Hong Kong’s years-long Covid-19 crisis has left deep scars on our society, which call for a critical rethink of how we look after our most vulnerable citizens. The ravages of Covid during the fifth wave have taken the greatest toll on our elderly.

As of April 9, the city’s death toll has risen to 8,705, with more than 95 per cent aged 60 or above. Among the deceased elderly, 55 per cent lived in residential care homes.

elderly home
An elderly care home. File photo: Wikipedia Commons.

Even before the death rate of elderly people spiked, the “no visit” policy at residential homes had caused the elderly inmates to live for months in anxious isolation.

The tragedy should not have been unanticipated and better preparations should have been made. When Covid-19 broke out in many parts of North America and the United Kingdom, care homes for the elderly were hotbeds of disease and death. Our residential care homes are in a much worse plight because of their overcrowded conditions.

It would be impossible to vastly expand the physical space of our care homes within a short period of time, but a more vigorous vaccination programme targeting the elderly would have done much to reduce death rates. Even though vaccination rates soared after the Chinese New Year, our vaccination programme has slowed. Today, only about 47 per cent of those aged 80 or above have received two shots.

The shortage of care homes for the elderly has long been a vexatious subject in the Legislative Council. The subvented residential care homes operated by non-government organisations are most preferred. With only 120 such homes, applicants have to wait four to five years. Legislators used to complain that applicants passed away before they could be allocated places in such homes.

an elderly man receiving Covid-19 vaccination at home.
An elderly man received Covid-19 vaccination at home. File photo: GovHK.

A complete overhaul of our policy on residential care for the elderly is a mission that cannot be kicked further down the road. Our population is rapidly ageing. The government estimates that in 20 years’ time, the numbers of elderly people aged 65 and above will double from 1.32 million in 2019 to 2.52 million or 33.3 per cent of our population in 2039.

With declining fertility rates and high life expectancy, taking care of the old and infirm and protecting them from another possible wave of a highly infectious epidemic has taken on new urgency.

Our social welfare budget has increased exponentially in the past decade. Recurrent expenditure has climbed from HK$42.2 billion in 2011-12 to around HK$105.7 billion in 2021-22 to become the highest area of recurrent government expenditure. Yet funding for elderly services – including day care centres and residential care homes – amount to no more than HK$14.1 billion, a pittance relative to demands and the government’s profligate spending in other less pressing areas, such as lowering the qualifying age for transport subsidy for the elderly and disabled persons. This single scheme requires additional expenditure of HK$2 billion in 2021-22.

Residential care services are provided by different categories of service providers, depending on the needs of the elderly and the level of government financial support. The 120 subvented ones have better facilities and charge low fees. Others provide service on a contract basis, or secure government support under a “bought place scheme”. The Social Welfare Department reports that there were altogether 35,448 publicly funded places at the end of last year. The numbers are clearly inadequate going forward.

medic medical doctor A&E emergency ER caritas covid covid-19 queue
Elderly patients in Caritas Medical Centre in Sham Shui Po, Hong Kong during the fifth-wave Covid-19 outbreak. File photo: Kyle Lam/HKFP.

Private sector service operators which cannot meet the Social Welfare Department’s specifications and hence do not qualify for government support operate their care homes on a shoestring. Elderly inmates are housed in cramped conditions with little medical support. It is small wonder that 98 per cent of residential care homes became infected by Omicron during the fifth wave.

Other than high rental costs, difficulties in the recruitment of care workers is another critical problem faced by residential care homes. Tasks like feeding, bathing, cleaning and turning senile elderly in their beds are extremely manpower-intensive, and not the cup of tea of most locals. That is why scandals of nursing homes maltreating their residents have broken out in the past. For this reason, even trade union hawks sitting on the labour advisory board have raised no objection to recruitment of care workers from mainland China.

Yet as wages in Guangdong continue to rise, even recruiting from nearby areas has become increasingly difficult. Service providers claim they have to recruit from the poorer, northern region of Guangdong, or Guangxi province. Training and accommodation costs add to pressure on the bottom line, which inevitably affect the quality of the services provided.

As is well known, at the peak of the fifth wave, arguments broke out between the Hospital Authority (HA) and elderly homes on how to take care of recovering elderly patients, whom the HA wanted to push out of their over-loaded system. Eventually the government agreed to build “holding centres” for these elderly persons.

Covid-19 holding centre Harbour Road Sports Centre bed
A holding centre set up by the Social Welfare Department at Harbour Road Sports Centre that began operation on March 16, 2022, to provide care services for elderly patients referred by the Hospital Authority. File photo: GovHK.

Medical experts have warned repeatedly that we should prepare for the sixth or seventh wave. With or without another pandemic, we should not allow our elderly people who need residential care to continue to live in unsatisfactory and potentially dangerous conditions. The current residential care system for the elderly is unsustainable.

The only way to cure this problem, in my opinion, is for the government to build residential care homes for the elderly according to acceptable standards, and invite private service providers to operate them.

The government used to complain about the lack of land to build more residential care homes. But a window of opportunity now opens for the government to introduce transformational change.

There are 1.8 hectares of land available for development at Sandy Ridge in the North district. The government originally allocated the land for development of columbarium, crematorium and a garden of remembrance to meet exploding demand for niches in related services. This project has been put on hold, and is likely to be scrapped, because of objections from Shenzhen.

Policy Address 2021 Northern Metropolis
The government’s plan to develop northern New Territories. File photo: Kelly Ho/HKFP.

This area, with transport links already designed and being developed to facilitate visits during grave-sweeping festivals, is well suited for development of a cluster of residential care homes for the elderly. The more spacious and pleasant surroundings of the northern New Territories will provide much better living conditions for the elderly, whether they are still mobile or not.

I remember vividly when the residential homes for the elderly at the Dills Corner Garden were to be demolished to make way for the development of Kwu Tung North, the elderly inmates appealed vehemently for relocation in the same area, and together as the same community.

A cluster of new government-built residential homes at Sandy Ridge could be integrated with the development of other services, such as traditional Chinese medical services, in the planned Northern Metropolis. Such a development would be much better for our elderly, our neighbours in Shenzhen and for our society as a whole.

Public expenditure for such a transformational project would be much more worthwhile than spending an estimated HK$7.49 billion on the transport subsidy scheme for the elderly and qualified disabled persons in 2025-26. Under this scheme, elderly persons aged 60 and above will enjoy transport convenience, but it is far more important to plan ahead and provide for their future when they become senile and need care in residential homes.

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The Hon. Mrs. Regina Ip joined the Hong Kong government in 1975, rising to the position of Secretary for Security and resigned in 2003. She is a member of the Legislative Council of Hong Kong, the chairperson of the New People’s Party and Savantas Policy Institute, Co-Chair of the Maritime Silk Road Society, and a member of the Executive Council for the fifth term of the HKSAR Government.