873504

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JAGXXX10.1177/0733464819873504Journal of Applied GerontologyChui et al.

Article
Journal of Applied Gerontology

Growing Old as a Member of an Ethnic 2020, Vol. 39(5) 463­–471

© The Author(s) 2019
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DOI: 10.1177/0733464819873504

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Framework

Cheryl Hiu-kwan Chui1 , Gizem Arat1, Karrie Chan2,

and Paul Wai Ching Wong1

Abstract
Hong Kong is experiencing significant demographic changes as a result of rapid population aging and immigration. Anecdotal
evidence suggests that ethnic minorities, in particular aged members of South Asian ethnic minorities, face significant and
diverse obstacles in accessing services important to their general welfare. This study is the first systematic attempt to
explore the long-term care needs of Nepalese older adults in Hong Kong and the barriers they face in accessing long-
term care services. Data were obtained through semi-structured interviews with 30 Nepalese older adults. We found that
Nepalese older adults have similar physical and psychosocial needs as those of their local Chinese counterparts. However,
participants face a range of structural, knowledge, and attitudinal barriers that together deter them from accessing long-term
care services, despite their right to do so. Policy recommendations to mitigate these barriers are given, with reference to
the World Health Organization’s Age-Friendly Cities Framework.

Keywords
diversity and ethnicity, long-term services and support, policy, minority, qualitative methods, social inclusion, age-friendly city

