Decisions to be taken ahead of those final days
As a survey shows end-of-life care costs are lower at nursing facilities than public hospitals, the government should explore the option of dying at home
Enabling the terminally ill to spend their final days at home may still be an alien concept in Hong Kong society. A lack of outreach medical support and cramped living space mean there are more hurdles to overcome if one chooses not to stay in a hospital or nursing home. Low public hospital charges and red tape in registering deaths outside medical institutions make the option of a comfortable death at home even less viable.
A recent study examined the issue from a different perspective. Having analysed the costs incurred and the time spent in institutions during the final year of 169 elderly people, the Haven of Hope Christian Service found the median total of end-of-life care costs for staying in a nursing home were 17 per cent, or HK$66,080, less than for those who died in hospital. The group urged the government to put more resources into nursing homes.
The findings are unsurprising, given public hospitals are heavily subsidised by the government, so it may not cost a fortune for one to spend their final days in a public hospital. That said, the overall financial cost to society can be substantial, and the burden is becoming heavier as the elderly population increases. By 2056, one in three citizens will be aged 65 or above, compared to four in 25 now.
If a previous survey on the preferences of elderly people regarding end-of-life care is any reference, as many as 5,250 nursing home residents opt to stay where they are. This means taxpayers may save more than HK$340 million a year if there are sufficient facilities. This also helps relieve our overloaded public health care system and free up resources for other priorities.
This is not just a cost issue, though. If given the choice, most would want to pass away with comfort and dignity. This means staying in a place one is familiar and comfortable with and be able to enjoy the company of family and friends. The government has commissioned studies on the feasibility of providing more choices for those who are dying, including remaining at home as an option. Inevitably, there are hurdles to overcome and issues to address, but it makes sense to explore more options as we grapple with challenges arising from our ageing population.