AGING AND THE FAMILY IN HONG KONG

Author(s): NELSON CHOW

Source: International Journal of Sociology of the Family , Spring 2007, Vol. 33, No. 1,
Aging in Asia (Spring 2007), pp. 145-155
Published by: International Journals

Stable URL: https://www.jstor.org/stable/23070767

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International Journal of Sociology of the Family, Vol 33, No. 1 (Spring) 2007

AGING AND THE FAMILY IN HONG KONG

NELSON CHOW
Hong Kong University

This paper examines the development of support services for elderly people in
Hong Kong, China and the special role that the Chinese family system plays
Since the early 1990s when the issue of support for elderly people was studied
by the then Hong Kong Government, a "care in the community" approach had
been adopted, meaning that elderly people should remain in the community as
far as possible and supported by their families. However, with a growing
elderly population, the supply of formal services often lacks behind the demand
It is noted that the Chinese family system in Hong Kong is changing fast and i
no longer capable of providing the necessary support that elderly people
require. Instead of advocating for a complete take-over by the government, it i
argued that the best strategy to support the elderly in Hong Kong is to combin
the efforts of both the government and the family, and only when the two ar
complementing each other would the elderly receive the best form of care.

INTRODUCTION

Comparatively speaking, Hong Kong is probably .a highly significa

examining the changing role of the family in supporting the elder
one hand, more than 98% of the population in Hong Kong is Chines
and known for a tradition of respecting the elderly (Chow, 19
other, economic development in the last 50 years has made Hong K
the most developed and affluent cities in East and Southeast A
GNP close to US$24,000 per capita.) Not unlike other developed
is encountering issues associated with an aging population, the weak
its family system, and the loosening of some of its traditional valu
words, as a result of the economic changes, the Chinese famili
Kong may no longer be capable of taking care of their elderly mem
the past, and there will likely be greater pressure on the state to p
necessary support and care.
As Hong Kong grows in affluence and there is greater emph
rights of the individual, would families there necessarily give less

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146 INTERNATIONAL JOURNAL OF SOCIOLOGY OF THE FAMILY

their elderly members? Could the traditional value of respecting the o

the onslaught of the modern force of individualism? If Hong Kong fo
footsteps of other developed societies in requiring a greater input
state in providing care for the elderly, should the same public social s
system be adopted? Are there other alternatives for Hong Kong th
suit its situation better?
This article on aging and the family in Hong Kong addresses th
questions. The discussion will begin with a description of the aging sit
in Hong Kong. The traditional values surrounding the Chinese family
and the way in which the elderly should be cared for are then examin
societal changes that have occurred, particularly the value in respe
old, and their impact on family support of the elderly will foll
discussion will be concluded with an evaluation of the efforts made
the people and the Hong Kong Special Administrative Regio
Government in supporting the old.

IS FILIAL PIETY STILL IMPORTANT?

In 1971, more than half of the population in Hong Kong was under 2
while those 65 and above accounted for only 4.5%. In 1991 the propor
the population aged 65 and above increased to 8.7%, passing the 7%
generally taken as the threshold of a mature population. By the end
those aged 65 and above in Hong Kong reached 12.1%, or a total of
persons, out of a population of just under 7 million people (Cou
Sustainable Development, 2006: Table 1.1). It is projected that by 2
Kong would have around 26.8% of its population aged 65 and ab
2,243,100 out of a projected population of 8,384,100 people.
The pace of population aging in Hong Kong may not appear exc
especially when one compares it to the experiences of other de
societies. However, it should be noted that people who are now growi
Hong Kong are often migrants, having moved to Hong Kong in the l
and early 1950s. Except for a small minority who were born and bro
Hong Kong, they could be described as the first generation
experienced aging in a modern industrial society. In other w
environment and, thus, the value orientation within which they now
is very different from the one with which they were acquainted wh
were young (Lee & Kwok, 2005). This has resulted in a discrepanc
the kind of care they may expect from their families and what they a
receiving from them. Studies on family care of the elderly conducte
Kong clearly indicate that while the elderly generally expect thei
and, in particular, their children to take care of them, the latter have
found to be either unwilling or unable to do so (Chou, Chow & C

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AGING AND THE FAMILY IN HONG KONG 147

