How will Hong Kong care for and house its growing number of elderly?

Projections suggest Hong Kong will have the world’s oldest population by 2050, but the city seems woefully unprepared
Creating enough new places in care homes, enabling those who want to age in place to do so, and ensuring enough quality service providers are just the start

Mike Rowse

Published: 3:30pm, 27 Aug 2023

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The problem of how to adequately take care of and house Hong Kong’s elderly population is not a new one. It is beginning to heat up, though, and the figures look serious.

According to projections published by the Census and Statistics Department, the number of people aged 65 and above is forecast to nearly double, from 1.32 million (18.4 per cent of the total population) in 2019 to 2.52 million (33.3 per cent) by 2039. In 2069, it is set to reach 2.58 million (38.4 per cent).

Separately, the United Nations estimates Hong Kong will have the world’s oldest population by 2050, with 40.6 per cent aged 65 and older. From other figures published recently, we know Hong Kong’s total fertility rate is well below the replacement level of 2.1 births per woman.

These are only projections, and the numbers vary, but the general message is clear: our population is ageing rapidly. What might this mean in concrete terms?

Property agency JLL recently crunched the numbers and estimated the number of residential care places would increase by just 0.24 per cent in the next 10 years while the number of seniors would grow by almost half. The agency’s conclusion was that we will need an additional 60,000 places in care homes by 2032. I am by nature an optimist, but I don’t think there is any way our community could provide or staff such a huge number of extra places.

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While we are still mulling the implications of these figures, Ombudsman Winnie Chiu Wai-yin recently announced the results of her direct investigation into the pilot scheme for community care service vouchers for the elderly. Ten years ago, the government introduced the trial scheme to support frail elderly people to “age in place” – that is, remain at home as long as possible – under the “money following the user” mode. The scheme was expanded in 2016 and 2020, but is still at the pilot stage.

Based on their individual needs, holders of these vouchers can receive nursing, personal care and other support services on a day care or home care basis, offered by service providers recognised by the Social Welfare Department. Those assessed as eligible for a place in a care home but unable to find one can apply for them. Chief Executive John Lee Ka-chiu has promised to make the scheme permanent starting next month.

The ombudsman found that the supply and demand of home-based services in different districts was generally in balance, but for centre-based services there was a shortfall of places in six districts – Eastern, Southern, Wong Tai Sin, Sha Tin, Islands and Yuen Long.

Expanding the scheme will bring challenges in two main areas. The first is cost. There is a co-pay arrangement whereby beneficiaries pay a proportion of the cost on a sliding scale, up to 40 per cent, depending on their financial circumstances. Nonetheless, costs are bound to rise as the scheme becomes better known.

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The second difficulty will be nurturing the development of sufficient numbers of good-quality service providers. These are drawn from three sources: NGOs, social enterprises and the private sector. Some services are routine – physiotherapy, haircuts, pedicures and so on – and recruitment should not be a problem.

But some services are very personal and require a substantial measure of commitment, even altruism. For the first two years of their lives when our children are young, we think nothing of bathing them and changing their nappies. But what happens when our parents require similar services towards the end of their lives? Will both parties be comfortable with the reversal of roles? The work is not glamorous and is unlikely to be well-paid.

From a wider perspective, the situation has implications for many government branches. Senior citizens generally become more conservative as they age and don’t always feel comfortable with change.

Many will want to age in place. If they must relocate, it should be somewhere close by where they are familiar with the shops, markets and parks. Most will wish to retain their personal autonomy for as long as possible, making their own decisions about life with minimum interference from outside the family.

A woman visits her elderly mother in a care home in Tuen Mun on March 24, 2018. The demand for elderly care in Hong Kong outstrips the supply of affordable care options, and ageing in place, where elderly people live in their own homes, is seen as a solution. Photo: Edward Wong

These are the sentiments that will help make the voucher scheme increasingly attractive. There are also implications for property development if compulsory acquisition displaces large numbers of seniors, with cash compensation insufficient to permit purchasing a suitable replacement property in the vicinity.

We also need to look at our health services to put more emphasis on keeping people well, not just fixing them when they get sick. We want them in robust health, postponing their becoming frail for as long as possible, perhaps altogether.

Could there be a role for artificial intelligence here? An article in the Financial Times last week outlined how columnist Patti Waldmeir’s AI-enabled artificial pancreas helped manage her Type 1 diabetes, for example.

Could we persuade people to exercise more? It doesn’t need to cost much or require extensive facilities. – perhaps a campaign by the Home and Youth Affairs Bureau to encourage everyone over the age of 50 to walk at least 30 minutes a day.

Ultimately, people must remain responsible for their own well-being, with the support of their families. But there are important things the government can do to pull or push them in the right direction.

Mike Rowse is the CEO of Treloar Enterprises