Introduction
Population aging occurs in many in high-income societies
(World Health Organization, 2007). This is primarily due to
declining fertility and rising life expectancies, as well as
parental life choices and government-instituted policies
related to the number of children in a family (World Health
Organization, 2007). Hong Kong is not an exception to this
trend. It is projected that the number of older adults aged 65
and above in Hong Kong will increase from 1.16 million
(16.6% of the total population) in 2016, to approximately
2.37 million (31.1%) by 2036 (Census and Statistics
Department, 2017). At the same time, Hong Kong is rela-
tively homogeneous in terms of the ethnicity of its residents
(92% are ethnic Chinese; 8% are non-Chinese ethnic). The
focus of our study is on non-Chinese, ethnic minority older
adults in Hong Kong, a group that has thus far been neglected
in both academic and public policy discourses. Rapid popu-
lation aging can also be observed among Hong Kong’s South
Asian minority population, such that the proportion of those
aged 65 or above increased from 966 in 2006 to 2,858 in
2016 for Indians, from 529 in 2006 to 633 in 2016 for
Pakistanis, and from 327 in 2006 to 713 in 2016 for Nepalese
older adults (Census and Statistics Department, 2016).
Thus far, studies have documented the way in which eth-
nic minority older adults exhibit poorer outcomes compared
with the majority population, including but not limited to
poorer quality of life and mental health outcomes, and higher
levels of loneliness, depression, and physical frailty (Kuo,
Chong, & Joseph, 2008; Lin, Bryant, Boldero, & Dow, 2016;
Ng et al., 2014). To account for the disparities in psychosocial
outcomes, international studies have identified three types of
barriers that ethnic minority older adults encounter in access-
ing long-term and other care services: structural barriers,
knowledge barriers, and attitudinal barriers (Doblyte &
Jiménez-Mejías, 2017; Oleski, Mota, Cox, & Sareen, 2010;
Sareen et al., 2007). Structural barriers refer to factors outside
of a person’s control, such as cost of treatment, inadequate
Manuscript received: May 7, 2019; final revision received: August 1,
2019; accepted: August 7, 2019.
1
The University of Hong Kong, Hong Kong
2
Hong Kong Christian Service, Hong Kong
Corresponding Author:
Paul Wai Ching Wong, Department of Social Work and Social
Administration, The University of Hong Kong, 5/F, Jockey Club Tower,
The Centennial Campus, Pokfulam Road, Hong Kong.
Email: paulw@hku.hk
464 Journal of Applied Gerontology 39(5)
government (policy) support, and lack of transportation
(Morgan & Sampsel, 1994; Oleski et al., 2010; Zhang, Zakus,
& Gao, 2016). Knowledge barriers may refer to a person’s
lack of understanding about the nature and severity of an ill-
ness or a general dearth of knowledge with respect to existing
services (Jimenez, Cook, Bartels, & Alegría, 2013; Patel,
2016), whereas attitudinal barriers can be understood in terms
of a person’s perception of illness(es) (e.g., stigma-related
concerns and fears or embarrassment about revealing per-
sonal details; Conner et al., 2010; Patel, 2016; Zhu, Tse, Tang,
& Wong, 2016).
Although these studies are illuminating, they are primar-
ily situated in the West, where racial and minority issues
have received considerable attention. Comparatively, few
studies have examined how ethnic minority older adults fare
in East Asia.
Long-Term Care Needs of Nepalese
Older Adults: Hong Kong as a Case
Example
Demographic changes carry direct implications for the
demands of long-term care (LTC) services (Chui et al.,
2019). In Hong Kong, LTC services comprise a wide spec-
trum of subsidized community care services (CCS) and resi-
dential care services (RCS). Older adults who want to receive
LTC services are assessed by government-accredited asses-
sors using a standardized assessment protocol. Both CCS
and RCS are provided by professionals, including nurses,
social workers, doctors, and care workers, through govern-
ment-contracted, nongovernmental organizations (NGOs).
LTC services provided by NGOs are typically financed by
the government.
