Mobil New Estate recently (5 May) revealed the murder of the caregiver's double corpse, with the 14-year-old father suffering from heart disease and the 86-year-old daughter who had been amputated due to severe diabetes, lying on the bar and bed respectively. It cannot be ruled out that someone lost his life and died, and another person was unable to take care of himself and died. Different from the five tragic cases of "killing relatives with relatives" last year, this is another kind of lament of "protecting the elderly with the elderly" and "protecting the elderly with the disabled", which shows that the elderly problem is now facing great challenges. As Hong Kong enters a "super-aging society", is the tragedy of caregivers really inevitable? When Hong Kong 59 spoke to Lam Ching-choi, a member of the Executive Council who is an important driver of elderly policy, earlier this year, he lamented that perhaps it would take a tipping point to build social consensus and promote major change.
The past report is now republished to ask all parties - when tragedy is frequent, is it time for a change?

Lam believes that Hong Kong's social, cultural and political ecology together constitute many caregiver tragedies. (Photo by Ou Jiale)

"In a civilized society, this is a tragedy." - "Protecting the elderly with the elderly" to "killing relatives with relatives" involves major issues ranging from "population aging" to "community governance", but Lam Ching-choi, a member of the Executive Council who is an important promoter of the elderly policy, admitted in an exclusive interview with Hong Kong 01 that "sometimes it takes until a tipping point" to promote major changes and reduce the recurrence of tragedies - because Hong Kong's social, cultural and political ecology together constitute this unfortunate reality - people-to-people relationships are fragmented. Notions of mutual aid and love are being challenged, social safety nets are flawed, and as long as society remains unable to build consensus in support of caregivers, there is no pressure or incentive for governments to prioritize. Lim has repeatedly stressed that the government undoubtedly bears the greatest responsibility, but the whole society should also think: as long as everyone is willing to go the extra mile and let caregivers feel that the society has not abandoned them, I believe we have enough strength to support them."

Government treats caregiver tragedy: "Sometimes it has to wait until tipping point"

Parents killing daughters, sons killing fathers, mothers killing children, fathers killing daughters, old husbands killing old wives - in the past 2022, there were five logistics related to caregivers, that is, on average, every two and a half months, a family was torn apart due to the overwhelm of caregivers. This scene of lamentations by caregivers of the old, weak, sick and disabled "dependent on each other" has sounded a serious alarm for Hong Kong, and it is urgent for the HKSAR Government to adjust its governance thinking and reallocate resources to deal with major issues ranging from "population ageing" to "community governance". However, the authorities have not responded positively, and every tragedy has become a cold number.

"The problem of caregivers can be said to be an 'invisible disease'. They may not normally see it, and they don't have 'I'm a caregiver' chiseled on their foreheads, but they do face a lot of difficulties." Lin Zhengcai, who has been concerned about elderly care for nearly 20 years, lamented that it is precisely because caregivers are relatively hidden, they are not easy to find, and there is no pressure group to deliver letters and demonstrations, so when the government formulates policies, it often does not give priority to their demands; Despite the repeated tragedies in recent years, and the previous Government finally commissioned the Polytechnic University to conduct and publish the Major Report on the Needs and Support Consultancy Study on the Needs and Support of Elderly and Disabled Carers in Hong Kong, due to the different needs and difficulty in definition, the relevant policies still face the big problem of "how to implement".

In Lin Zhengcai's view, the most difficult problem is that the whole society has not yet condensed a consensus that "caregivers need to support together", "if even the society feels that it is not important, the government will not care."

However, this statement is inevitably doubtful - one of the meanings of the existence of "government" is that it should make good use of power and resources to actively solve social problems, improve the quality of life, and reduce the occurrence of tragedies, and if the authorities adhere to the "If it ain't broke, don't fix it" mentality, will it not "force" more and more caregivers to desperate?

"It is unfortunate to say that regardless of Hong Kong's political system or political ecology, tragically speaking, the reality is like this." Lam Ching-choi used the "Primary Medical and Health Blueprint", which was released 35 years late and finally released at the end of the year, as an example to explain that the issue of "primary healthcare" has been discussed by the British and Hong Kong governments in Hong Kong and the SAR Government, and the implementation is quite sufficient, but due to the "preventive" nature of the work, it is difficult to achieve immediate results and cannot obtain "political votes", so it has not been implemented for many years. It was not until the public healthcare system exploded in recent years, such as the waiting list for specialists for several years and the shortage of acute beds, that the public finally realized that "something would happen" and "it turned out to be not as good as imagined", that "primary medical care" could take the first step.

