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More Hong Kong retirees are homing in on Greater Bay Area but healthcare issues prove hard to handle for some

“The food and the living environment at this care home are great. My favourite activity is to take a stroll,” she added. “Hong Kong is smaller and more packed, which is less comfortable.”

The Home For The Aged Nansha in Guangzhou has six Hongkongers living there. Photo: Xiaomei Chen

Lu, who has some family in Guangdong, is among a growing number of elderly Hongkongers who have opted to live across the border in the Greater Bay Area although such a move is not without its own challenges.

Elderly residents and concern groups told the Post that although more support measures were in place and others in the pipeline, fundamental differences in the healthcare system across the border still deterred some from moving there – or forced them to return to Hong Kong.

Government data showed around 88,000 Hong Kong residents aged 65 or over were considered to be “usually residing” in the province at the end of 2022, about 11 per cent more than the 79,100 five years earlier.

Beijing unveiled its bay area scheme in 2019, laying out an ambitious plan to link Hong Kong, Macau and nine cities in Guangdong into an economic powerhouse by 2035. Authorities also pledged to create a favourable environment for Hong Kong and Macau residents to retire in the province.

Elderly able to use Hong Kong healthcare vouchers at 7 more bay area centres

The Hong Kong government last week announced an expansion of the city’s medical voucher scheme for the elderly, allowing retirees to spend the annual HK$2,000 subsidy at seven more hospitals and dental clinics in bay area cities.

Hong Kong has long been plagued by a shortage of places in residential care homes.

As of January 31, 16,756 people were on a waiting list for government-subsidised places, which cost residents around HK$1,600 to HK$2,000 a month. The average waiting time ranges from a year to 16 months.

Residents enjoy a Lunar New Year fair at the Home For The Aged Nansha. Photo: Xiaomei Chen

Ample outdoor space, gardens and large private rooms are a rare sight at most care facilities, a direct result of the city’s long-running land shortage problem.

Monthly fees for private facilities with better living conditions can range from a few thousand to tens of thousands of dollars, placing a hefty financial burden on the elderly and their families.

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The city’s residential care homes, viewed by many as a last resort, also suffer from insufficient manpower and poor reputations.

Living in the community is not any easier for many of the city’s older generation.

Dr Florence Fong Meng-soi, deputy director of the Asia-Pacific Institute of Ageing Studies at Lingnan University, said the elderly might face a lack of community care services and a shortage of medical and nursing staff.

A shortage of healthcare workers, including occupational and physical therapists, also led to insufficient care services, she noted.

A better option?

To some elderly Hongkongers, retirement on the mainland in the bay area, which includes Guangzhou among the nine Guangdong cities, is an attractive proposition.

Last April, Nansha, a district in Guangzhou, rolled out measures to allow Hong Kong and Macau residents who had lived in the area for more than six months to apply for a place at its public care homes. Those who have worked in the area for more than six months and their immediate family members are also eligible for the scheme.

Home for the Aged Nansha is the only facility covered by the policy so far, with Hongkongers living there paying a monthly fee of around 2,000 yuan, the same as other residents. Applicants wait an average of just 25 days before they can move in.

Six Hong Kong residents live in the home currently.

Nansha District Civil Affairs Bureau told the Post that the new policy catered to the growing population of Hong Kong and Macau people in the area, treating them just like other Guangzhou residents and enhancing their sense of belonging.

“It helps to solve the problems faced by Hong Kong and Macau elderly retiring in Nansha and fulfils their needs,” a bureau spokesman said.

“To Hong Kong people, care homes in Nansha have a comfortable living environment, more spacious living space, professional nursing services and affordable prices.”

Hongkongers waking up to bay area potential – but more needed, say experts

The Hong Kong government also has a policy covering care home spots in the province. In 2014, it launched the Residential Care Services Scheme in Guangdong, under which elderly residents waiting for government-subsidised home places can opt for one of two facilities in Shenzhen and Zhaoqing.

If they choose the option, they can live in a care home without being placed on a waiting list and are fully subsidised by the government. They also get a six-month trial period where they can move back to the city without having their places on the Hong Kong waiting list cancelled.

Other policies include the Guangdong Scheme and the Portable Comprehensive Social Security Assistance Scheme, which allow the elderly to continue to receive Hong Kong government subsidies while living in the bay area.

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Living life to full

Nansha-born couple He, 94, and his 95-year-old wife Guo lived in Hong Kong for 22 years after arriving in 1997. But having grown to dislike the Hong Kong lifestyle, they moved back to their birthplace in 2019, staying in a double room with a private toilet in the Nansha care home ever since.

“Elderly homes in Hong Kong seem very scary. They are usually located on one storey of a building,” He said.

“I can imagine how crowded it can be. One person may only have a bed and a desk. When you stand, you can see the life of the other elderly residents as the partitions are very low.”

He said he loved the spacious living environment in Nansha and the better air quality, as well as a multitude of activities the care home offered.

“I love playing the piano from time to time. It prevents me from getting dementia,” he said. “I also love visiting the mahjong room and tea room. I can make friends over tea and talk about everything with them.”

