Search results

This article analyses community care services (CCS) in terms of availability, awareness, accessibility, and acceptance (the Four A’s approach), untangles the deep-seated factors underlying the CCS and provides some short-term, medium-term, and long-term recommendations.

A literature review was conducted, including relevant government reports, consultation papers, Legislative Council papers and articles from academic journals from 1980 to the present.

The Four A’s approach shows that applicants to both centre-based services and home-based services endure lengthy waiting times because of the limited number of CCS. Furthermore, the awareness of day respite services is approximately 50 percent, which lags behind other CCS. Accessibility is contingent on a cross-district day respite service system and a lack of consistency between the quota and the proportion of older adults in the districts. Finally, the level of service provided by CCS is unsatisfactory due to inflexible service provision. Reviewing the brief history of long-term care services (LTC) reveals the deep-seated factors at the core of their heavy reliance on the subvention model, in contrast to the adoption of the ‘mixed economy of care’ by residential care services (RCS). An imbalance in budget allocation to RCS and CCS is also revealed.

Although the principle of ‘ageing in place’ was introduced in 1977, the institutionalisation rate (6.8 percent) of older adults remains unexpectedly high in Hong Kong, even surpassing its Asian counterparts, whereas the usage rate of CCS hovers around 0.8 percent. Thus, how to implement policy concerning LTC services for older adults must be re-evaluated.

The purpose of this paper is to review the development of mental health service policy in Hong Kong. After the return of Hong Kong’s sovereignty to China, mental health services in Hong Kong transformed from an institution-based care model supplemented by community care to a staging model covering primary prevention, early identification, treatment and integration. However, the staging model is subject to cultural barriers, including collectivist values and medical dominance. Therefore, the development of a community-based inclusive development model that follows a rights-based strategy and addresses the regression of the staging model (due to cultural barriers) should be considered.

It is a comprehensive literature review which covered the journal articles, policy review papers and service reports. The foundation of this review was laid upon the development of traditional Chinese culture and values. As brought by the influence of the Western world, the mental health service policy was cling towards a medically oriented system. Following the worldwide change in the definition of disability, the ideology of the mental health service system has been developing into a community-based and person-centred model which emphasised on equal participation and human rights. This review serves to evaluate and discuss how a community-based inclusive development can be further developed in Hong Kong.

A formal support system for providing personal assistance to people with mental health issues through supported decision-making and certified peer specialists forms the principal foundation of a community-based inclusive development model. A review and reconsideration of laws governing guardianship, compulsory treatment and detention should be conducted to enable the local implementation of supported decision-making.

The paper addressed and integrated the theoretical, historical and practical issues in developing a community-based inclusive mental health service policy in Hong Kong.

Hong Kong entered an ultra-low fertility regime nearly two decades ago (Census and Statistics Department, 2013). The causes of ultra-low fertility in Hong Kong are the same as those in other developed economies (Tu and Lam, 2009). The phenomenon, in most of the western world and East Asian societies, is attributed to the incongruence between individual-oriented and family-oriented institutions (McDonald, 2000), or simply role incompatibility between work and motherhood (Stycos and Weller, 1967). One viable solution to alleviate role incompatibility is to introduce family-work reconciliation policies, including maternal and paternal leaves, subsidized child care and health care and work facilities that allow for breastfeeding (Lappegard, 2010). The purpose of this paper is to assess the family-friendly measures for enhancing fertility.

The paper analyzes the current demographic conundrum and makes recommendations.

Subsidized child care is an effective measure if it satisfies the five main criteria, namely, availability, accessibility, acceptability, cost, and quality, suggested by Rindfuss et al. (2003). Other family-friendly measures are inadequate in absolute terms and inferior to those of Asian countries such as Japan, Singapore, and South Korea (Ministry of Manpower, 2014; OECD, 2013). The possibility of shifting away from the ultra-low fertility regime remains doubtful, especially because low fertility is a combined effect of an increasing prevalence of single older women (Census and Statistics Department, 2014), a shift of the utility function of children toward other consumable goods (Inglehart, 1982) and a desire for achieving upward intragenerational and intergenerational social mobility (Ariès, 1980).

