The problem of how to adequately take care of and house Hong Kong’s elderly population is not a new one. But it is beginning to heat up and the figures look serious.
According to projections by the Census and Statistics Department published last month, the number of people aged 65 and above is forecast to nearly double from 1.32 million (18.4 per cent of the total population) in 2019 to 2.52 million (33.3 per cent) in 2039. In 2069, it will reach 2.58 million (38.4 per cent). Separately, the United Nations estimates that Hong Kong will have the world’s oldest population by 2050, with 40.6 per cent aged 65 and older. From other figures published recently we know that Hong Kong’s birth rate is well below the replacement level of 2.1 per woman.
Now these are only projections, and the numbers vary, but the general message is clear: our population is ageing rapidly.
What might this mean in concrete terms? A local property agency recently crunched the figures and estimated the number of residential care places would increase by less than half of one per cent in the next 10 years while the number of seniors would grow by almost half. The agency’s conclusion was we need to find an additional 60,000 places in care homes by 2032.
I am by nature an optimist but I have to say straight out I don’t think there is any way on earth our community could provide or staff such a huge number of extra places.
While we are still mulling the implications of these figures, the Ombudsman has recently announced the results of her direct investigation into the Pilot Scheme on Community Care Service Vouchers for the Elderly. Ten years ago, the Government introduced the Pilot Scheme to support frail elderly persons to age in place under the “money-following-the-user” mode. The scheme was expanded in 2016 and 2020 but is still at the pilot stage. Based on their individual needs, holders of community care service vouchers can receive nursing, personal care and other support services on a day care or home care basis offered by service providers recognised by SWD. These vouchers can be worth up to $10,000 per month. Persons assessed as eligible for a place in an old peoples’ home but unable to find one can apply for them. Chief Executive John Lee Ka-chiu has promised to make the scheme permanent starting next month.
The Ombudsman found that the supply and demand of home-based services in different districts was generally in balance but for centre-based services there was a shortfall of places in six districts, namely Eastern, Southern, Wong Tai Sin, Shatin, Islands and Yuen Long.
Expanding the scheme will bring challenges in two main areas. The first is cost. There is a co-pay arrangement whereby beneficiaries pay a proportion of the cost on a sliding scale up to 40 per cent depending on their financial circumstances. Nonetheless costs are bound to rocket as the scheme becomes better known and the number of eligible persons increases.
The second difficulty will be nurturing the development of sufficient numbers of service providers of the right quality. These are drawn from three sources: NGOs, social enterprises and the private sector. Some of the services are quite routine – physiotherapy, haircut, pedicure etc – and recruitment should not be too much of a problem. But some services are very personal and require a substantial measure of commitment, even altruism. For the first two years of their lives when our children are young, we think nothing of bathing them and changing their nappies. But what happens when our parents require the same services towards the end of their lives? Will both parties be comfortable with the reversal of roles? So the work is not all glamorous and will probably not be particularly well paid.
Taking a step back and looking from a wider perspective, the situation has implications for many branches of the government. Senior citizens generally become more conservative as they age, and don’t always feel comfortable about change. Most will want to “age in place” that is, in their own homes as far as possible. If they really must relocate, then somewhere close by where they are familiar with the shops, the markets, the parks for morning exercise. Most will wish to retain their personal autonomy for as long as possible, looking after themselves and making their own decisions about life with minimum interference from outside the family. These are the sentiments that will help make the voucher scheme increasingly attractive. There are also implications for property development if compulsory acquisition would displace large numbers of seniors, with cash compensation insufficient to permit purchase of a suitable replacement in the vicinity.
We also need to look at our health services to put more emphasis on keeping people well, not just fixing them up when they get sick. We want them in robust good health with the “frail” stage postponed if not omitted altogether. Could there be a role for AI here? An article in the Financial Times last week outlined how the columnist was being helped to manage her Type 1 diabetes. Can we persuade people to exercise more. It doesn’t need to cost much or require extensive facilities. – perhaps a campaign by the Home Affairs Bureau to encourage everyone over the age of 50 to walk for at least half an hour a day.
Ultimately individuals must remain responsible for their own wellbeing, with the support of their families. But there are important things the government can do to pull or push them in the right direction.