An exploration of older Hong Kong residents’ willingness to make copayments toward vouchers for community care

Because of its rapidly aging population, Hong Kong faces great challenges in the provision and financing of long-term care (LTC) and needs to explore sustainable funding mechanisms. However, there is a paucity of research on older people’s willingness to pay (WTP) for LTC services in Hong Kong. This study utilizes data collected in Hong Kong in 2011 (N = 536) to investigate older people’s receptivity to this financing mode by assessing their co-payments for a community care service voucher scheme and then testing how potential factors affect respondents’ amount of co-payment. Results show that respondents’ WTP was positively associated with family financial support, financial condition, and positive attitudes toward this novel policy and negatively associated with family caregiving support. Direct and moderating effects of family financial support on WTP were found. The policy-related implications of LTC financing to improve older people’s acceptance of co-payment mechanisms, financial condition, and shared responsibility of care are discussed.     

Preventing economic hardship among Chinese elderly in Hong Kong

Over the next 20 years, Hong Kong will face a rapidly aging population as the number of older adults aged 65 or above increases to approximately 1.4 million by 2021, that is, 17% of the total population. In 2001, there were 1.2 million adults aged 45-59. To assess the differences between these middle-aged adults and the current cohort of older adults, we identified the challenges that Hong Kong society will face in meeting the financial needs of older adults in the coming two decades. In this paper, we examine the retirement economic status of three groups of older adults: those who are financially independent, those who are financially supported by their adult children or children-in-law, and those who are receiving welfare assistance. We describe the current situations of these groups, prevailing social policy, future trends, and recommend policies for tackling problem areas.     

National policy approaches to social care for elderly people in the United Kingdom and Singapore 1945-2002

The authors compare policy approaches in the United Kingdom and Singapore on social care for older persons. The context of these approaches is discussed showing the development of policies, in each country from the aftermath of the Second World War to the present. Given that Singapore is a former British colony, it is of interest to scholars of social policy to examine its welfare approach as compared to the welfare state approach espoused by the United Kingdom. Both nations are faced with the challenges of an aging population, which necessitates handling similar problems with strategies that are in harmony with their respective economic, social, and cultural contexts. This paper considers their divergence of philosophies and policies, concluding with the recognition that the major difference lies in national and governmental expectations regarding the extent of the financial and regulatory responsibility for care for older people carried by the individual, the family, and the state.     

Preventing Economic Hardship Among Chinese Elderly in Hong Kong

Abstract

Over the next 20 years, Hong Kong will face a rapidly aging population as the number of older adults aged 65 or above increases to approximately 1.4 million by 2021, that is, 17% of the total population. In 2001, there were 1.2 million adults aged 45-59. To assess the differences between these middle-aged adults and the current cohort of older adults, we identified the challenges that Hong Kong society will face in meeting the financial needs of older adults in the coming two decades. In this paper, we examine the retirement economic status of three groups of older adults: those who are financially independent, those who are financially supported by their adult children or children-in-law, and those who are receiving welfare assistance. We describe the current situations of these groups, prevailing social policy, future trends, and recommend policies for tackling problem areas.     

Financial worry among older people: Who worries and why?

This study sought to clarify what drives economic worries among older people. Based upon the data from a national sample of adults aged 65 and older in Israel (N = 550), we examined associations between financial worry and economic status, lifestyle, social network, concerns about functional health, long term care needs and cognition, and population group. The main financial worry was that pension funds will not suffice for one's entire life. Multivariate analysis revealed that financial worry was negatively related to perceived income adequacy and age, and positively related to concerns about care and to apprehensions regarding one's ability to make decisions. Immigrants from the former Soviet Union were found to worry less. Understanding the different sources of financial worries among older people is essential insofar as older people are increasingly expected to take personal responsibility for their financial futures. Dealing with negative outcomes that stem from financial worries are important programming and policy goals in an era of population aging.     