To date, extensive research has been conducted in rela-
tion to the provision of long-term social and health care
for older, ethnic Chinese residents in Hong Kong (Chen
et al., 2016; Cheng, Lum, Lam, & Fung, 2013; Fu, Chui,
Kan, & Ko, 2018; Lum, 2012; Lum et al., 2016). Studies
have thus far identified a range of deficits regarding the
city’s LTC system, including but not limited to manpower
shortages in residential care homes (Chui, 2011; Wong &
Lum, 2015), an abnormally high institutionalization rate
(6.8%) among Hong Kong older adults compared with
other East Asian societies, and disengagement between
the city’s health care and social service systems (Fang,
Lou, & Kong, 2016).
However, there has been a paucity of studies on such care
for ethnic minority older adults. Our concern is that ethnic
minority older adults do not enjoy the same level and ease of
access to social and health services as their ethnic majority
counterparts. When disparities in access to health support
exist, older adults experience a worse quality of life, more
physical ailments, and higher levels of loneliness and depres-
sion, compared with the ethnic majority population (Kuo
et al., 2008; Lin et al., 2016; Ng et al., 2014).
Nepalese older adults were chosen for this study because
they constitute one of the most rapidly aging ethnic minor-
ity groups in Hong Kong. Furthermore, limited but emerg-
ing evidence suggests that the Nepalese population appears
to reside in more segregated neighborhoods and have
weaker ties within the wider Hong Kong society, compared
with other South Asian groups such as Indians, who may
have a longer historical presence in Hong Kong (Ale, 2013;
Erni & Leung, 2014). Although some studies have been
conducted focusing on the Nepalese community specifi-
cally (Ale, 2013), none to our knowledge have examined
the needs of Nepalese older adults per se.
In light of existing research gaps, drawing from the per-
spectives of Nepalese older adults in Hong Kong, this study
examines the following research questions: (a) What are the
LTC needs of Nepalese older adults in Hong Kong, a city that
has been relatively ethnically homogeneous until more
recently? (b) What are the barriers that Nepalese older adults
face in accessing these LTC needs?
Method
This study adopted a qualitative explorative method of
inquiry, in the form of semi-structured, in-depth interviews.
This was carried out in collaboration with a local neighbor-
hood elderly center (NEC), which specializes in providing
services to ethnic minorities under the project Support to
Ethnic Elderly (Project SEE). Project SEE recruits South
Asian ethnic minority older adults aged 60 and above via
outreaching within the defined service boundary of Kowloon
West district in Hong Kong. The project provides a range of
services including consultation service, need assessment and
referral service, and mutual support groups, among others.
At the time of the study, as of March 2018, 182 South Asian
older adults were receiving services from Project SEE.
Among these 182 South Asian older adults, purposive
sampling via direct telephone contact was used to recruit eli-
gible participants to the study. The inclusion criteria were
threefold: (a) aged 60 or above, (b) Nepalese, and (c) perma-
nent Hong Kong residents.1 Of the 182 South Asian older
adults, 68 met the inclusion criteria, of whom 30 agreed to
participate in the research. The recruitment process took 3
months to complete.
After obtaining informed consent from participants, they
were asked to complete a brief questionnaire with respect to
their demographic background and current health status. One
Nepalese research assistant fluent in Nepalese, English, and
Chinese then proceeded to conduct the interviews in Nepalese
alongside a member of the research team. During the inter-
views, participants were asked to express their opinions on
the LTC system in Hong Kong, their own health and social
care needs, and the difficulties and barriers they faced, if any,
in accessing social and health care services provided by the
LTC system. All interviews were conducted between
December 2017 and April 2018 and were audiotaped. This
Chui et al. 465

