Live in HK, die in Guangdong?

CHINA - Intrepid hikers hoofing it up Shenzhen's tallest peak, the 943m Wutong Mountain, are rewarded with 360-degree views of the city, and even Hong Kong on a clear day.

Peer directly down, though, and there, nestled in verdant shade, is a squat five-storey building. Zoom in further and you see a stout 89-year-old woman out for a walk while prattling in quickfire Cantonese.

As Madam Chan Yuk Chun makes her way with the help of a walking stick, a breeze brings the tang of salt from the sea beyond the nearby port of Yantian.

Given such favourable fengshui, it is little wonder the Hong Konger says she feels more than at home here, in a place that was alien to her for most of her life. "Here in Shenzhen, the air is much fresher, the sky is bluer and the sun seems brighter," she gushes.

Madam Chan was born in Hong Kong in 1924. She lived there for 88 years, survived a world war, watched Hong Kong boom and pass from British to Chinese rule, all while raising a son and three grandchildren. But she will die here in Guangdong, she says.

Last July, she moved across the border from her home on Hong Kong Island, to the Yee Hong nursing home in Yantian, joining 51 others from Hong Kong. Now even more elderly could be making the one-way journey.

As Hong Kong's population ages, it is facing a nursing home crunch. About 28,000 old folk are on the waiting list for places in government- subsidised homes, a wait of up to three years. In 2011 alone, more than 5,000 died waiting for a bed.

Now the government is looking at what it calls "portable welfare" - encouraging Hong Kong's needy elderly to consider homes in Guangdong by subsidising their places there.

Two homes privately run by Hong Kong charities are under consideration. One is Yee Hong; the other is Helping Hand, in Zhaoqing city.

Under another scheme that will begin in November, Hong Kong retirees living in Guangdong will be able to collect from the government an old-age allowance of HK$1,135 (S$186) that was previously denied them.

Both incentives put a larger migration pattern in play. Since 1997, when Hong Kong returned to China's rule, a trickle of elderly Hong Kongers have crossed the border in an ironic reversal of the time in the 1950s when they fled strife-torn China. Many are poor and say they can no longer afford Hong Kong's cost of living.

Some 30,000 are expected to benefit from the allowance plan. Among them, at least 2,000 are in nursing homes.

Recognising the benefits to land-starved Hong Kong, Labour and Welfare Secretary Matthew Cheung told the South China Morning Post two weeks ago: "This is an important first step - a major strategic step allowing the elderly their freedom to retire (in Guangdong). We are pretending that Guangdong is Hong Kong."

Nursing home culture

Tackling the demographic challenge is no child's play.

Hong Kong is ageing fast. Latest statistics show that those aged 65 and above will comprise one third of the population by 2041, up from 13 per cent today. The number will increase to about 2.5 million from today's one million.

Deepening the problem is the fact that Hong Kongers tend to rely on nursing homes to house their elderly. The city has 925 nursing homes, including 288 which are government-subsidised.

About 6.8 per cent of Hong Kong's old folk - about 68,000 people - live in these institutions, says Dr Terry Lum, director of the Sau Po Centre on Ageing at the University of Hong Kong.

That is a far higher rate than elsewhere. Singapore, for example, has more than 60 nursing homes, housing more than 8,000 - 2.2 per cent of its silver-haired. About 500 are on the waiting list, said a Health Ministry spokesman.

In Taipei, 113 homes provide 5,825 beds. If all are occupied, that would represent just 1.6 per cent of the city's aged.

One reason for Hong Kong's dependence on nursing homes is that many elderly are first-generation immigrants who left behind extended family networks.

Another is the size of most Hong Kong homes. "Most families live in small homes, and if you have an elderly, disabled family member, you need a wheelchair and a special bed," says Dr Lum.

"They just don't have enough space. So when the elderly become frail, they become a huge burden on the families."

Poor families, where children earn less than HK$10,000 a month are particularly reliant on nursing homes. So if they can get their elderly family member into a government- subsidised home with welfare handouts covering all costs including food, "it becomes a very rational choice", Dr Lum says.

About 40 per cent of nursing home residents are on welfare, he estimates.

Yet, in a manifestation of the "not in my backyard" syndrome, many Hong Kongers resist having nursing homes built near their residences, says Professor Alfred Chan, chairman of the Elderly Commission that advises the government on ageing policies.

"It's a hot potato issue. In the long run, as the number of older people increases, we may have to explore more land and places across the border for residential homes."

The controversial solution

Still, shipping one's frail parents off to a foreign land remains a controversial idea here, just as it was in Singapore in 2009 when then Health Minister Khaw Boon Wan suggested Singaporeans could save money by using cheaper nursing homes in Johor, Malaysia.