"In a civilized society, this is a tragedy." Looking back at the tragedy of caregivers in recent months, Lin Zhengcai is also helpless, "sometimes it is necessary to wait until a tipping point is passed" to promote major changes and reduce the recurrence of tragedies.

But can Hong Kong afford to wait? Who can ensure that caregivers' "bombs" do not create another "governance storm"?

The Carer's Platform, comprising 20 social welfare organisations, estimated last year that there were at least 100 million carers living with Hong Kong. (Profile picture)

Passive support is fragmented and complex: "I've heard all these questions"

According to the Census and Statistics Department's Thematic Report on Demographic Statistics 2016: The Elderly, there were more than 15,30 elderly people living alone in Hong Kong at that time, and nearly 20,100 elderly people lived only with their spouses, i.e. one in three elderly people needed to fend for themselves or care for the elderly. Last year, the Caregiver Platform, comprising 13 NGOs, estimated that there are at least 24 million co-resident carers in Hong Kong, responsible for caring for 8,24 elderly people in need of assistance, 4,5 chronic patients, 3,9 people with disabilities, 31,0 children with special educational needs, 6,<> people with intellectual disabilities and <>,<> children aged <> to <>.

"Elderly people living alone, elderly people living in double hands, and caring for the elderly with the elderly were not so serious more than 10 years ago." Lin Zhengcai mentioned that in recent years, social movements have caused tears, coupled with the barriers brought by the new crown epidemic, people-to-people relationships have become disintegrated, "a greeting in the past may have been the 'last straw on the camel's back' for caregivers", but now there are no more, and there are more unfortunate incidents. He worries that with the wave of migration, many children are left alone, and the problem of caregivers will become more serious.

In fact, problems are everywhere. The 70-year-old sister Qin is a typical case of "caring for the elderly with the elderly", and she must take care of her 86-year-old husband, who suffers from cognitive impairment and abuses from time to time, and must not relax for a moment; During her three-hour interview with Hong Kong 01, she repeatedly mentioned that "she may be the protagonist of the next tragedy". Ah Sheng, who is in his 50s, is a caregiver under the "wave of immigration", because his brother has not been in Hong Kong for many years, and his sister suddenly moved abroad, he can only take care of his 88-year-old mother alone, which makes it difficult for him to balance his personal work and care burden, and his rhythm of life is also disrupted, and he seems helpless.

In all these cases, the government either does not know how to support it, but it simply fails to provide enough support. At present, limited support is provided to carers mainly through living allowance, respite services, "centre-based" community support, "home-based" community care and elderly community care service vouchers. However, the relevant policies have long been criticized: one is fragmented, lack of coordination, and fails to clearly define the target of support; The second is that there is a gap between the reality and limited number of places and the real needs of caregivers – for example, respite services only provide 230 designated day respite places and 330 designated residential respite places for the elderly, which is a drop in the bucket for hundreds of thousands of elderly carers.

Sister Qin also said that some home-based support services have too much porridge, and even if they apply, they are still not arranged. For her, the various measures are actually "useless, you have to help me solve practical problems", such as increasing the amount of living allowance, relaxing the application threshold, allowing other assistance to be received at the same time, at least to relieve financial pressure, buy nutritious milk powder for her husband, buy bed warming felt, and let her have more money to steal respite. Ah Sheng also believes that the government's support is one-sided, scattered and complicated, for example, a social worker once visited his mother's home to help his mother do sports, but when he asked if he supported the caregiver's services, the other party said that he was only responsible for the rehabilitation of the elderly, and he checked online by himself. "On the surface, measures can help us." But in fact, he needs more knowledge of caring for the elderly and personal psychological counseling to help him cross many psychological barriers.

"I've heard all the questions you just said. It's really hard for caregivers to understand how the whole [caregiver support] system works." Regarding the gap between government support policies and caregiver needs, Lam believes that the problem is not a lack of resources, but that "the variety of services is quite large and complex, and even insiders may not be completely aware of it, believing that only professionals can understand every service". He suggested that the Government concentrate resources on strengthening "case management" services, especially hoping that the elderly centres under review will accelerate their transformation, increase the number of case managers to provide "one-stop" help to carers who are willing to receive services, follow up on some complex and high-risk cases like the "Major Crime Unit", and then guide them to make good use of the entire support system, including government resources or social forces, so that many problems can be solved.