study was approved by the Human Research Ethics Committee Table 1.  Sociodemographic Characteristics of Nepalese Older
of The University of Hong Kong. Adults (N = 30).
All audiotaped interviews were transcribed verbatim, Total (N = 30),
translated into English, and analyzed using thematic analysis Characteristics n (%)
(Braun & Clarke, 2006) appropriate to qualitative explor-
ative studies. Specifically, several analytical steps were Age group (years)
 35-39 —
taken, including familiarizing ourselves with the data, fol-
 40-44 —
lowed by the generation of initial codes that were relevant to  60-64 2 (7)
our research question, using an inductive approach. Relevant  65-69 5 (16)
quotations were highlighted and subsequently classified into  70-74 17 (57)
different categories. These categories were further refined to  75-79 4 (13)
allow for our research team to recognize and identify emer-   80 or above 2 (7)
gent themes. A continuous iterative and flexible process typi- Gender
cal of explorative studies was adopted throughout the data  Female 18 (60)
analysis process (Singh, 2007).  Male 12 (40)
To enhance data reliability, three researchers coded tran- Marital status
 Married 20 (67)
scripts independently. Where there were discrepancies, con-
 Widowed 9 (30)
sensus was achieved through discussions on the part of the  Separated 1 (3)
research team. Specifically, some disagreements regarding Education level
the categorization of codes arose, but these were minimal.   Never received formal education 23 (77)
For example, one researcher coded unpleasant exchanges   Primary level 6 (20)
with health care professionals as a structural deficit, whereas   Secondary level —
the two remaining coders argued that this was an attitudinal   Tertiary: diploma 1 (3)
barrier. We resolved such issues by returning to the partici- Occupation
pants’ quotations and by eliciting the input from our com-  Retired 28 (94)
munity partner to reach a consensus. In addition, we  Employed 1 (3)
 Others 1 (3)
supplemented in-depth interviews with nonparticipant obser-
Years of residence in Hong Konga
vations and informal exchanges with representatives of our
  Less than 10 2(7)
community partner. Several safeguards were also taken to  10-20 7 (23)
account for personal biases. For instance, during the inter-  21-30 1 (3)
view process, we asked the participants to clarify their mean-   >30 18 (60)
ing, if these were not presented clearly. The research team Type of housing
also triangulated the data with the input of our community   Subdivided rental housing 22 (74)
partner, who has firsthand frontline experience providing   Private housing (rental) 4 (13)
services for Nepalese older adults. The emergent themes  Owner 4 (13)
were shared among the research team and were agreed upon Household size
prior to our finalization of these themes.   One person (live alone) 2 (7)
  Two persons 6 (20)
  Three persons 4 (13)
Results   Four persons 5 (17)
  Five persons 7 (23)
As illustrated in Table 1, most participants were female   Six persons 4 (13)
(60%), married (67%), had lived in Hong Kong for more   Seven persons or above 2 (7)
than 30 years (60%), had never received any formal educa-
a
Two missing for older adults.
tion (77%), were retired (93%), and lived in subdivided
rental flats (74%). Most participants were in the age ranges
of 70 to 74 years (48%) and 65 to 69 years (26%). return to their “home countries” to retire), almost all partici-
We present our results in two sections: (a) LTC needs and pants indicated that they would prefer to age in Hong Kong,
(b) the barriers that participants faced in accessing relevant in their current residential communities. Participants saw
services in light of these needs. Illustrative quotes from par- residential care as a last resort.
ticipants are presented to substantiate the emergent themes. The preference to age in place is in alignment with the
Hong Kong government’s LTC policy imperatives and is
consistent with the expressed wishes of Chinese older adults.
LTC Needs of Nepalese Older Adults Participants indicated that admission to RCS was perceived
In contrast to the public perception that South Asian ethnic by the Nepalese community as shameful to older adults,
minorities are transient (Kapai, 2015) (e.g., planning to likely because it is a sign of fragility and inability to care for
466 Journal of Applied Gerontology 39(5)
Table 2.  Types of chronic diseases among Nepalese study participants (N=30).
Note. Multiple responses allowed.
themselves, as well as an inability on the part of their chil-
dren, who have failed to take care of their parents. Participants
expected members of younger generations to care for them
as they aged:
If you leave your parents in nursing homes, the community sees
you in a negative light immediately. (P21, F, age 65-69)
Interviewer: Just now you said that you would prefer not to stay
in homes for [older adults], but under what circumstances would
you consider it appropriate to live in these homes?
Participant: For those who are treated badly by their families.
(P13, F, age 75-79)
Nursing homes aren’t seen as a good practice in Nepalese culture
. . . [Children] would not want to leave the care of their parents
in the hands of another. (P22, M, age 70-74)
If you are incapacitated, then you have to stay [in a nursing
home]. But when you are able, [nursing homes] are not a
nice place. To walk around, to go here and there, to stay at
home is better . . . Nursing homes are not right. (P25, F, age
65-69)
Physical Health Needs
All participants indicated that they were living with some
forms of chronic illness, highlighting the importance of
accessing health and social care services that cater toward
their physical health needs. Table 2 illustrates the type(s) of
chronic illness found among participants, with hypertension
(70%) and diabetes (57%) being the two most common
health conditions. This is comparable to the overall rates of
chronic disease found among the general older adult popula-
tion (e.g., hypertension as 62.5%) in Hong Kong (Census