Since Hong Kong still subsides in the regime of the lowest-low fertility, an evaluation of the related family-friendly measures will provide constructive insights to the Hong Kong Special Administrative Region Government how to provide incentives to citizens to consider making childbearing decisions.

Because the introduction of family-friendly measures and gender ideologies are intractably linked (Brewster and Rindfuss, 2000), Hong Kong stays in the middle of nations of families and nations of individuals, influenced by western ideas and traditional family values. It is hence worthwhile to examine the effectiveness of different family-friendly measures.

Hong 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.

The 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.

Subsidized 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.

The 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.

Although 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.

This paper demonstrates that Hong Kong currently provides four pillars of old-age protection: a publicly managed and noncontributory social security system (zero pillar), a funded contribution scheme (the second pillar), voluntary personal savings (the third pillar) and informal support, formal social programs and other individual financial assets (the fourth pillar). This paper aims at evaluating current four pillars of old-age protection and unraveling the deep-seated causes underlying the current old-age protection model by tracing a short history from 1965 onward. This paper aims at making recommendations about the current old-age protection model.

The paper analyzes the current four pillars of old age protection. A comprehensive literature review was conducted covering relevant government reports, academics' journal papers and nongovernmental organizations' reports concerning the development of old age protection system from 1965 to the present.

The poverty rate of elderly residents was approximately 44.5% between 2009 and 2018, indicating that the four pillars of old-age protection had been unable to alleviate poverty in the aging population. The development of the current four pillars is attributed to a residual welfare system, the effectiveness of which is further dependent on familial dependence or welfare financialization. However, the reliability of familial dependence is affected by the declining coresidence rate and low fertility rate, whereas welfare financialization not only predominately favors financial institutions but also exacerbates income polarization. Therefore, the University of Hong Kong (2014) introduced an additional pillar of noncontributory social pension and assistance, which generated a contentious debate. The Hong Kong Special Administrative Region (HKSAR) government initiated a public engagement exercise on retirement protection in 2015 to assess public opinion on old-age protection. These consultation exercises were met with broad public disappointment because of the explicit reservations imposed by the government on the proposals.

Although the government's resistant attitude can be attributed to the residual welfare system, pension reform needs to be urgently implemented at three levels, namely strengthening of each pillar, emphasis on the pillar's interrelatedness and introduction of the first pillar.

The poverty of the elderly population is serious in Hong Kong. It is important to solve the deep-seated problems faced by the current old-age protection model. Hence, it comes a critical time to design a sustainable old-age protection model despite the heated discussion on the establishment of a central provident fund and pension system among officials since 1960s.

The aging of a population poses significant challenges to healthcare, housing, social security and elderly care services. Active aging is promoted by the Hong Kong government but is compromised by a shortage of nurses, doctors and professional aides. This study aims to review the history of nursing education in Hong Kong, evaluate Hong Kong's nursing manpower policy with a macro–micro analysis based on sociological imagination and provide sound recommendations.

This article analyzes the nursing shortage in Hong Kong. A comprehensive literature review was conducted, concerning the Hong Kong healthcare workforce and covering relevant government reports, consultation papers and articles from academic journals from 1943 to the present.

The nursing shortage in Hong Kong can be understood from both absolute and relative terms. The total number of practicing nurses and fresh graduates registering through the four aforementioned pathways increased from 17,034 in 1996 to 61,295 in 2020 (growth rate of 74.4%), but it is predicted that there will be a shortage of 455, 1,383 and 1,669 nurses in 2020, 2025 and 2030, respectively. Moreover, Hong Kong had 8.2 nurses per 1,000 people in 2020. Although this rate exceeds those of China, South Korea and Singapore, it lags behind those of the USA and Australia as well as the international recommendation of nine nurses per 1,000 people. The nurse shortage has been further aggravated by an interaction between macro factors, including aging population, a lack of coherent and long-term nursing manpower policy (an analysis is based on a health policy triangle), numerous obstacles imposed on nurses from abroad and micro factors emanating from an interplay of push–pull factors among nurses.

