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Can sending elderly to Guangdong solve Hong Kong’s care home shortage problem?

by Total Lam and Brian Wong

Uncle Cheung sits bundled up in a thick jacket and wears a knitted wool hat. It is a cold wintry day in Zhaoqing, Guangdong but the 83-year-old Hong Kong retiree is comfortable in his surroundings. “I tried out staying here for a month first. I was satisfied with the accommodation, food and services. So then, I chose to live here,” he says of the Hong Kong Jockey Club Helping Hand Zhaoqing Home for the Elderly.

Cheung is originally from Guangdong and came back with his wife two years ago. Their daughter had emigrated to the United States and the couple had no other family in Hong Kong, but they have a son who lives nearby in Zhaoqing.

The vegetable patches in Zhaoqing home

What Cheung likes about the centre is the space and the facilities. Whereas elderly homes are crowded in Hong Kong, here there are spacious corridors, huge television rooms, landscaped gardens, exercise equipment, a fishpond and vegetable patches.

He can also receive acupuncture to alleviate recurrent pain in his lower back in one of the two rehabilitation rooms at the centre. Massage and traditional Chinese tuina therapy are offered too.

Cheung is one of only 25 Hong Kong elderly people out of the 103 residents at the home, which opened its doors in 2001 with the aim of providing accommodation and services to elderly people from Hong Kong as its priority. The Hong Kong Jockey Club also has another centre in Shenzhen, the Society for Rehabilitation Yee Hong Heights, providing similar services.

The centres were built to help alleviate pressure on the demand for places in government-subsidised nursing and care homes in Hong Kong. Figures from the Social Welfare Department show that close to 30,000 elderly people were on the waiting list for such places at the end of January this year. They can expect to wait for an average of 35 months for a place in a nursing home and 20 months for a care-and-attention home.

In this year’s Policy Address, the government stated it plans to purchase 300 to 400 residential care places in the Zhaoqing and Shenzhen homes for those on the Central Waiting List for subsidised residential care in Hong Kong. This follows the implementation last October of the Guangdong Scheme for Hong Kong residents aged 65 or above living in Guangdong. Under the scheme they will keep receiving their Old Age Allowance without having to return to Hong Kong every year.

The government insists the policies are aimed at providing the elderly with more choice and are not an attempt to “outsource” Hong Kong’s increasing elderly population.

So far, more than 9,000 people are benefitting from the arrangement. Legislator Chan Yuen-han, of the Hong Kong Federation of Trade Unions, says the federation’s mainland service centres have received many enquiries from elderly Hong Kong people in recent months.

Chan says many of the elderly who retire in Guangdong do so because that is where they originally came from and they do not have many relatives in Hong Kong. “Goods and food are cheap. Living spaces are bigger than in Hong Kong, and most importantly, relatives are here [in the Mainland],” says Chan.

She says there are also groups of friends without prior social networks in the Mainland who retire there together. Some may have bought property in the Mainland when prices were lower. However, as they grow older and their health deteriorates, depleting finances and the cost and quality of medical care become concerns. The appreciation of the renminbi adds to their woes and some choose to return to Hong Kong.

As Hong Kong residents have to pay out of their own pocket for medical care in the Mainland, those who require care or are by themselves are better off staying in an elderly home. Psyche Wai, the social service manager at Helping Hand who regularly visits the Zhaoqing home, says half of the residents there are unable to take care of themselves and some of them have Alzheimer’s disease.

The home has two in-house doctors and consultation fees are covered by the compulsory medical insurance residents are required to buy. A team of physiotherapists, occupational therapists and social workers from Hong Kong also make frequent visits to the home.

However, Wai says residents still want to return to Hong Kong and stay in the Northern Hospital when they need emergency or further treatment. They refuse to go to mainland hospitals as they are worried about the quality of care. “The support is far better when you go to Hong Kong hospitals. You would be more confident and the fees are lower than in the Mainland,” she says. Although a direct ambulance service from Zhaoqing to Huanggang port in Shenzhen is available at extra charge, the trip takes four hours.

These concerns may explain why the uptake for places in the home remains low despite the facilities and range of services available. Walking slowly along a corridor, 78-year-old Mr. Lau (who does not want to disclose his full name), says he is desperate to go back to Hong Kong.

It is not because he does not have a good life in Zhaoqing — he spends his time planting tomatoes, reading poems and practicing calligraphy — but he is worried about his health. Doctors have told Lau he will be unable to walk someday due to an insufficient blood supply to the brain. He also suffers from prostate problems.

Lau has applied for a subsidised residential care place in Hong Kong. “The [Social Welfare Department] officer said if I am not permanently disabled, I have to wait for at least three years. Do I have to become a cripple so that I can live in an elderly home?” he asks.

