By: Karen Lok Yi Wong
The population is aging in different parts of the world. By living longer, a person has more complex health and mental health care needs, which can be too challenging for the person to be cared at home, and thus need professional residential care.
With experience in residential care in Hong Kong and Vancouver, I found that while both cities share many similarities such as being world metropolitans and having a rapidly aging population, their residential care policies are similar but also different in many ways. This article will try to compare the residential care policies in these two cities.
First, both cities has a mix of public and private residential care, but Hong Kong is mainly private, while Vancouver is mainly public. The difference is related to their funding mechanisms for their welfare systems. While both cities follow a capitalist, liberal and residual welfare ideology and allow market provision of welfare, the welfare system in Hong Kong is funded by a significant share of both the government and the market, but Vancouver, compared with Hong Kong, is mainly funded by the government.
A public led residential care system can ensure better monitoring of standard of services with regards to, for example, size of space per service user, ratio of staff to service user, and range of services provided to service users, but a private led system can allow greater flexibility to support specific needs of service users.
Second, although residential care in both cities charge service users based on means tests, the unit to be means tested is different. Hong Kong means tests the service user as well as his or her whole family, but Vancouver only means tests the service user.
The difference is related to how they see collectivism and individualism. As a Chinese society, Hong Kong emphasizes more on collectivism, which means that a person is considered to be a part of the family before he or she is considered to be an individual. Therefore, apart from the service user, his or her family is also included to be means tested.Also, because of traditional family values, the family is considered to have the responsibility to provide as much care and financial support as possible.
Therefore, the family is means tested to make sure that the family has already provided as much financial support as possible and the government is the last resort. However, this leads to heavy care burdens to the families, especially those who are overwhelmed by taking care of the care receiver, yet the family income is too high for subsidies for public residential care but not enough for quality private residential care. What some of these families do is that both the care receiver and the family sign legal papers to officially claim that they no longer have family relationship, so that only the care receiver is means tested, and since the care receiver usually has very low income, he or she becomes eligible for the subsidies for public residential care.
However, even if the care receiver and his or her family continues to remain their family relationship, officially claiming no family relationship with each other is still a traumatizing process to many people, especially because Hong Kong is a Chinese society which is deeply influenced by traditional family values.
In Vancouver, only the service user is means tested, because of the society’s emphasis on individualism, which means that a person is considered as an individual before he or she is considered to be a part of the family. However, some argue that this may lead to abuse of public resources. For example, the subsidies for public residential care may go to service users who already have financial support from the family and indeed do not need the subsidies.
To sum up, while Hong Kong and Vancouver share many similarities, their residential care policies are similar but also different in many ways. This article discussed their differences on the proportion of private and public residential care, as well as the unit to be means tested. It is difficult to tell which cities have better residential care policies. They are just different because of different funding mechanisms on their welfare systems and how they see collectivism and individualism.
Karen Lok Yi Wong
Karen Lok Yi WONG (BA, MA, BSW, RSW) is a registered social worker with an interest in older adults. She received her social policy training from the University of York, UK and social work training in UBC, Vancouver, Canada. She has extensive experience of working with older adults and families in different settings, including community senior service centres, care homes and support groups, in York, Hong Kong and Vancouver.