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HongKong> Opinion> Content
Monday, October 22, 2018, 11:15
City’s aging population needs more trained carers
By Stuart Gietel-Basten
Monday, October 22, 2018, 11:15 By Stuart Gietel-Basten

The Policy Address makes some important gestures toward improving services for the elderly population in Hong Kong. But they seem to be not enough to ensure a decent standard of living and adequate care provisions for our elderly.

The provision for an additional 2,000 service positions in 2019 under the Enhanced Home and Community Care Services as well as an extra 5,000 under the Enhanced Bought Place Scheme are to be welcomed. But, this barely “keeps up with inflation” in terms of the rising number of people who will require such services. Similarly, improving the ability of NGOs working in elderly care to expand their facilities and develop new sites is a positive step; but in the absence of land reform enabling more affordable expansion opportunities it is hard to envisage any major change.

For those who wish to move to Guangdong or Fujian province to see out their later years, the extension of the Old Age Living Allowance will no doubt be a boon. But, the fact that relatively few people have already availed themselves of this opportunity over the years means that the prospect is simply not an attractive one. The rising cost of living on the Chinese mainland, coupled with the modest level of allowances and the necessity to give up social housing are just some reasons for the lack of take up.

Reform of the Mandatory Provident Fund and abolishing the offsetting arrangement is again to be welcomed as long as employees are not penalized. However, this again barely “scratches the surface” in terms of the provision of an adequate income for senior citizens. No mention of elderly poverty is made in the Policy Address section concerning poverty alleviation. Without radical changes, we can only resign ourselves to the spectacle of living in one of the richest places on earth while simultaneously having one of the highest elder poverty rates in the developed world.

It is clear that the SAR government is not pursuing a radical policy shift in terms of population aging. This continues to suggest that a lifetime’s contribution to the society and economy of Hong Kong does not, in itself, entitle anyone to a decent retirement income or, for that matter, some of the long-term care needs that might arise. The obligation is on the individual and the family to provide financial and ongoing physical support for chronic sickness. If that’s not available: tough.

NGOs do an amazing job with the resources they have. The Hospital Authority provides a good service which clearly contributes to our having the longest life expectancy on Earth. The Social Welfare Department is staffed with highly committed professionals who devote themselves to care. But there is just not enough backup at either the institutional level, nor at the individual level in terms of radical pension reform. Take the SWD, for example. It is well known that ‘aging in place’ (at home) is highly preferable to institutionalization. The SWD is following best practice by being strongly committed to this concept and enabling as many as possible to remain at home for as long as possible. Yet, the provision of a relatively modest number of extra vouchers under the Pilot Scheme on Community Care Service Voucher for the Elderly — the scheme to support aging in place — just shows that the SWD does not have much leeway to act properly on this commitment.

We can see echoes in precisely the same approach to child care. The “Hong Kong model” of migrant domestic workers being one of the main pillars of child care is clearly to be applied to elder care too. Changing family norms coupled with ever more complex care needs mean that children are less likely (and able) to meet the care needs of their parents. So, in the absence of the state-led support we see in other parts of the world, they are “franchised out” to migrant domestic workers. The benefits for the government are clear: aging occurs at home and the burden is solely placed on the shoulders of the family. All of this means less spending on institutions, social workers, and the like.

Given that migrant domestic workers make up about 5 percent of the total population, and how central they are to the Hong Kong care economy, then, it is perhaps surprising that the Policy Address pays relatively scant attention to them. The demand for migrant domestic workers — and to work in care in particular — is highly likely to increase across the region. On the other hand, the supply is likely to stagnate or even decline. But, we don’t only need to think about things at the economic level. Care work is specialized work; a vocation. From knowing how to get someone into the bath without hurting either yourself or the person under your care through to the management of medicines and nutrition: Caring for people with chronic illnesses requires training, mentoring and support.

If, indeed, Hong Kong formalizes the choice to make migrant domestic workers the cornerstone of the elder care system, then recognizing their contribution as professional carers is the first step. This means providing proper, certified training which can be verified and transferred as part of their professional development. Removing the residency requirement from immigration would be critical too in order to allow families to “share” specialized carers. Finally, migrant domestic workers should receive an enhanced salary to recognize their specialized vocation as carers. Coupled with enhanced support for both NGOs and the provision of care workers under the Social Welfare Department, such a model could well be workable.

This can be a “win-win” approach — albeit under less-than-perfect circumstances. Elderly people receive better care and would likely be able to remain at home for as long as possible; families have peace of mind that their parents are in capable hands; migrant domestic workers develop transferable skills and receive extra income and the government can continue to wash its hands of the responsibility of providing adequate long-term care itself.

The author is associate professor of social science and public policy at the Hong Kong University of Science and Technology. His research focuses on the impact of population change on policy in East Asia.


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