and Statistics Department, 2009).
Psychological and Cognitive Health Needs
Some participants indicated that they experience bouts of
loneliness due to weakening family and cultural ties. This
makes them susceptible to depression. The interviews further
revealed that some participants may be showing early signs of
cognitive impairment. As illustrated by one of the quotations
below, one participant struggled to return to her house. This
suggests that there is a need to make provisions for early
screening services for cognitive impairment and to imple-
ment programs designed to slow down the progress of such
impairments:
Sometimes, I can’t even go back to my own house . . . I have to
ask others to take me or I have to wait for my memories to come
back and then return by myself. (P10, F, age 70-74)
Yes, it is very difficult to pass a day . . . I don’t meet my old
friends much either these days. Some went to the UK, others
returned to Nepal. In the past, there were more older people who
would hang out together. Now, some have gone to Nepal, some
have gone to work, some have gone to the UK. Now, I barely
meet anyone. (P23, M, age 70-74)
I need a friend . . . It’s hard to be on my own. (P29, F, age 60-64)
Chui et al. 467
Financial Needs
Some participants indicated that they were experiencing
some financial hardship due to rising prices for food and
other daily living costs. Some also mentioned a lack of
employment opportunities. Given that Hong Kong does not
have a universal pension system, it is evident that financial
vulnerability and its bedfellow, poverty, are matters of great
concern for our aging society. There is evidently a need for
further assistance in ensuring the financial well-being of eth-
nic minority older adults in Hong Kong:
The prices are going up day by day. It has become more
expensive. Everything is expensive, like food and lodging. All is
costly. (P27, M, age 70-74)
Barriers to Accessing the LTC System
With respect to the barriers that Nepalese older adults face in
accessing LTC services, we have organized our findings into
three main categories: structural barriers, knowledge barri-
ers, and attitudinal barriers.
Structural Barriers
Concerns were raised by our community partner with respect
to the current Standardized Care Need Assessment
Mechanism for Elderly Services (SCANMO), which must be
completed before any subsidized services can be granted to
older adults in Hong Kong. The first concern is related to the
ability of current assessors, being local Chinese people, to
accurately conduct the needs assessments of ethnic minority
older adults. Given the lack of professional training in cross-
cultural communication and awareness on the part of asses-
sors, it is feasible to posit that a large number of South Asian
older adults may have been wrongly denied access to the
LTC system due to miscommunication between social work-
ers and their potential clients. The second concern is related
to SCANMO itself; it is only made available in English and
Chinese. Inadequate translations may affect the quality and
accuracy of the assessment process.
Furthermore, as espoused by some participants, existing
services do not offer practices or services in a way that is
culturally sensitive to their needs:
We don’t know how to communicate with them [hospital staff],
so we just go there with one of our family members. I tell my
symptoms and problems to my family and then they convey
them to the doctor. (P16, M, age 70-74)
It would be hard to survive in [residential] homes because we
have language miscommunications and we cannot follow their
instructions. We also cannot follow their diet. If we don’t eat,
then they may scold us. (P10, F, age 70-74)
We feel like we do have rights, but we also feel like we don’t
have them, because we don’t have anyone helping us to translate
our words. Since we cannot communicate, when a doctor or
someone important asks us what’s wrong, we cannot really tell
them clearly what problems we have if we don’t have anyone to
translate our words. So how can they help us if they don’t
understand us? (P22, M, age 70-74)
When you have to go to hospital and when you do not know how
to communicate, you need to find people . . . My children are
sometimes free and sometimes are not free. This can be a
problem. (P30, F, age 65-69)
Cumulatively, these structural barriers may lead to inequi-
table disparities in LTC service access between ethnic minor-
ity older adults and local Chinese older adults.
Knowledge Barriers
It was observed that most participants had minimal knowl-
edge of the types of LTC service provisions available in
Hong Kong. We also found that Nepalese older adult partici-
pants had poor health literacy; that is, “the degree to which
individuals have the capacity to obtain, process, and under-
stand basic health information and services needed to make
appropriate health decisions” (U.S. Department of Health
and Human Services, 2010). For example, many participants
were unaware of the diverse range of subsidized services that
are available to all older adults in Hong Kong. Nor were they
aware of the procedures involved in accessing these
services:
Interviewer: For government housing, you have heard of it but
have not applied for it, right?
Participant: No.
Interviewer: You do not know where to apply?
Participant: We don’t know. (P6, M, age 70-74)
Interviewer: So, you need to go to the Social Welfare Department
. . . and fill out forms. Do you face difficulties regarding how to
fill in the forms, or do you know where to get the forms?
Participant: [We] don’t understand . . . I don’t know anything.
(P16, M, age 70-74)
When my grandson has holidays, he will take us [to the
hospital], but when he doesn’t, what to do? I will be lost as to
what to do . . . Where can I get support? So, it is a real struggle.
(P18, F, age 65-69)
It was evident that the participants had limited knowl-
edge with respect to navigating their way around the city, to
access appropriate health and social care. Most relied
