not include help with cleaning in cases where the person being cared for was incontinent, for example.
Women were less likely to receive help from other members of their families in looking after the disabled than they would receive for other home chores, according to another study by Dr Kwok quoted in their report.
In the HKCSS report, based on interviews with more than 1,700 people who looked after the disabled, elderly or children, 65 per cent of those caring for mature disabled people and 72 per cent of those looking after the mentally handicapped were women.
The average age of carers of the mature disabled was between 50 and 59 and their average household income of $9,500 was $2,200 lower than for the general population. A large chunk of that income - 19 per cent was spent on the disabled person.
In the case of care for the elderly, 57 per cent of those caring were women. The responsibility had forced a significant number of carers - 12 per cent - to give up their jobs, while a quarter had reduced their working hours.
Just under half the carers said they had no one outside the household to help them. Less than two per cent used home help services while 17 per cent used social centres and 13 per cent used day-care centres.
In the case of children aged six and under, less than 10 per cent of fathers considered themselves the main carers, confining their role to disciplining and outdoor activities.
The proportion of non-working mothers, at 75 per cent, was surprisingly high. Three-quarters said that having a child had brought worries and tensions, though 80 per cent recognised the importance of being a parent.
The survey found that parents frequently had to leave children alone. Sixteen per cent of parents said they had left a child without the care of someone over the age of 16 or over in the week before the survey. Of these, 61 per cent had left them for more than an hour, while nearly four per cent had left a young or vulnerable child unattended for two hours or more.
The study did find that those looking after dependent family members regarded it as their duty and were willing to continue, though in many cases they overestimated their ability to do so.
''There is an obvious need for greater publicity of services and easier access, and education to promote greater sharing of care responsibilities within the family and through informal networks,'' the report concluded.
It said that the needs of the carers had to be taken into consideration, along with the needs of those receiving care.
Professor Nelson Chow, in his paper The Need for a Family Policy in Hong Kong, stressed that women could no longer be relied on to shoulder the caregiving role, now that more women went out to work, old people lived longer and needed more care, and more marriages broke up.
He called for a family policy that would allow for more co-ordinated and comprehensive support for those needing and giving care.
Before 1980 most families in Hong Kong were extended, with three generations sharing one home. Today, more than 60 per cent are nuclear families, according to the council's study. The number of women working has increased from 49 per cent in 1971 to 57 per cent in 1991.
In the same period, the proportion of elderly over the age of 65 has increased from 4.5 per cent to 8.7 per cent. Professor Chow said that by 1991 there were more than 100,000 single-parent families in Hong Kong.
''The family system in Hong Kong has already developed to such a stage that it is no longer feasible to expect it to perform its traditional functions,'' reported Professor Chow.
''It is definitely essential for the various family welfare services to come under an implicit family policy so that certain common objectives could be drawn and acted upon.'' Such a policy should support rather than negate the traditional functions of the family. The HKCSS study gave several examples of how carers could be supported, such as by providing them relief through short-term residential or day-care services.
Informal support, through self-help groups, should be developed, along with encouraging a greater flexibility among employers to allow carers to continue work.
''Support and services should be made available so that they can exercise their rights to develop aspects of life other than as a carer,'' the report said.
Women were less likely to receive help from other members of their families in looking after the disabled than they would for other household jobs