Therefore the expectation of the elderly toward family care does not alway
mesh with the reality.
Despite the changing circumstances, evidence indicates that filial pi
still remains as one of the most fundamental values of the Chinese in H
Kong (Chow, 2004). A survey conducted in Hong Kong in 1998 reported
75.4% of the more than 1,000 respondents answered in the affirmative
they were upholding the tradition of respecting the old (Chow, 2001). Simi
findings were reported in another study on the tenacity of the notion of
piety in Chinese societies, in which it was pointed out that while filial piet
was regarded as an important value, its practice had changed to go along w
the demands of the time (Kwok & Lee, 2005). In other words, while
notion of filial piety remains strong as a value in Chinese societies,
influence on the behavior of the people is less obvious.
To explain the lingering effects of the value of filial piety in Chin
societies, one has to link it up with the significant position occupied by
Chinese family system. Latourette once described the traditional Chin
family system as one that "had a leading part in economic life, in so
control, in moral education, and in government" (1964: 565). Furtherm
five cardinal relationships were identified in traditional China as exist
between kings and subjects, fathers and sons, husbands and wives, am
brothers, and, last, between friends. It is important to note that three of
above five applied to family members with the most fundamen
relationship being that between parents and children. Hence, filial piety w
treasured in traditional China not only as a value to ensure that elde
people were probably taken care of but also as a means to regulate th
behavior between members or even those within the wider society. As
wrote:

While the functioning of filial piety was limited to relationships between parents
and children, their veneration of age was traditionally a means of inspiring.
respect and obedience by the young toward all the other senior members of the
family and society as a whole (1959: 51)

In other words, as long as the family system in Chinese societies is sti

regarded as important, especially in teaching people how they should rela
with each other, it appears that the notion of filial piety would still be uphel
as a value that should be passed on from one generation to another. In Hon
Kong, as late as 2005, the Chief Executive (2005), Mr. Donald Tsang, of th
HKSAR Government, still spoke highly of the role played by the family
"Cherishing the family is a core value of our community. Family harmony is
the foundation of social harmony" (paragraph 45). "We will promote th
values, ethics and individual responsibility needed for family harmony
through various channels such as media publicity and district activities

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148 INTERNATIONAL JOURNAL OF SOCIOLOGY OF THE FAMILY

(paragraph 47). He added, however, that the family system in Hong K

also meeting a number of challenges:
Like many other places, families in Hong Kong bear the brunt of social and
economic changes. Divorced and single-parent families are on the rise. Cros
border employment separates families. An ageing population means mor
elderly people need health care and other forms of attention. Many parents of
dual income families have to juggle their jobs and family life, (paragraph 46)

It is, thus, clear that while the notion of filial piety is still regard
sacrosanct in Hong Kong, the role that the family system has been playi
supporting the elderly is definitely diminishing (Chow, 1999a). It can als
expected that as new generations of elderly people come up to repla
existing one, they will have even more divergent views about the not
filial piety and hence the role of the family in supporting the old. It is cle
while the HKSAR Government is prepared to accept the responsibili
meeting the needs of the elderly, it is reluctant to take over the rol
traditionally belongs to the family. The question now stands is, therefor
what way that governmental and family support can complement
supplement each other in securing for the elderly in Hong Kong a life th
both positive and productive?

THE DIMINISHING FAMILY ROLE AND CARE IN THE COMMUNITY

Although the notion of filial piety is still very much upheld, it does not imply
that family support for the elderly is as strong as before, as the family system
itself is undergoing rapid changes. First, it should be pointed out that though
traditionally, the Chinese family has given the image that it must be
extended one in which, says Labourette, "parents enjoyed a serene old ag
honored by all, with their descendants about them, and tenderly cared for as
declining years brought physical weakness" (1964: 572); in reality, and
except for the wealthy ones, the traditional Chinese family has never bee
large, and the image is certainly not true in present-day Hong Kong (Le
1991). Since the early 1980s the average size of the Hong Kong family h
been found to be less than four persons, and the figure for 2001, the last tim
a census was conducted, was 3.1 (Census and Statistics Department, 2001)
Another noteworthy point is that the elderly in Chinese societies are often
perceived to have lived with their children, particularly the eldest son in the
family. While there might still be such an expectation, especially among the
older generation, the reality is that more and more elderly people in Chinese
societies are living alone or as elderly couples. As far back as 20 years ag
the results of the 1986 bi-census in Hong Kong showed that 11.0% of th
elderly population aged 65 and above were living alone, 42.1% were livin
with their unmarried children, and only 27.2% were living in what is generally