entirely on their younger family members, even though the
current system provides support services, such as outpatient
escort services.
468 Journal of Applied Gerontology 39(5)
Attitudinal Barriers
Some participants also recounted unpleasant incidents and
encounters with the local population, which led them to
develop a negative attitude toward the city’s LTC system.
This effect on individuals is powerful and can deter them
from seeking available and appropriate community support:
It would be nice to have the same rights, but I feel like we don’t
enjoy the same rights. They separate us. I noticed. Like last time,
they told me that the branch I went to was not for people like me. I
asked them where to go . . . They told me to go to the other branches
in Tsuen Wan or Hong Kong Island. If we all were treated the same,
it would be good, but they don’t treat us all the same. (P19, M, age
70-74)
We don’t know how to communicate with [medical staff] so we
just go there with one of our family members . . . We don’t know
much, so we don’t talk. (P16, M, age 70-74)
Together, these examples reflect a range of structural,
knowledge, and attitudinal barriers that participants encoun-
ter in relation to the city’s LTC system. These barriers may
further dissuade Nepalese older adults, who as a community
are already marginalized, from seeking LTC services, despite
their right to do so.
Discussion and Implications
This study identifies the LTC needs of Nepalese older adults
in Hong Kong and highlights a range of structural, knowl-
edge, and attitudinal barriers that Nepalese older adults con-
tend with in accessing relevant health and social care
services. Overall, we found considerable empirical evidence
that highlights a range of barriers that Nepalese older adults
face in accessing LTC services.
Structurally, it seems that current social workers, service
delivery, and assessment tools—the entire LTC system, in
fact—do not sufficiently take into account the needs of eth-
nic minority older adults in Hong Kong. Specifically, the
SCANMO mechanism may not generate correct assessments
because of the lack of cross-cultural training on the part of its
administrators. Again, the fact that the SCANMO is only
available in Chinese and English may affect the quality and
accuracy of the assessments. In terms of knowledge, partici-
pants in this study demonstrated poor health literacy and
basic knowledge regarding where to access relevant support.
Attitudinally, adverse experiences and encounters with local
populations may further deter ethnic minority older adults
from seeking help.
Consistent with international ethnic minority studies
(Jimenez et al., 2013; Patel, 2016; Zhang et al., 2016), we
found that Nepalese older adults are disadvantaged in multi-
ple ways, despite having the same rights to access LTC ser-
vices as all Hong Kong citizens. As with ethnic minorities in
other countries, Nepalese older adults experienced a range of
structural, knowledge, and attitudinal barriers accessing the
LTC system, which highlight their considerable level of mar-
ginalization from mainstream services. It is also noteworthy
that many of the LTC needs, including physical, psychoso-
cial, and financial needs identified by study participants and
their preference to age in place, are similar to those of local
Chinese older adults (i.e., chronic illnesses and social isola-
tion; Chui, Tang et al., 2019; Chui, 2011; Lum, 2012; Lum
et al., 2016). The fact that Nepali and local Chinese do share
commonalities pertinent to LTC needs can be useful for
mainstreaming service provisions for older adults from
diverse sociocultural backgrounds. However, although it is
likely that some Chinese older adults (i.e., low-income, sin-
gleton older adults) may experience some knowledge defi-
cits, it appears that ethnic minority older adults face the
added obstacle of service access and service navigation due
to language and cultural barriers.
With respect to affecting positive change among ethnic
minority older adults, we propose a framework (see Figure 1)
in reference to the age-friendly city (AFC) framework put
forth by the World Health Organization (2007). The AFC
framework has been endorsed by the Hong Kong’s Chief
Executive Policy Address since 2016.
Structurally, there is a need for service mainstreaming, to
mitigate existing structural barriers as identified by study
participants. Service mainstreaming would require existing
service systems to go beyond simply offering translation ser-
vices to Nepalese older adults. They should incorporate and
consider the needs of ethnic minorities in any planned policy
action, such as the design, implementation, and delivery of
social services. It is also imperative to test and validate
whether or not current assessment tools are appropriate in
accurately assessing the LTC needs of ethnic minority older
adults. Such service mainstreaming would be difficult to
implement without enhancing the cultural competence of
those professionals entrusted with the care of older adult men
and women from ethnic minorities. There is also a need for
the systematic collection of data related to service provision
and usage for older adults, to gauge policy effectiveness.
Again, to inform the future design of LTC policies and ser-
vices, further systematic studies need to be completed across
the gamut of ethnic minorities in Hong Kong.
The provision of better access to social services for older
members of ethnic minorities is not just related to the behav-
iors and attitudes of health and other care professionals.
Thus, it is important to empower, as far as possible, ethnic
minority older adults themselves in terms of health literacy.
There is a need to conduct public education campaigns spe-
cifically aimed at minority populations. Knowledge about
existing health and social services could be disseminated via
both traditional media (i.e., newspaper and radio/TV chan-
nels) and new media (i.e., websites and apps) for ethnic
minority older adult populations.
Chui et al. 469

