Problems encountered by elders in residential care services in Hong Kong

Abstract

PurposeHong Kong implements a policy for the aging population involving the core themes of “aging in place as the core,” “institutional care as backup” and “continuum of care.” Encouraging elders to live independently at home is a top priority, and elders who are not able to live at home independently are provided with various residential care services, namely Hostels for the Elderly, Homes for the Aged, Care and Attention (C&A) Homes for the Elderly and Nursing Homes (NHs). The purpose of this paper is to analyze the adoption of the publicly funded model of providing residential care services of elderly in Hong Kong.Design/methodology/approachThe paper analyzes the current conundrum encountered by elders in residential care services and makes recommendations. A comprehensive literature review was conducted covering relevant government reports, academics' journal papers and nongovernmental organizations’ reports concerning residential care service of elderly from 1965 to present.FindingsSubsidized residential care homes for the elderly (RCHEs) clearly outperform private RCHEs in terms of space and staff provisions, but the supply of subsidized RCHEs cannot meet the demand. Hence, between 2007 and 2018, the average waiting time was 33 months for NHs and that for C&A homes was 23 months. Several viable measures to meet the demand are purchasing Enhanced Bought Place Schemes (EBPSs) from private RCHEs, subsidizing elders who opt for living in private RCHEs by providing them with Comprehensive Social Security Assistance (CSSA) and residential care service voucher (RCSV) and subsidizing elderly applicants who opt for living in RCHEs in Guangdong. However, these viable measures are problematic because of the inadequate quality of EBPSs and private RCHEs, which is attributed to the costing arrangement of public and private RCHEs that were established in the colonial period. The brief history of RCHEs also indicates a deviation from the original policy aim, namely aging in place, which was introduced in the Green Paper on Services for the Elderly in 1977.Practical implicationsThe supply and quality of community and home care services should be thoroughly examined; effective community and home care services can prevent and even delay unnecessary institutionalization. Another complementary solution is to devise a long-term plan for residential care services. To address disparities in quality standards in different RCHEs, adopting the combination of punitive and compliance models such as conducting frequent inspections and implementing an accreditation system for private RCHEs is imperative.Originality/valueAlthough the principle of “aging in place” originated in 1977, the institutionalization rate 6.8% of elders was unexpectedly high in Hong Kong and even surpassed the Asian counterparts. It necessities to rethink how to implement policy concerning long-term care services of elders.