This week I had the opportunity to talk to Cathy Li, director of Sunshine Buddies NGO (陽光老友記同學). Having worked as a social worker since 1990 in community centres, care homes, and her own NGO, her breadth of knowledge and involvement in the elderly service industry runs deep. To find out more about Sunshine Buddies, please follow the link: https://sunshinebuddies.com.hk/
The Role of Elderly Care Facilities
Li has previously worked to serve community with the Salvation Army Centre for Senior Citizens by organising trips and interest classes for the elderly. She reminisces about elderly she had worked with, helping them reconnect with musical interests and performing together:
"The elderly were very happy about that because performing Cantonese Opera was a luxurious thing to do in the past. Only the upper class could afford to do that. But now, they can do it in the community."
She comments that in her elderly services career, the elderly are "very energetic" and "felt delighted since no one accompanied them to go out otherwise". The role of elderly community centres have taken on the role as a place where elderly can not only find socialisation activities but also fulfill wishes that once were out of reach to them in their working days. Yet, at the same time, she found some elderly expressed concerns about their financial status and felt the need to continue actively working "side hustles":
"We observed that after being retired, the male loses their role in the family as a breadwinner. That’s why they are so eager to find a job. It is normal for female not to work and stay home to take care of the family. For the males, they are depressed as they lost their original role, status, and a normal routine of life. Working as a part-time, they can work for 3 days and be off for 4 days."
Through her NGO, Li has been actively supporting elderly in finding part time jobs. She comments that some do not like going to community centres and felt that with the motivation of a job, they could move away from their negative emotions and rebuild self-confidence. As the social role of elders has traditionally been one of "kin-keeper", the concept of retirement and aging today as one of leisure and independence is perhaps a means of celebrating life not necessarily appropriate for all.
Relationships
As we discussed her career in care homes, she explains that care homes for the elderly first appeared in Hong Kong in the 1980s where the city was still a fishing village and the aged population was smaller as they were still young and working hard for better lives. She states that in the early days, some elderly were placed into the care home simply because of family disputes - it was seen as somewhere to distance the elderly. Additionally, declarations for adult children for not providing financial support to elderly institutionalised parents are commonly named 'bad son statements'. Despite the negative perception, care homes are more widely accepted today, but out of necessity. On the other hand, they provide a space for socialising, similar to community centres which more actively provide the social activities.
"[...] With the government’s subsidy, even lower-income families can afford to send their elderly to a RCHE without much financial burden."
"Some of them have attempted suicide as the young do not care about them. It is now common for kids to move out from their parents. An RCHE is like a big family. There are people to chat with the senior, listening to their stories."
"[An old couple] thought their flat was the most comfortable place for them. They refused to go to RCHEs even though they were very old and with some diseases. When I interviewed him, he said one gentleman he used to talk to in the park died. They felt like their friends will be gone one by one. That is why the RCHE in that community is valuable."
Li recalls recommending a spacious care home to elderly, which she describes as looking like a maze. However, some were not happy there as they could not get used to the new living environment. She states that "People prefer to stay in the district they used to live in.". Hearing this, I began to question how the preference of the new - new homes in new locations - impacted the way elderly perceived themselves, the contrasting "old".
Tipping the scales: Private - Public
When asked the profitability of running an elderly care home, it was evident that they could be profitable as private care homes could control the value they charged. Li states that the greatest challenge is recruitment of high-quality workers as it is considered an "unpleasant" job nature to feed and bathe the elderly. Additionally, care home workers earn minimum wage, stating "The workers in private care homes have a lower salary than those who work in government-owned care homes. The wages are around $10,000.". Although there is a Navigation Scheme for Young Persons in Care Services, the young people trained workers do not for long, for which the low wage could be a contributing factor. Similarly, the various cases of elderly abuse in care homes could possibly be due to burn out and low wages. Li, however, also says "Higher wages do not mean more motivation to work—the atmosphere of the care home matters.".
So where does most of the expenditure go?
"Nowadays, the largest expenditure of a care home for the elderly is rent. 1/3 is the rent, 1/3 is the salary, and the rest are miscellaneous expenses. [...] The smartest way is to purchase the property. You will be in trouble if the property owner increases the rent."
As the economy is arguably "better" than before, people can afford to choose better RCHEs. Higher expectations from the public including an expectation of 9.5sqm per person and tighter inspections from the government, operators are pushed to provide better services and living environments. Homes participating in the Enhanced Bought Place Scheme (where the government subsidises units) have minimum of 9.5 or 8.5 sqm per person, as compared to the previous 6.5. It appears that the lower quality homes are being phased out.
Additionally, homes the government subsidise receive abundant resources to not only care for their residents, but also to hire the required number of staff such as therapists and social workers. The clear incentive to join the government subsidy scheme begs the question as to whether the government is trying to gain a form of control in all care homes in Hong Kong, despite the economic cost it would have to subsidise majority of homes. Li revealed that if a home was at maximum occupancy and required space to upgrade to EBPS spatial requirements, they would find means to push residents out:
They want the elderly to move. They will increase the fee if the elderly refuse to leave. This is a way to force the elderly to leave and find another elderly care home. There are plenty of RCHEs now all over the city.
This cosmetic treatment of care homes in the private sector to secure benefits further creates an imbalanced preference towards government-owned homes. It is clear that within the industry, there are some who view the elderly as commodities to move around. Yet, age is a universal experience - to what extent are stakeholders defining their own future?