However, the prerequisite for effective case management services is that caregivers can be seen. Lin Zhengcai mentioned that most of the carer tragedies that have occurred in recent months have not been followed up by social workers, and if there have been social workers who have been in contact but we cannot catch the vulnerable position of caregivers, then we can reflect on how to do better. But the most difficult thing is that the caregiver is not the recipient!" He explained that all existing social service mechanisms require recipients to take the initiative to seek help, "You have to raise your hand and say you need services, but if even people in need are not willing to raise their hands, what can we do to help them?" (Editor's note: The families involved in the twin killings in Mobil New Estate are not followed up by social workers and are not subsidized by SWD.) )

But why is the government in a passive role? Shouldn't we take the initiative to build a "safety net" for caregivers?

Mr Lam suggested that the Government concentrate resources on strengthening "case management" services, with case managers providing "one-stop" assistance to carers who are willing to receive services. (Photo by Ou Jiale)

Social safety nets are broken: "We really need to think"

"This safety net cannot be built by the government alone." Lim believes that although the government has a responsibility to support caregivers in need, the bottom of the safety net should be built by every citizen, "but this is our weakest link, especially in recent years, and I think we really need to think about how we can rebuild our social safety net together."

After the half-hour interview, Lin Zhengcai reiterated at least ten times that "we really need to think" - "we" mean the government and society, and "need to think" about the change from "governance concept" to "social culture".

The first problem that needs to be changed is that Hong Kong lacks a long-term vision, fails to prevent micro-developments, and does not understand dynamic governance.

"Hong Kong doesn't like long-term planning, and we don't like to dig out serious problems that we can't see on the surface and clean them up from under the carpet, otherwise President Xi Jinping wouldn't have repeatedly reminded us to solve deep-seated problems." Lin Zhengcai said that the shortcomings of "habit of instant eating" and "not asking for solutions" are the root causes of the accumulation of social problems, which lead us to treat many crises coldly.

This is true of the early years of "primary medical care", and the current lack of attention to "caregiver issues" is also due to the fact that we do not take seriously what "population ageing" and "elderly symbiosis" are all about.

In an exclusive interview with Hong Kong 2018 as early as 01 as the chairman of the Commission on the Elderly, Lam Ching-choi pointed out that "many people still mistakenly think that population ageing in Hong Kong is only 'going on now', and feel that there is still a buffer period before entering population aging", but in fact, Hong Kong has moved from an "ageing society" to a "super-aged society", when thinking cannot keep up with changes, resources naturally lag behind, medical demand is oversupplied, elderly care facilities are insufficient, and caregiver pressure will multiply and other problems will follow.

Lam Chingcai was worried and used the "tortoise and rabbit race" as a metaphor to call on Hong Kong to catch up; After four years, it cannot be said that the government has made no progress, but the results depend on the wisdom, and Lam Zhengcai is most pleased that the general public has begun to accept the concept of home-based elderly care, and understand that the wishes of the elderly to stay at home for the elderly should be respected, and they cannot just be sent to residential care homes for the elderly; He also made great strides towards the "zero waiting time" targets of "Integrated Home Care Services" and "Improving Home and Community Care Services", with the waiting time reduced from an 2018-month peak in 18 to 2021 months at the end of 5.

The ageing of the population behind caregivers is closely related to many issues, including ageing in place, housing shortages, family structure, neighbourhoods, community governance, social welfare, gerontechnology, and more. (Profile photo/Photo by Zhang Haowei)

The second issue that needs to change is that Hong Kong is not used to thinking about structural issues and not being comfortable with looking at policy holistically.

"I often say that we don't just take care of the elderly, we take care of the family, so if we do a good job of family concept or family policy, many elderly care policies will be implemented more smoothly." Lin Zhengcai said that the aging of the population behind caregivers is closely related to many issues, including ageing in place, housing shortage, family structure, neighborhood relations, community governance, social welfare, gerontechnology, etc., so the orientation to solve the problem of population aging should run through the policy scope of population, family, elderly care, innovation and technology, education, land, housing and other aspects.

