15th World Congress on Long Term Care in Chinese Communities Organized by Federation of Long Term Care in Chinese Communities 29 November – 1December 2018 Hong Kong, China

Developing an Indigenous Model of Long Term Care in Chinese Communities Emeritus Professor Nelson Chow Department of Social Work and Social Administration The University of Hong Kong

Topics to Discuss To develop a model of long term care indigenous to communities which are influenced by the traditional Chinese cultures in their values. To examine the strengths and limitations of current policies adopted in these communities in regard to the support of people requiring long term care. To review the place of values, particularly the practice of filial piety, in the formulation of an indigenous model of long term care in Chinese communities.

Long Term Care for Older People Rapidly Becoming an Issue of Major Concern in Chinese Communities Increasing number of older people in the population, longer life expectancy and the rising need for long term care. Governments spending more on providing services to support older people requiring long term care. Rising tensions between generations –Who should take up the responsibilities?

Long Term Care for Older People Rapidly Becoming an Issue of Major Concern in Chinese Communities (Continued) Older people are increasingly aware of the political power which they command. “It is worth noting that any new policies or programs will be guided not only by perceived needs of the elderly but by the degree of economic and political influence they possess.” (Hermalin, 2001) As workers and consumers, older people are making an impact on the performance of the economy.

Definitions of Long Term Care A range of services that addresses the health/personal care/social needs of individuals who lack some capacity for self- care (Kane & Kane, 1982) Long term care for the elderly as providing personal care/health/social support services for an indefinite period of time who have lost some capacity for self-care because of ageing, chronic illness or impairments of mental/physical functions (H B Cha, 1998)

Questions Facing Chinese Communities in Caring Older People Requiring LTC Should they completely adopt the Western approach in caring older people requiring LTC? Should they totally disregard the traditional respect for the elderly and family responsibility in formulating relevant policies? How could they devise a less costly but equally effective model of LTC?

Changes and Challenges to LTC Policies in Chinese Communities Koreans are looking for changes with respect to diminishing traditional family values and the desire for independence in later life among older people. (Chee & Levkoff, 2001) The obligation to support one’s parents was generally felt by the children in China, but action was only taken when the parents were in need. (Lee & Xiao, 2001)

Changes and Challenges to LTC Policies in Chinese Communities (Continued) Hong Kong SAR: “Care in the Community” continues to be the official policy in LTC and acknowledges that both community support and institutional care services are in short supply. (Report on LTC, 2017) Singapore: “not only does the [Singapore] government promote the attitude that the public should look upon aging as a personal responsibility, shared with their immediate families; it also seeks to provide a social infrastructure in which these responsibilities can be realized.” (Mehta and Vasoo, 2001)

A Summary - Long Term Care Services in Chinese Communities Long term care services are generally non-existent or in short supply. Institutional care often forms the only form of long term care service; an absence of home-based services or are still at early stages of development. The family remains the primary and sometimes the only resource on which the elderly may rely.

A Summary - Long Term Care Services in Chinese Communities (Continued) Little sign that the state will be able to make up for the declining ability of families in providing care for older people requiring LTC. Care for the elderly is increasingly seen as a shared responsibility of public services and private families, and a responsibility that should be shared more equitably between men and women.

Are Values Still Relevant? Evidence clearly shows that the influence of moral values, particularly respect for the elderly, is in rapid decline. Other factors, such as health of older people and their financial independence, appear to have overshadowed filial piety in regulating the relationship between older parents and their adult children.. Children no longer feel solely obliged to support their older parents and other senior relatives.

Harsh Realities Facing Long Term Care Policies The need for long term care will rapidly increase with ageing populations Scarce institutional care often forms the only formal long-term care services and home-based services are general unavailable. Same for professionals required Older people in need of long-term care are often financially inadequate and the supply of public resources is lacking behind demand

Harsh Realities Facing Long Term Care Policies (Continued) Family support is diminishing, though the value of filial piety is still treasured and puts upon families the responsibility to care for their older members. Children increasingly look to the State for assistance in providing support for their elderly parents in need of long-term care. The dilemma – Older people in need of long-term care are facing decreasing family support, while State input is not forthcoming in the near future.

An Indigenous Model of Long Term Care in Chinese Communities Though diminishing in influence, filial piety must be retained as the value underlying the policy as older people in Chinese communities have no other alternatives to command the respect of the younger generations. Children’s sense of responsibility to support elderly parents should be recognized and their abilities to provide support be realistically assessed.

An Indigenous Model of Long Term Care in Chinese Communities (Continued) A long term care policy for older people should be built upon the basis of a community care approach, integrating the contributions of families, communities, and formal support services. Comprehensive insurance coverage for long term care should be introduced by state schemes.

Conclusions and Warnings A total rejection or complete acceptance of family support is inappropriate in long term care. Respect for the old should be treasured and observed in ways appropriate for the current situations and cultures. The right of older people as citizens should be stressed in their use of formal services and state support.

Thank You Wishing that our deliberations will generate a better and healthier future for our beloved elders