The proportion of the Hong Kong population aged 65 years or older was 18% in 2019. The availability of healthcare workers is essential for attaining optimal health outcomes for older adults. The high turnover rate of nurses in public hospitals negatively affects the provision of timely high-quality medical services in the dual-track medical system. Therefore, workforce projections should be made every three years. Such policy should rely primarily on local nurses trained both by University Grant Committee-funded institutions and by self-financed tertiary institutions. Foreign nurses should be a supplementary resource. The budget allocated to the public healthcare sector should be increased to improve remuneration, provide abundant training opportunities and improve working environment to retain nurses in public hospitals.

Given that deep-seated problems surrounding the quantity and quality of nurses, the avenues for pursuing nursing degree education and the turnover rate of nurses in public hospitals remain unsolved, it is imperative to investigate how to alleviate the healthcare workforce shortage in Hong Kong.

Hong Kong is considered to be an aging population because of the ultralow fertility rates and long life expectancy of its population. A promising solution to remedy this age imbalance is to recruit young people from outside Hong Kong. The inflow of Type II babies (i.e. babies born of Mainland Chinese women whose spouses are not Hong Kong citizens) has created an abundance of them within the young population. The paper aims to discuss this issue.

These controversies have been evaluated being mindful of the operation of a free economy in Hong Kong and the relevance of upholding the rule of law (Wong, 2012).

Wong’s (2012) recommendations to endow the Hong Kong Government with the authority to approve applications from a one-way permit system and to separate the right of residency of Type II babies from their entitlement to welfare services have also been summarized.

The inflow of Type II babies, however, has also generated public controversy concerning the intensifying competition for both public and private hospital services between Hong Kong residents and Mainlanders. This controversy has given rise to some questioning of whether a reinterpretation of the law is warranted to deny residency to Type II babies whose parents are not Hong Kong residents (Wong, 2012).

The aging crisis in Hong Kong is unique in that it was caused by several waves of immigration and emigration, coupled with inadequate investment in tertiary education (Wong, 2013b). The purpose of this paper is to study the causes and outcomes of the Hong Kong aging crisis and, where appropriate, advise on mitigation strategies.

The paper analyzes the current demographic predicament and makes recommendations.

A viable method for alleviating this demographic problem is to introduce various immigration schemes; however, these have been rendered futile because of a lack of infrastructure necessary for attracting immigrants and mitigating the protectionism that occurs among local workers and in trade unions in Hong Kong. A purely open and proactive immigration policy should involve prioritizing the admission of professionals and laborers across pillar industries and areas where technical skills are in short supply, as well as setting a daily immigration quota of 50 to recruit professionals with university degrees from abroad (Wong, 2013a). A comprehensive immigration policy should also be complemented by encouraging Hong Kong residents who work overseas to return (Wong, 2013a).

The paper analyzes the demographic predicament of labor shrinkage in Hong Kong and summarizes the recommendations for attracting talent and professionals from abroad.

The production of the ‘good life’ or the ‘less bad-life’ (Berlant, 2007, 2011), especially among generations of the Marcos dictatorship and the Epifanio de los Santos Avenue revolutions (henceforth, EDSA revolutions) in the Philippines, is animated by the ‘mobility imperative’ (Farrugia, 2016). The mobility imperative includes processes that encourage or demand mobility (Farrugia, 2016) for individuals and institutions. It figures in various ‘systems of practice’ (Levitt, 1998, 2001) among families in migrant-sending communities, government and corporations that magnify how migration is the ticket to better life (McKay, 2012) or its glorification as a heroic act (de los Reyes, 2013, 2014). Among the generations of the Martial Law and the EDSA revolutions, therefore, the ‘good life’ is hinged upon departure as professionals (e.g. nurses and engineers), workers in elementary occupations (e.g. construction and domestic workers) or mail-order brides or pen pals. Put simply, the good life in these generations is a function of remittances.

This chapter examines how the contemporary generation of young people construct the ‘good life’ in differential and new terms (de los Reyes, 2023; McKay & Brady, 2005) from previous generations. Using interviews and vision boards of left-behind children (15–18 years old), it argues that left-behind children critically appraise the ‘mobility imperative’. The chapter shows that there is a growing imagination of alternatives to the migration-induced good life among left-behind children, and therefore, they gradually refuse the ‘mobility imperative’. For them, the aspired good life consists of potentially being employees or entrepreneurs in their own villages and living a life with their own families (de los Reyes, 2019, 2020).