Physically, it is not that far from Hong Kong to the homes in Guangdong. It takes 1.5 hours by bus from Kowloon to Yee Hong, including clearing Customs twice, and about 3.5 hours to Helping Hand.

Psychologically, however, "the distance is very difficult to overcome", acknowledges Mr Ng Hang Sau, chief executive officer of the Hong Kong Society for Rehabilitation, which runs Yee Hong.

There is a whiff of unpleasantness about it - that children appear to be abandoning their parents far away. But Mr Ng, a veteran social worker, says such unfilial behaviour actually tends to manifest itself at the emergency departments of Hong Kong's public hospitals, where the daily fee is just HK$100.

The stigma explains why the take-up rate at the Guangdong homes has been low so far.

Yee Hong was established in 2005 on the assumption that Hong Kong's elderly, 98 per cent of whom hail originally from Guangdong, would be happy to return to their ancestral home, says Mr Ng.

Yet, today, only 52 of its 350 beds are occupied by Hong Kongers. Two years ago, the home started accepting mainlanders too, although Hong Kongers get priority.

The same goes for Helping Hand, which opened in 2000 and where only 33 of 300 beds today are occupied by Hong Kongers.

This is despite the homes being more spacious and cheaper than private homes in Hong Kong.

A 500 sq ft room shared by four at Helping Hands costs 1,850 yuan (S$382) to 4,000 yuan a month, depending on the level of care needed, says executive director Bella Luk.

In Hong Kong, private homes are cramped and some could be partitioned into cubicles with wooden boards. Yet, they charge between HK$6,000 and HK$8,000.

Madam Yiu Ching, 90, shudders as she recalls the conditions she saw in Hong Kong before going to Yee Hong. "Those old people are squeezed in cubicles and it smelt terrible," she says. "I think I will die faster if I lived there."

The Guangdong facilities clearly try their best to create a home away from home.

At Yee Hong, the Chinese signs are in the traditional script used in Hong Kong rather than mainland's simplified script. The staff, mostly mainland hires, speak both Mandarin and Cantonese, says superintendent Jackie Mo.

Leisure activities include Cantonese folk dancing on the terrace. In a "nostalgia" room, posters of well-loved Hong Kong films such as 1976's Private Eyes starring the Hui brothers are displayed.

Still, moving to Guangdong was not easy for those The Sunday Times spoke to. No matter how comfortable they are, they feel they are away from home, family and old friends, and even familiar food.

Madam Yiu turns teary as she recalls her initial homesickness. "I could not sleep for months, thinking about my sons, daughters and grandchildren."

But she got used to it as they came to visit every week "to make me feel better".

Mr Tso Tee Cheung, 80, a retired businessman, is full of bravado about living alone, speaking of how he cherishes his "independence".

Yet, as he shows how he sings alone to a karaoke machine in his suite while surrounded by numerous photos of his family on the walls, it feels as if he would rather be belting it out with them present.

"When you are old, you learn how to entertain yourself," he says with a smile. His younger daughter, a former deputy general manager at a mainland company listed in Hong Kong, did not return calls and e-mail messages.

Not a permanent fix

Emotions aside, another tricky point is that Hong Kongers on the mainland do not have easy access to quality medical care.

Many do not trust the local system; Mr Tso, a cancer survivor, goes back to Hong Kong every few months for check-ups. As they are not mainlanders, they are also not entitled to subsidies in local hospitals.

The homes have worked out a system where a doctor on the premises takes care of basic needs.

But if specialist treatment or surgery is required, the residents are ferried to the border where they call for a Hong Kong ambulance to pick them up on the other side.

Dr Lum sees the Guangdong option as a stop-gap measure and believes that ultimately, Hong Kong has to figure out a way of taking care of its elderly within its borders.

This is because future generations of Hong Kong elderly who were not born in Guangdong will find moving even tougher than today's old folk.

Says the 48-year-old: "For someone like me, it would be like moving to Singapore or Macau. The next generation of older people will be more educated, more independent and have more financial resources. Most will like to stay in their home and community as they age. It is important that we gradually convert Hong Kong to be an elderly- friendly city."

Prof Chan says work is in progress to achieve this. For instance, from September, needy elderly will be given HK$5,000 of vouchers each month for day-care services. The goal is to lower the proportion of elderly in nursing homes to 5 per cent, he adds.

In a decade or two, Madam Chan's son, a 57-year-old trading businessman who declined to give his full name, will enter his twilight years himself.

He doesn't miss a beat when asked how he wants to grow old. "Of course, if the conditions are right, I hope to be at home with my family," he says.

But he argues that there are daunting factors if one is ill and old - for instance, the costs of hiring a nurse, finding space at home - which cannot be ameliorated just by government handouts.

"Being able to age at home looks like Shangri-La to me," he argues. In which case, Guangdong may just have to do.

xueying@sph.com.sg


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