Assessment of financial decision making: an informant scale

Older adults with cognitive impairment are a population at great risk for financial exploitation. At-risk older adults often have difficulty reporting on their own financial abilities. Collecting information from trusted others is vital for professionals investigating the financial exploitation older adults. There are few reliable, valid, and standardized informant-report measures of financial capacity, and none that assess decisional abilities for an ongoing, real-world financial transaction. The present study sought to examine the psychometric properties of a new informant-report scale of financial decisional abilities in older adults. One hundred fifty participants were recruited to complete the Family and Friends and Interview regarding a known older adult’s financial decisional abilities. A factor analysis identified two subscales. The full scale had adequate sensitivity and specificity to detect an informant’s current concerns regarding financial exploitation. The Family and Friends Scale is a useful tool for collecting informant-report regarding an older adult’s ability to make financial transactions.     

Age-Friendly Neighbourhoods as Civic Participation: Implementation of an Active Ageing Policy in Hong Kong

In response to challenges brought by population ageing, Hong Kong has adopted an active ageing policy framework and built age-friendly neighbourhoods to encourage the participation of older people. This article distinguishes between the civic and political participation and emphasizes active involvement in community and neighbourhood activities as a way to encourage the civic engagement of older adults. The promotion of age-friendliness is set at two levels: concerning policy and practical/operational issues, both of which are interrelated with the purpose of offering civic engagement opportunities for older people. The experiences of Hong Kong reflect both top-down and bottom-up approaches, where civic participation is promoted by encouraging life-long learning and developing caring communities, as well as carrying out a variety of neighourhood programmes. It is suggested that different stakeholders, such as older adults, NGOs and other social organizations, shall all be included and play important roles in promoting civic participation of the elderly through creating a conducive environment. The initiatives, whether these are in policy or at operational levels, should be integrated into actions that are aimed to enhance quality of life for all residents and create a more age-friendly neighbourhood.     

Family support in late life: A review of the literature on aging,disability, and family caregiving

ABSTRACT

For older adults and people with disabilities in the United States, family caregiving is an important part of remaining at home and in the community. As care recipients and caregivers age, family dynamics change, and the health, social, and financial impacts of this (largely unremunerated) work have implications for individuals, families, and social policy. In this review, the authors map the literature across multiple fields related to disability and aging to understand caregiving in late life, what it means to be an older caregiver and/or to care for older people. The authors summarize the findings of 97 articles to address the care, services, and supports family caregivers provide for older adults; negative and positive impacts for caregivers serving in this role; supports that family members use or need; and societal impact of family caregiving. Much of the literature describes the work family caregivers provide and negative impacts of caregiving. Less attention is devoted to caregiving benefits, supports used by family caregivers, and societal impacts. The authors conclude with an agenda for future research that attends to the need for research that includes: more diverse samples, new types of caregivers, longitudinal data, qualitative data and analysis, and comparative research.     

Correlated factors with filial piety expectations of older Koreans and Korean-Americans

ABSTRACT

Changing filial piety expectations have been examined from the viewpoint of younger generations. However, research on older adults’ perspective of this cultural phenomenon is virtually absent from the empirical literature. In an effort to address the changing family life circumstances of Korean and Korean-American families, this study explores older adults’ filial expectations from their own children and correlated factors associated with the expectation. The cross-sectional survey study with 449 older adults found that the majority of respondents still believe that adult children should assume responsibility for the care of their parents. Several factors such as age, education, income, living arrangements, self-rated health, year of immigration, and social support were significantly correlated with filial expectations among older Korean-Americans. Only satisfaction with social support received from family and friends was significantly related to older Koreans’ expectations. Implications for social work practice are discussed and further research directions are suggested.     

Changing Perception of the Rights and Responsibilities in Family Care for Older People in Urban China

As an ageing society, China has undergone various political and economic transitions since the 1980s, which has raised a series of social and policy concerns about the practicality of relying on family support in the care of older people. To understand the changing social expectations and the corresponding societal responses, the shifting perception of the rights and responsibilities associated with the family care of older people has to be comprehended first. Based on 39 qualitative interviews in two Chinese cities, Beijing and Guangzhou, this research contributes to an understanding of the pursuit of a “good life” by older people in contemporary urban China. It points to the argument that independence and autonomy in old age, as valued by the interviewees, will not be realised unless there is a shift in policy to recognise and respect the individuality of older people and facilitate their life choices.     