Policies clearly need to be shared by different departments, "because they are all deep-seated problems that we should face together"; Unfortunately, at present, apart from the Labour and Welfare Bureau, other government departments still seem to think that the "elderly policy" is not their own business – which is where Lam Ching-choi has been most dissatisfied with his performance in the past four years as a member of the guild: "Because I have not been able to push all the bureaux and departments to meet the challenges brought about by the "population ageing" with us... But in fact, there is no department or bureau that can say that it has nothing to do with the 'aging of the population'."

For example, the Innovation Technology and Industry Bureau should assist in the development of gerontechnology to help the elderly solve problems encountered in living autonomy, health screening, home safety, rehabilitation and social life, so as to enhance the quality of life and self-care ability of the elderly; As for the Education Bureau, it can educate young people to understand "aging", "so as not to know how to take care of the elderly in the future, or you may not be able to adapt to it when you are old"; The Development Bureau, which is responsible for urban planning, "fails to design future cities in response to the ageing of the population, and the community cannot fully cooperate with the ageing at home, which will lead to different types of problems"; "I asked at an internal government meeting why when we are building more and more PRH estates, the overall population of PRH households is getting smaller and smaller? When our housing policy actually [encourages] to divide a family into several, do we create a lot of people living alone in disguise?"

If you can't see the overall situation, it's inevitable to be blinded; If you cannot read structural contradictions, I am afraid that it will be futile. "Every policy affects different aspects of caregivers, and the government needs to constantly reflect on whether those policies are helping caregivers or causing caregivers to be more anxious?" Many policies are conflicting, resulting in many downstream problems, such as the generation of a large number of unsupported caregivers, and now that families have fewer birthrates, the elderly are lonely, and social apathy is becoming more and more serious, "Should we think about what is wrong upstream?" How can we maintain policy coherence?"

Lim stressed that the government undoubtedly bears the greatest responsibility for caregiver issues, but the whole society also needs to go one step further. (Photo by Ou Jiale)

The third problem that needs to be changed is that there is too much individualism, and the value of mutual love is increasingly lost.

One of Lam's most important issues related to caregiver issues is the collapse of "social capital," because social unrest in recent years has weakened human ties and challenged the traditional virtues of mutual help and love.

Social capital is a number of systems, relationships and standards used to influence the quality and frequency of social interactions, which help to build citizens' social participation, interpersonal networks, complementarity, mutual trust and love, mutual assistance and reciprocity, understanding and solidarity, common values, etc., and inject a human touch into the community. At present, the HKSAR Government mainly develops social capital through the Community Investment and Sharing Fund, encourages cross-class and cross-sectoral co-operation between different organisations, and builds mutual aid networks in the community. Lam Ching-choi, who became a member of the Foundation Committee in 2005 and then served as chairman for six years, is still impressed by the spirit of solidarity among neighbors when he was in the district, such as many volunteer building directors who went out to care for the needs of families and connect different neighborhoods. But at the same time, he lamented that whether it is a public housing estate or a private housing estate, "many people have closed their doors."

"I don't know if I can say that, we may be influenced by Western culture and emphasize individualism." Lam observed that whenever new small communities are built, developers always use "exclusivity" as a solicitation, "saying that we are very noble here, inaccessible to outsiders, and very private residents; But why can't we sell 'inclusiveness'?" He is a self-proclaimed "idealist" and pursues values, so since he became a member of the guild in 2017, he has also actively encouraged government officials to "let go of their baggage and talk more about values", firstly, through the process of value identification to value internalization, to set upward and downward policy goals and reasonable policies for the entire government, and secondly, to clearly express to the public the government's determination to solve problems, show its willingness to rehabilitate, reorganize the use of public resources, and lead the society in a common direction.

Despite this, Lin Zhengcai also laughed at himself that talking about "value discourse" and "deep-seated contradictions" in Hong Kong is like "suicide poison", and it is difficult to attract attention; Still, he will continue to push for government and social change. At the end of the visit, Lim reiterated that the government undoubtedly bears the greatest responsibility, but the whole society should also rethink: as long as everyone is willing to go the extra mile and let the caregivers feel that the society has not abandoned them, I believe we have enough strength to support them."

(The report was first published on January 2023, 1, and the original headline was "Saving the Carer・17|Dialogue with Lin Zhengcai - Who Will Take Care of the Carer?") 》。 )