A Culturally-inclusive Age-friendly Cities

framework

Structural domain Attitudinal domain Knowledge domain

Service mainstreaming
Explicit and effective guideline for
professional and frontline staff in
all governmental departments
Cultural inclusion checklist
Empirical-driven knowledge
Systematic data collection on
service usage
Further public education and inter-cultural
exchange
Cultural exchange with Nepali
between the wider ethnic minority
community and local Chinese
society
Breakdown knowledge barriers
Additional public education among
the Nepali community and larger
society
Empirical-driven knowledge
Transdisciplinary participation
Qualitative and quantitative
research studies
Knowledge dissemination
Traditional media (e.g.,
newspapers, radio/TV channels)
New media (e.g., websites, apps)

Figure 1.  Key recommendations for promoting a culturally inclusive age-friendly city.

In a society that espouses equality and inclusiveness, the
ethnic Chinese majority has a responsibility to support mem-
bers of ethnic minorities who wish to access social services.
The Chinese ethnic majority, through additional public and
educational campaigns, can become more knowledgeable
about the social service needs of ethnic minority older adults
and the means through which they can help them to more
easily negotiate their way through the city’s LTC system.
Advocates of intergroup contact theory (Walch et al., 2012)
contend that the promotion of social interactions between
ethnic minorities and local Chinese residents will help reduce
ethnic minorities’ susceptibility to social isolation and loneli-
ness, and, at the same time, serve as a source of affirmation
for ethnic majority citizens who seek to provide practical and
moral support for ethnic minority citizens.
Our study has some limitations. First, although we gained
an in-depth understanding of the LTC needs of Nepalese older
adults, our findings may not be directly transferable to other
older adults of the same or different ethnicities. For instance, it
may be that Nepalese with cognitive and/or physical impair-
ments may encounter a different set of challenges as they navi-
gate the city’s health and social care systems. Future studies
into the needs of this group of Nepalese older adults may be
insightful. Furthermore, our findings may not be directly
transferable to other South Asian ethnic minority groups such
as Pakistani and Indian older adults in Hong Kong. Although
it is probable that they face similar difficulties (e.g., language
barriers), the distinct characteristics of each ethnic group may
also generate different results. The cultural nuances that exist
among various ethnic minority groups and corresponding LTC
needs warrant further systematic examination. Finally, this
study primarily focuses on identifying barriers and problems
in accessing LTC services. It would be equally valuable to
identify the protective and supportive factors of ethnic minor-
ity older adult population groups, to both achieve a balanced
point of view and develop strategies to maximize the effec-
tiveness of these protective factors.
Conclusion
To conclude, the aging of Hong Kong’s population will con-
tinue unabated, in the cases of both the ethnic Chinese
majority and the city’s ethnic minorities. This poses very
real and relatively new challenges to those responsible for
the planning and delivery of health care and other social ser-
vices, to ensure that the city’s resources are allocated appro-
priately and equitably. Although a large body of literature
examining the LTC needs of older adults exists, none of
these studies focuses on ethnic minority older adults. Our
explorative study marks the first attempt to do so and high-
lights the range of structural, knowledge, and attitudinal
barriers that Nepalese older adults encounter in accessing
LTC services. To promote a culturally inclusive AFC, it is
evident that policies and procedures need to be developed
and implemented to ensure equitable access for ethnic
minority older adults. This would ensure that the issue of an
aging population, which is currently a concern, does not
exacerbate and become a crisis.
Authors’ Note
This study was approved by the Human Research Ethics
Committee (HREC) of the University of Hong Kong (HREC No.
EA1710005). Gizem Arat is now affiliated with Lingnan
University, Hong Kong.
470 Journal of Applied Gerontology 39(5)
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article: This
research was funded by the Hong Kong Equal Opportunities
Commission.
ORCID iD
Cheryl Hiu-kwan Chui https://orcid.org/0000-0002-3284-5724
Note
1. Permanent residents are defined as those who have the right of
abode in Hong Kong. The Immigration Department specified six
categories of people who are eligible to the right of abode (e.g.,
permanent residential status) in Hong Kong. For non-Chinese
citizens, right of abode may be granted when the person con-
cerned has entered Hong Kong with a valid travel document and
has ordinarily resided in Hong Kong for a continuous period of
not less than 7 years.
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