Perceived Need for Home- and Community-Based Services: Experiences of Urban Chinese Older Adults With Functional Impairments

Guided by Cantor’s social care model, this study identified individual, family, and social support factors that influence urban older adults’ need for home- and community-based services, including medical and rehabilitation, instrumental care and support, and psychosocial services. The data were extracted from the Sample Survey on Aged Population in Urban/Rural China conducted by the China Research Center on Aging in 2006. Results from multiple logistic regression show that older adults’ need for medical and rehabilitation services is significantly related to instrumental activities of daily living, depression, not having filial children, friend support networks, and having a confidant. Older adults’ need for instrumental care and support is related to their educational attainment, financial strain, instrumental activities of daily living, not living with children, and friend support networks. Finally, older adults’ need for psychosocial services is significantly related to educational attainment, depression, not being married, friend support networks, and having a confidant. Implications for social service development are discussed.     

Living Arrangements and Informal Support for the Elderly

ABSTRACT

A network of informal care and support provided by family, friends and neighbors often forms the basis for elderly care. Changes in the structure of Chinese family alter this supportive function, and changes in traditional values affect the nature of the network and support provided. This is especially so in modernized Hong Kong where the traditional role of the family and especially children's duty of care for their aged parents (“filial piety”) may be weakening. This proposition was investigated by a qualitative study involving in-depth interviews with 50 older persons in a modern new town (Tuen Mun) in Hong Kong. Living arrangements, geographical proximity and the quality of relationships between potential caregivers and the elderly affected needs for and provision of informal support. Traditional Confucian filial piety is undergoing modification, perhaps erosion, implying ongoing changes in inter-generational relations in this modernized Asian society.     

“We Have to Create Family”: Aging Support Issues and Needs Among Older Lesbians

Gay and lesbian seniors are more likely to be single, live alone, and be childless. The current evidence base suggests that limited social supports are associated with a variety of health disparities among all older adults. Research regarding the aging issues of lesbian seniors is scarce. This instrumental collective case study of 4 older lesbians (ages 59 and older) illustrates unique aging support concerns, issues, and needs. The purpose of the case study is to increase provider sensitivity and provide supportive evidence of the need for more research. Findings suggest that limited biological family support, childlessness, and “families of choice” may be important factors in support service and health care decisions for older lesbians. Implications for care providers in working with the older lesbian population include exploring existing supports and assisting with the formation of culturally acceptable support systems and services. Given the current evidence base regarding the impact of social support on elder health, it is critical for providers to have a better understanding of elder lesbians’ unique concerns and needs relating to support and health care services in order to prevent health disparities among this vulnerable population.     

Community Care in Taiwan

SUMMARY

This article explores the policy definitions and the funder roles of central and local governments in community care in Taiwan. The notion of community care has been adopted in Taiwan following the model of Hong Kong but the main question of the article is whether this has resulted in actual service provisions at the community level, forming an alternative to institutional care. The data has been collected from several sources: policy documents, official statistics, surveys, general reports, funding provision reports, and empirical studies. The results show that neither central nor local authorities are seriously involved in caring for elderly people or persons with disabilities in Taiwan's communities. In Taiwan, community care for these groups of people still means, in practice, informal care provided by female family members without any support from public policies.     