For 81-year-old Ho Shun, proximity to Hong Kong, and to his family, was a major motivation to move from the Zhaoqing home to the other mainland facility for the Hong Kong elderly in Shenzhen, Society for Rehabilitation Yee Hong Heights in Yantian.

Living in Shenzhen makes it more convenient for Ho to attend his medical check-ups every 12 weeks in Hong Kong. It takes just 20 minutes to get from Yee Hong Heights to the Shatoujiao Port by shuttle bus.

For minor problems, Ho consults doctors in the Shenzhen centre. On the day of Varsity’s visit, he had just taken some flu medicine in the home’s clinic. However, Ho says he would prefer to go back to the Northern Hospital in Hong Kong if there were an emergency or any serious illness.

Being in Shenzhen also makes it easier for Ho to visit his family and buy any necessities in Hong Kong. “I can get home in about two hours,” says Ho, “When [my family] calls me to have a meal, I can just go back.”

Ho seems to be enjoying the best of both worlds, the space and facilities in the Shenzhen home and all the conveniences of nearby Hong Kong. But for 75-year-old Lee King-wan, it has taken time to get used to life in the Mainland.

Lee sold her flat in Hong Kong to pay for her son’s treatment for kidney disease. She applied for public housing but was still on the waiting list after four years. She then rented a flat in Futian, Shenzhen before moving to Yee Hong Heights with her husband two years ago.

The couple live in a superior type of residential care unit called a “villa” which is actually a 500-square-foot independent flat. She says she does not want to live with other elderly people in the centre, although she does dine with other residents in the main building next to her flat. She also attends a cooking class offered every Thursday to have a social life.

Lee says it was hard to adapt at the beginning. “The [mainland] chef is a Hakka. He put five-spice powder in stewed pork, I would faint upon smelling it,” she says.

The villa in the Shenzhen home

Even at the Shenzhen centre, Hong Kong seniors make up less than half — 65 out of 175 — of the total number of residents. The rest are from the Mainland and Lee noticed cultural differences. She says mainland residents do not know what “good morning” is in Cantonese and have different habits.

The centre is still operating under capacity as it can accommodate 350 elderly residents. But there have been more enquiries since the Guangdong Scheme was introduced. The number of Hong Kong residents rose by 50 per cent last year, compared with 2012.

As interest in retiring to Guangdong picks up, Jackie Mo Si-jie, director of Hong Kong Jockey Club Shenzhen Society for Rehabilitation Yee Hong Heights, points out the province faces its own aging problem. “There aren’t enough elderly homes in Guangdong to meet the needs locally,” she says.

In fact, there are just 15.8 residential care places per one thousand elderly people in Guangdong, which means it ranks in the bottom five in China. So, the province cannot simply be viewed as a solution to Hong Kong’s own lack of subsidised residential care for the elderly.

Besides, not all Hong Kong elderly are willing to move. “If I need to live in the Mainland, I need to change my lifestyle to follow local customs; it would be inconvenient,” says 83-year-old Granny Hung. Her son and carer says that without sufficient ancillary facilities, it would not be much different to migrating to America or Canada.

Civic Party Legislator Alan Leong Kah-kit says moves to provide the elderly with greater choice is not bad in itself but there should be medical facilities nearby. He also accuses the government of being shortsighted.

“You [the government] neither increase hugely the government elderly homes, nor put more resources into training doctors or nurses. You only talk about two elderly homes which are underused in the past 10 years,” says Leung. “Going to heaven is much easier than entering elderly homes.”

Government statistics show that 5,100 elderly people died last year before they could get a subsidised residential care place in Hong Kong.

Leung’s view is echoed by Vivian Lou Weiqun, associate director of Sau Po Centre on Ageing and an assistant professor in the Department of Social Work and Social Administration at the University of Hong Kong. “It is not reasonable to study a solution that can only benefit a few hundred people,” Lou says.

Lou says the policy is only suitable for the healthy elderly and that even if medical services in the Mainland were subsidised, Hong Kong people would come back for treatment because they do not trust the mainland medical system.

“If you are only thinking we have too many elderly, then we will put some [in the Mainland], I think it is irrational,” says Lou, “I don’t deign to guess the [policy’s] intention, but my evaluation is that the cost of such a policy is higher than the benefit.”

Lou says it would be easier to handle existing problems locally than to set up new systems in other places. She thinks the bar is set too low to apply for a residential care place, leading to a long Central Waiting List. On the other hand, she says that if there are better community services, there would be less of a need for residential care.

Lou conducted a study with the Housing Authority and found the elderly were far more confident and reassured about living in their communities when there were elderly service units available locally. “When [they] live together, there is support,” says Lou.

Edited by Tommy Lee