Mr He, with his wife, says he loves the spacious living environment in Nansha. Photo: Xiaomei Chen

Linda Tsang Chi-man, executive director of the Greater Bay Area branch of the Hong Kong Federation of Trade Unions (FTU), said a survey last June by the group found that around 40 per cent of 2,004 respondents placed the bay area as one of their options for retirement, with Shenzhen, Guangzhou and Zhongshan the top three cities.

The organisation currently served more than 50,000 elderly people who had moved from Hong Kong to the bay area, she said.

Tsang said that among the benefits of retiring on the mainland was a lower cost of living compared with Hong Kong.

“Even if you are receiving the Hong Kong government’s Old Age Living Allowance, which is around HK$4,000 per month, and living in Zhongshan or Huizhou with your spouse, the quality of life is still better than that in Hong Kong,” she said.

“For the elderly who can still travel around, they are able to go on trips. Many of them told me they got a mainland driving licence and bought a car for several tens of thousands of dollars.”

Staffing at care homes was more sufficient and the workers were younger than in Hong Kong, she added.

Healthcare concerns

Hongkonger Amy Lau*, 68, retired in 2016 and moved to Zhongshan two years later. She chose the city because most of her family lived there, it had a relaxed and slower pace of life and the cost of living was cheaper.

But because Lau suffers from chronic medical conditions related to her heart, liver, bones and veins, she has to travel back to Hong Kong at least once a month for medical appointments at a public hospital.

“I am not sure whether the medicines on the mainland are different from the ones I am taking,” she said.

“The healthcare system in Hong Kong is different from the mainland’s. Medical consultations in Hong Kong are free of charge, and I only have to pay for medicines.”

Lau said medical insurance on the mainland was also too expensive for her.

Patient groups call for clarity on using Hong Kong healthcare vouchers on mainland

Since 2020, Hong Kong and Macau residents have been able to buy mainland Social Security Insurance, which has different premiums depending on the city. In Zhongshan, Lau would have to pay 809.76 yuan this year.

The Hong Kong government this week announced plans to expand its elderly healthcare voucher scheme to five more hospitals and two dental centres in five cities in the third quarter of this year at the earliest, in addition to two current service points in Shenzhen.

Lau said she would stick with medical services in Hong Kong as all her records were in the hospital she attended and she had never heard of the Zhongshan one covered by the expansion.

Moving back

The FTU’s Tsang, recognising the recent improved measures, said although more elderly Hongkongers were showing an interest in retiring in the bay area, she had seen a number of residents return to the city permanently, with the major factors being healthcare and old age care.

“We see some of them have chosen to move back to Hong Kong, especially the older ones who migrated to the bay area a long time ago and are over 80 years old now,” she said.

“They may have realised that they have lost the ability to take care of themselves or their spouses, and have to live in homes for the elderly.”

She added that these people might not have confidence in healthcare services in the bay area or could not afford them, or were not familiar with care homes there.

Ivan Lin says some elderly people are deterred from moving north by potential health issues. Photo: Elizabeth Cheung

Ivan Lin Wai-kiu, a community organiser at the Society for Community Organisation (SoCO) with 10 years’ experience on elderly issues, said he also knew of residents who had opted to return to Hong Kong because of health problems.

“I have a case who suddenly turned blind, and another one who was found to have glaucoma,” he said. “If the elderly need to undergo surgery or have multiple appointments on the mainland, it may be troublesome for them.”

He said potential health issues or chronic illnesses had also deterred some elderly people from moving north.

“When you move to the bay area, many grass-roots elderly may need to give up their public housing or middle-class ones have to sell their flat in Hong Kong,” he said.

“In case of any medical issues, they may have to return to Hong Kong alone and live in subdivided flats during their treatment.

“I have another case who wished to reunite with her children and grandchildren on the mainland but she was worried that across the border she could not find the biologic drugs she had been taking.”

‘Elderly healthcare voucher expansion in bay area may hurt Hong Kong businesses’

SoCO patients’ rights advocate Tim Pang Hung-cheong noted that the government’s HK$2,000 healthcare voucher only covered outpatient services.

“It cannot solve other needs of the elderly who might have chronic illnesses and serious conditions that require hospitalisation,” he said.

Pang called policies for elderly Hongkongers living in the bay area “piecemeal” and urged the government to set up a high-level committee to achieve a more integrated effort.

Authorities could consider factors such as the number of residents involved, communications between the mainland and Hong Kong, and capacity, Pang said, adding that the Hong Kong government could also allow people to buy social security insurance on the mainland with their health vouchers.

“It may require a longer time for the authorities from both sides to handle these measures,” he said.

Pang added that in the future, authorities could remove restrictions on the exchange of health data and bio-specimens between the mainland and Hong Kong to facilitate cross-border treatments and research and development.

“If we have to reassure residents about the prospects of retiring in the bay area, we have to cover other more specialised medical needs and even care home services.”

* Name changed at interviewee’s request

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