We hear a lot about the aging population – and usually it is negative. In reality, it is a remarkable example of human social and technological progress. In less than a century, humanity in much of the world has made huge improvements in things like access to clean water, waste disposal, food, medical care and education. As a result, we can expect to live significantly longer than our ancestors just a few generations ago.
As human beings, we should celebrate this as a wonderful achievement. But to policymakers and planners, the aging population is a headache. Essentially, it disrupts established patterns and systems. Hong Kong is no exception to this.
In many cases, these challenges are long-term and change of any sort tends to be unpopular, so it is tempting for us as a community to leave it for a few more years. Raising the retirement age is a classic example.
In some cases, we need to address sensitive and usually private issues that we would prefer not to talk about, or even think about. For example – where should people spend the end of their lives, and actually die?
Various academics and policy groups, as well as the government’s Elderly Commission, have been asking some of these difficult questions. Our Hong Kong Foundation and the Business and Professionals Federation of Hong Kong (BPFHK) have also contributed interesting studies. It is possible to see a broad way forward.
Although we think of this as a highly complex issue, it comes down to some fairly basic principles. But it does require some new ways of looking at things.
For example, part of the problem goes away if we simply re-think what we mean by ‘elderly’.
Our traditional way of thinking is that people retire at 60 or 65. This dates back to a time when people lived until, say, 75. But an amazing 50 percent of people born today can expect to live to the age of 100. We need to accept the fact that a longer life-span means a longer active, and working, life. The arithmetic of retirement savings means that today’s young generation should probably think in terms of working to the age of 75.
Another step, stressed by the BPFHK, is to stop looking at elderly care as a category of social welfare and start thinking of it as part of healthcare. This might sound abstract, but it has big implications in terms of planning and expenditure – and quality of care for the elderly. Our current system lacks coordination and channels resources (and patients) into residential and hospital systems, when this could be avoided.
This leads to the issue of housing for the elderly. Although one in five households in Hong Kong is made up of senior citizens, the accommodation is often unsuited for people who are aging. This adds to pressure on hospitals and care homes. But with modern technology and better home design (or refurbishment) – backed by appropriate building regulations – we can make our housing far better for older people to live in. Specialized accommodation and facilities at some Housing Society estates show how this can be done.
This leads on to a highly sensitive subject most of us would prefer to avoid discussing: dying. If our homes are suitable for us to live in as we get older, they should be suitable for our lives to end in as well. However, with 90 percent of deaths taking place in hospitals, “dying in place” with dignity is rare in Hong Kong.
This calls for various reforms. On a basic level, we need to revise some of the bureaucracy involved in reporting deaths, removing dead bodies and issuing death certificates. As a matter of policy, we should expand hospice facilities and the availability of healthcare for people in their own residences.
These sorts of reforms are not about sudden shifts, but a longer-term transition to adapt to changing circumstances.
The process will involve changes in training and human resources in response to rising demand for caregivers and other professionals. And it will require new thinking on allocation of public resources and on partnerships between the public and private sectors.
This is a big issue, but not an impossible one. Longer life spans are a result of human achievement – so surely we are smart enough to adapt. The main concern is that we see no sense of urgency. Ideally, we in Hong Kong, with a rapidly aging population, should start taking serious steps now.
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