Thoughts on Elderly Care in Hong Kong

Hong Kong’s social medical service give many citizens a “free ride,” but what does the future look like for the system and its aging patients?

Some who are lucky enough to make it past and enjoy the retirement age of 65, a number which is proposed to rise to 70. (photgraph: Raymond Yeung | sociecity)
Some who are lucky enough to make it past and enjoy the retirement age of 65, a number which is proposed to rise to 70. (photgraph: Raymond Yeung | sociecity)

Hong Kong, once a British colony, boasts a much-praised socialized medicine program. After the handover of power from England to China there was much concern over the possibility of the program failing under communist rule. Yet, such decline did not come close to happening and for the most part Hong Kong prospered. Today, the city enjoys the luxuries of a government run medical system, with state of the art technology and ample resources at its disposal. Through the marvels of modern medicine and surgical procedures, life expectancy in Hong Kong is one of the highest in the world.

One of the city’s biggest challenges however — and a common one for many modern cities — is servicing a rapidly aging population.

According to Hong Kong Council of Social Services (CSS), as of mid 2008 persons aged 65 and above make up 12.6 percent of the population; this figure is expected to rise to a staggering 27 percent by 2033. What is also of concern is the rapidly increasing elderly dependency ratio. CSS research tells us that by 2023, every 1,000 employed persons will need to support 282 elderly persons age 65 and above.

While the government in Hong Kong provides relatively excellent medical and social services to the elderly, the system is not perfect. For example, an elderly person who is experiencing non-critical medical problems could wait years before any detailed inspection is conducted. More often than not, the conditions of such lesser medical problems manifest themselves in the future in different ways, due to life style changes and natural aging. Urgent care will always be provided if and when such conditions deteriorate into a life-threatening situation, but the government doesn’t take what might seem like the more economical route of investing in prevention before expensive last minute procedures are needed. Such are the limitations of socialized medicine.

While there are plenty of private venues for faster treatments, the majority of Hong Kong’s population chooses to appreciate the vast resources provided by the government, and find themselves at the mercy of the waiting line.

Even with advancements in medicine and technology, economic issues often find their way to the top of all challenges.

With a small but increasing amount of elderly experiencing Dementia and other metal illnesses, it often complicates the matter even further. There have been numerous cases of patients not having provided a will before being admitted to state care, loosing consciousness, and creating a great deal of ethical debate. The existence of any life extending devices or services prompts decisions for doctors and/or social authorities, and the choice to not use these life-extending options is seen as abandoning life. Who would want to be blamed for such atrocity? Yet the cost of life extension is tremendous, and no one would “choose” to pay the tab unless forced.

In a society of socialized medicine, indecisions to extend or terminate life and a family’s inability to pay for life extending medical services often trickle down to the state. The astronomical cost invoked by unresolved ethical dilemmas compounded with a rapidly increasing population demanding more services could jeopardize the future of this state-run life support system.

With increasing cost and dependency on life extending technologies, society at large is faced with a hard-t0-stomach choice of deciding at what point a human life is no longer worth saving.

Permanent Camp

Aside from fixing health problems of the elderly, there is also a great need to house them. This service is also state sponsored, though there are many privatized homes to choose from. My grandmothers from both sides of the family have both been admitted into elderly homes in the past decade. For them — one aged 106 and the other 89 — both are lucky to be staying at private nursing homes with 24-hour service including anything from meals to entertainment. For those who lack the financial power by the time they reach this age, it means another waiting line.

Elderly Home bathing room.
Shared among 4 or more elderly patrons, always slightly wet, always smelled of bleach (photograph: Raymond Yeung | sociecity)
My father was the director of one of such nursing home, and my intimate experience with the nursing home is not entirely positive. While relatively good physical care is provided, the quality of life and enjoyment of life, is lacking. Many elderly suffering from minor medical problems often find themselves in constant, however subtle suffering, and most of these homes use dormitory styled rooms, housing same sex patrons in the same room.

Medical care is often the reason for sending one’s elderly member into private care, while less often the choice is made to segregate for social reasons. An elderly’s separation from their immediate family often creates other mental health developments within, and although is difficult to ascertain if this separation always provokes further mental health decline, it certainly does not help promote mental health.

Having been around a nursing home most of my childhood I often find the regular or irregular visits of other families not much different than people visiting zoo animals.

Most visits consist of several family members, sometimes a maid in tow with several children who have just came from school, each crowing around the elderly person, who is often disoriented by the sudden social shock and clamor. This usually continues for no more than an hour before the family disappears. It is most shocking when overseas young expats return home after years of being away, where it is not unusual for elderly to have entirely forgotten about their grandchildren. For a few, luckier elderly, the visits are more consistent and accommodating.

Perhaps this current state of board living is the best society can come up with; aside from a number of elderly left behind, living on their own in a shoe box or over crowded apartment, or the few homeless. From a moral standpoint, the future of elderly care in general is bleak, a camp-like enterprise with elements of a factory; a scripted social life for the unknown number of days left ahead, and a defibrillator ready to go, saving a half broken body again, and again.

For those who can no longer work much less walk, life in the elderly home is inevitable, even if living means just having enough awareness to wait for death to come.

Resources:

World Life Expectancy – https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html
HK Council of Social Services – http://www.hkcss.org.hk/download/folder/el/el_eng.htm
Elderly Commission – http://www.elderlycommission.gov.hk/en/About_Us/Introduction.html
Elderly Health Service – http://www.info.gov.hk/elderly/english/addressntel.htm

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