Contact Reduces Transprejudice: A Study on Attitudes towards Transgenderism and Transgender Civil Rights in Hong Kong

ABSTRACT

This paper examines the relationship between Hong Kong Chinese people's contact with transgender/transsexual (TG/TS) people and attitudes toward transgenderism and transgender civil rights, based on Allport's Contact Hypothesis. The term transprejudice is introduced to refer to the negative valuing, stereotyping and discriminatory treatment of TG/TS people. Data are presented from a population-based survey with a random sample of 856 Hong Kong Chinese persons aged between 15 and 64, using the Chinese Attitudes towards Transgenderism and Transgender Civil Rights Scale (CATTCRS). Attitudes, assessed on both personal and institutional dimensions, are examined in relation to participants’ gender, age, educational level, religiosity, and previous contact with transpeople. Results suggest that previous contact with transpeople was significantly associated with attitudes reflected in the scale; decreased social distance, decreased social discrimination, and decreased transprejudice, increased awareness of discrimination against transpeople, increased support for equal opportunities, increased support for post-operative transsexual civil rights, and increased support for anti-discrimination legislation. Our findings support the contact hypothesis, that contact has a positive effect on attitudes towards TG/TS persons. We discuss the implications of these findings for public education interventions and public policy, as well as for research.     

Pluralistic ignorance in Sino–Hong Kong conflicts: the perception of mainland Chinese people living in Hong Kong

This study examined pluralistic ignorance in the context of conflicts between Hong Kongers and mainland Chinese in Hong Kong. This focus differs from past studies, which have mainly explored in-group pluralistic ignorance regarding whether people could correctly perceive the opinions of others who belonged to the same social group as they did. The present study investigated whether people could correctly perceive the public opinion of a collective to which they did not belong. Using two representative samples of mainland Chinese students and local students from three universities in Hong Kong, this study found that mainland students overestimated the local public’s unfavorability regarding Chinese mainlanders and the Chinese government. This overestimation was found to be positively associated with their attention to media content about the Sino–Hong Kong relationship and the extent to which they perceived the pertinent media content to be biased toward Hong Kong but negatively associated with their interpersonal communications with Hong Kongers about issues regarding the Sino–Hong Kong relationship. The overestimation of the local public’s unfavorability of Chinese mainlanders and the Chinese government reduced the willingness of mainland students to stay in Hong Kong for further study, work, or domicile. Based on the findings of this study, further research on pluralistic ignorance is recommended in order to determine how migrants perceive the mainstream opinion in the society to which they migrate.     

The post-80s generation: exploring the attitudes toward family and housing

ABSTRACT

Previous literature has paid attention to housing pathways and cohort features of young people, but studies connecting the two themes are lacking. This paper offers a perspective on the cohort analysis of young people based on their housing choices and aspirations. With empirical evidence from a two-round social survey, this study explores the ‘not leaving home’ pattern of the housing choices of young people in Hong Kong. With some supplementary subgroup analysis, the cohort label of a ‘post-80s generation’ in Hong Kong is challenged. Contradictions are revealed in the views of our young people about housing and family life, and further analysis is conducted to examine the impacts of economic and sociocultural factors in the local context of Hong Kong. This study argues that we need to look beyond the shared features and subgroup differences and consider how sociocultural factors, particularly gender, marriage, education, and social norms, interact with economic factors to shape housing choices, aspirations and apparent contradictions in the viewpoints of young people regarding their personal development and housing futures. In doing so, the paper also engages with debates around intra and intergenerational dynamics and inequalities. The paper focuses on Hong Kong but these debates have international resonance.     

Persistence and challenges to filial piety and informal support of older persons in a modern Chinese society: A case study in Tuen Mun,Hong Kong

Social support networks, consisting principally of family members, neighbors, and friends, can provide various support functions to older persons. As societies modernize, changes in family structure might alter this supportive ability, and changes in traditional values affect the nature of the network and support provided. This may especially be so in rapidly modernizing societies as in the Asia–Pacific region where the traditional role of the family and especially children's duty of care for parents (“filial piety”) may be weakening. This proposition was investigated by a qualitative study in a modern new town (Tuen Mun) in Hong Kong. In-depth interviews with 50 older persons in public housing estates were triangulated with data from focus groups and key informants. Living arrangements, geographical proximity, and the quality of relationships between potential caregivers and receivers affected needs for and provision of support, and there were interactions between various components of informal support. An important finding, which also has policy implications, is that traditional Confucian filial piety may be undergoing modification, perhaps erosion, implying ongoing changes in intergenerational relations in this modernizing Asian society.