The Government takes a positivist non interventionalist stance on the care of older people and uses traditional Chinese Confucian values to justify this, stressing that welfare is the responsibility of the family, volunteer organisations and the market (McLaughlin, 1993). High value is placed on self reliance, individual effort and filial piety (Lui et al, 2000: Wong & Chow, 2002). The chief Executive makes clear that the state will continue to only provide a safety net for those whom the family and market have failed and provide services to strengthen family function rather than replace it (Chui and Wong, 2005, Tao, 2004). There has been no recognition of social welfare as a right which diverges significantly from Western ideas (McLaughlin, 1993)
Community care policy in Hong Kong and ‘Ageing in Place’ helps people to remain in their community for as long as possible. It is argued that older people prefer care by the family rather than strangers and are generally resistant toward entering any institution (Lui et al, 2000). Care in or by the community has played an indispensible role for older people when taking this into account and enables them to prolong and retain their way of life (Chui and Wong, 2004). There are however, some significant issues with current policy.
The family provides the majority of care on an informal basis with around 70% of older people living with their adult children (Chan and Phillips, 2002). Traditional Chinese values which upheld this are now facing challenges from rapid social changes such as urbanisation, migration and globalisation, leaving older people with fewer family ties and diminished social networks (Chui, 2008: UN 2003: Lui et al, 2000).
Cultural heritage and filial piety has been watered down in Hong Kong as it has become highly urbanised leaving a considerable gap between the expectations of older people and the care they actually receive (Chui, 2008). Lui et al (2000) found that in instances where older people felt like a burden and experienced a loss of control this has lead to people taking their own lives. Hong Kong has the highest elderly suicide rate in the world and this has considerable implications for policy.
Social changes weakening the ability of the family to care for older relatives highlights the importance of formal provision of care. Although there are a wide range of services available formally, availability is low. Strict means testing results in only the most deprived and alone receiving assistance yet care in the community is at the core of ageing policy (Chui and Wong, 2004: Chan and Phillips, 2002: Tao, 2004). Policy statements are unclear and represent ‘policy moral panic’ resulting in a significant lack of resources being allocated to improve services and a lack of integration (Chan & Phillips, 2002).
The voluntary sector plays a key role in the provision of services for older people but the use of voluntary agencies is highly problematic as it removes the state from front line accountability (Chan and Phillips, 2002). There is a contradiction between the states non interventionalist stance and the strict regulation of the voluntary agencies. Agencies are subsidised by the ‘Community Chest Fund’ (CCF) which is financed by voluntary donations. A lump sum is paid provided they meet strict government set standards leaving little incentive for the variation of service provision (Chan, 2005). Although the community chest attempts to co-ordinate these agencies there is still service duplication, fragmentation and waste (Wong, 1993).
In conclusion, the Hong Kong Government need to address reservations that a better quality and quantity of community support will threaten family care. There is a strong need for better considered policy making instead of an assumption that the family can and will continue to provide the majority of care for the older population. With the population rapidly ageing and a decrease in fertility, these issues need to be adequately addressed instead of further policy moral panic as by 2025 one in four people are expected to be over 65 (Chan, 2005).
Hong Kong’s elderly suicide rate and scale of depression is a major indicator that current methods of care are not working for significant proportion of people. The burden it places on families without adequate support has many implications. Even though there have been developments in community care, whilst the government is adamant to maintain Confucian values it looks as though the care of older people will continue to be shouldered by their families. Realistically there should be a fairer share of care between families, the government and the market/voluntary sector with cash subsidies for family carers or less strict means testing to enable a larger proportion of older people to receive the care they need (Chan and Phillips, 2002).
References
Chan, C (2005) Managing Welfare in Post Colonial Hong Kong in (eds) Walker, A and Wong, C (2005) East Asian Welfare Regimes in Transition. Bristol. Policy Press
Chan, A and Phillips, D (2002) Policies on Ageing and Long Term Care in Hong Kong in (eds) Chan, A and Phillips, D (2002) Ageing and Long Term Care: National Policies in the Asia Pacific. Singapore. Institute of South East Asian Studies
Chui, E (2008) Ageing in Place in Hong Kong – Challenges and Opportunities in a Capitalist Chinese City. Ageing International [32] pp167-182. [Accessed: 27/10/2009] Available at:
Chui, S and Wong, V (2005) Hong Kong, From Familiaristic to Confucian Welfare in (eds) Walker, A and Wong, C (2005) East Asian Welfare Regimes in Transition. Bristol. Policy Press
Economic and Social Commission for Asia and the Pacific (2003) Urbanisation, Migration and Globalisation Causing Changes in Family Structure and Intergenerational Support. Bankok. United Nations Publications [Accessed: 17/11/2009] Available at:
Lui, M, Lee, D and McKenzie, A (2000) Community Care of Older Chinese People in Hong Kong. Australian Journal on Ageing [19] 4 pp180-184. [Accessed: 27/10/2009] Available at:
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Tao, J (2004) The Paradox of Care: A Chinese Confucian Perspective on Long Term Care in (ed) Kennett, P (2004) A Handbook of comparative Social Policy. Cheltenham. Edward Elgar Publishing Ltd
Wong, L (1993) Community Care in China and Hong Kong. Asian Journal of Public Administration [15] 2 pp159-176. [Accessed: 27/10/2009] Available at:
