Ageing society

Hong Kong should consider the needs of its elderly residents when deciding on future land supply

Lam Ching-choi says Hong Kong lacks adequate facilities to ensure its growing elderly population can live long, healthier lives. Thus, the city needs to explore the issue of land supply from the perspective of elderly care

PUBLISHED : Wednesday, 12 September, 2018, 6:17am
UPDATED : Wednesday, 12 September, 2018, 6:23am

Imagine you’re an 85-year-old dementia patient. Cognitive frailty can make a routine 15-minute minibus ride to the doctor an embarrassing and terrifying ordeal.

Still, you’re celebrated as one of the individuals whose high life expectancy has put Hong Kong on the map. In Hong Kong, a population of over 7 million is crammed onto a mere 1,106 sq km of land. Despite its small size and frenetic pace of living, Hong Kong once again boasts the world’s highest life expectancy for women and men.

According to the latest study, released by the Japanese authorities, the average life expectancy of Hong Kong women is 87.66 years and that of Hong Kong men is 81.7 years.

Does longevity lead to happiness though? Hong Kong’s rapid ageing continues to be a major policy challenge and existing facilities are hardly adequate for the growing elderly population. Many issues arising from this “silver tsunami” are closely related to land supply. Hence, the needs of the elderly must be included in the discourse on future land use. What is the connection between the two?

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In Hong Kong, 8 per cent of the elderly live in residential care homes, which is much higher than the elderly institutional rate of around 3 to 4 per cent elsewhere. At present, the statutory minimum per capita floor area of these homes is 65 sq ft, and there are tens of thousands of elderly people waiting for a place.

For those suffering from chronic illnesses, the risk to their health is higher if their living space is too small, as infections are transmitted much more easily.

A lack of space for elderly care facilities is especially a concern in old districts. For example, there are many large public housing estates in Kwai Tsing.

It has been more than 30 years since the establishment of these estates, their 511,000 residents are growing older and the government is setting up a district health centre to facilitate the care of elderly residents suffering from chronic diseases, through services such as drug counselling and physiotherapy. Currently, due to the difficulty of securing adequate space, the nurse clinic is only temporary, occupying a corner of a district councillor’s office.

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The redevelopment of older districts will affect whether the elderly can age in place – for example, whether bathrooms can be modified to enhance accessibility, whether the building is equipped with lifts and whether exercise areas are adequate.

However, it is difficult to improve planning ratios in old districts. A too-high development density will have an adverse effect on the mental health of the elderly. Based on research findings, elderly people living alone are at higher risk of depression, dementia and various chronic diseases, and even suicide.

Instead of focusing on life expectancy, the government should consider adopting a healthy life expectancy index. The World Health Organisation has similar indicators because people not only wish to live longer, they wish for longer, healthier lives. While Hong Kong is now renowned for the longevity of its residents, we should work harder to ensure it is healthy longevity.

The government needs to include more fitness facilities and primary health care centres that are easily accessible to the elderly in urban areas, so that seniors can enjoy leisure and care services locally, instead of having to travel long distances. We can look to our Asian counterparts for inspiration.

Singapore’s Housing and Development Board estates include spacious communal areas called “void decks”, which are used for weddings, funeral wakes and various activities, as well as senior citizens’ corners – where elderly Singaporeans gather with their neighbours.

In contrast, Hong Kong has limited space for dignified end-of-life care, and more than 90 per cent of Hong Kong people spend their last days in hospitals. This not only heavily weighs on public hospital resources, it also means weeks or months away from the comfort of home and companionship of family members, as well as futile medical examinations and end-stage treatments. The root cause of all this is inadequate land supply.

In fact, to fully reform elderly care in Hong Kong, there are three mountains to climb: funding, human resources and land supply.

In the first two areas, the government has been generous, investing resources in enhancing elderly care services and staff supply. But while there is a consensus in the community on the need to reform elderly care, there are insufficient discussions on related land supply policies.

I am in favour of the enhanced East Lantau Metropolis plan, which proposes to reclaim 2,200 hectares of land in the central waters between Hong Kong Island and Lantau Island.

Even if some of the newly reclaimed land might not be suitable for housing development, it could still house elderly care and community facilities, so our seniors may enjoy healthy longevity.

Lam Ching-choi is an Executive Council member and chairman of the Elderly Commission