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AGING AND THE FAMILY IN HONG KONG 149

described as extended families, with the rest in other types of

accommodations (Central Committee on Services for the Elderly, 1988).
Evidence shows that the trend for children to move away from their parents
and start their own families is now accepted as irreversible and Hong Kong is,
of course, no exception (Chi & Chow, 1997). Hence, the elderly must face the
reality of leading an independent life.
To live alone or as an elderly couple in old age does not necessarily imply
that support is not forthcoming from children or relatives who may live
nearby. However, the change in the residence pattern of elderly people in
Hong Kong must be considered in the context that the majority of them have
migrated to live here after World War II, and some of them have never
succeeded in getting married and building a family. As such and it is probably
true of most of those who now live alone, they simply have to do without the
support of family. Another factor that one must consider, so far as family
support for the elderly is concerned, is that the development of new towns in
Hong Kong, which now accommodate more than half of the total population,
has often attracted young married couples to live in them, while leaving their
elderly parents in the old districts. In other words, the internal migration,
which has gathered much speed since the establishment of the SAR
Government, has often resulted in reducing the amount of family support
available to the elderly (Chow & Chi, 2003).
The diminishing role of the family in providing support for the elderly has
not gone unnoticed. As early as 1972, the then Hong Kong Government
established a Working Party to look into the needs of the elderly and to make
appropriate recommendations for it to follow. The Working Party reported a
year later and suggested an approach that later became the direction for
further development of services for the elderly in Hong Kong. In brief, the
approach proposed was to concentrate on "care in the community" as the
guiding principle. This meant, said the Working Party on the Future Needs of
the Elderly (1973) that:

services should be aimed primarily at enabling the elderly to remain as long as

possible as members of the community at large, either living by themselves or
with members of their family, rather than at providing the elderly with care in
residential institutions outside the community to which they are accustomed.
(1973: 15).

In theory the care in the community approach has its attractions as it is in line
with the Chinese tradition, which stresses the importance for the elderly to
remain as members of the community and being accepted by their own
families. Few objections can be raised, at least conceptually, against the "care
in the community" approach but, as Little (1979) had pointed out, "While lip
service is given to the value of community living for the elderly, home

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150 INTERNATIONAL JOURNAL OF SOCIOLOGY OF THE FAMILY

delivered services to supplement family care are in most countries serious

deficient" (1979: 10). This is also true of the situation in Hong Kong. Th
shortage of services has now become a permanent phenomenon despite th
repeated demonstration by survey on social service needs of the elderly that
the supply is lagging far behind the demand (Chi & Kwan, 2005). Th
situation is also aggravated by the fact that as the Government is emphasizing
the role of the family in supporting the old, there is little incentive for
thriving private sector to be developed to cater for their needs, leaving only
those without family support to turn to the Government for help. This has,
therefore, resulted in a lopsided development in that support services for the
elderly in Hong Kong are either directly or indirectly subsidized by the state
The lack of services to support the elderly, who have been encouraged
remain in the community as far as possible, has created a paradox in that whi
the idea is laudable, it has however resulted in much hardship and sufferi
for those who need help.
Other than the problem of the insufficient supply of support services for
the elderly, another shortcoming of the approach had also come into ligh
When the Working Party put up the recommendation for the adoption of th
care in the community approach, members admitted that they "looked fo
solutions which....would cost less, would make the least demand on scarce
manpower resources and that could be implemented reasonably quickly
(2005: 44). The adoption of the approach may cost less to the government, but
the Working Party has overlooked the fact that families that have elderl
members to take care of are, in reality, bearing the burden and the expenses,
either directly or indirectly. That explains why the care in the communi
approach, ever since its implementation as from the early 1980s, has hard
favorably been received by the general public, which still prefers to apply fo
their elderly family members admissions into nursing homes, especially thos
subsidized by the government.
Furthermore, as the care in the community approach is put into practice, it
becomes obvious that the Working Party, in making its recommendations, ha
failed to take into sufficient account the dynamics and relations among t
family, the community and elderly themselves. In fact, in proposing the care
in the community approach, the Working Party has never made clear the rol
of family care in relation to other community services and, particularly, the
part that the family should play in the care of the elderly. What has bee
assumed is that the Chinese family in Hong Kong should continue to perform
its function as caregiver for the elderly and that as long as the elderly were
living in the community, and best with their families, they should be happy
However, are these assumptions correct? Do communities in Hong Kong
provide the elderly with the right kind of environment for a satisfactor

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AGING AND THE FAMILY IN HONG KONG 151

living? What kind of care could elderly people in Hong Kong expect from
their families and the community?

THE CHANGING COMMUNITY AND FAMILY CARE

When the Working Party (1973) adopted the care in the community appr
as the guiding principle for the future development of services for the el
it referred to the community either as the environment that the elderly k
as sources from which the elderly could possibly obtain care and atte
(1973: 15). Thus the community possesses a geographical dimension a
the same time, implies a set of social relationships within which h
available. This insistence on the role of the community has not changed o
the years and it was stated in the policy paper on social welfare publishe
1991 (Hong Kong Government, 1991) that while social welfare serv
should be made available to all, "such an objective cannot be ach
without the support of an input from the community throug
establishment of networks of informal care and support provided by fam
friends and neighbors" (1991: 18). In the report of the Working Party on
for the Elderly (1994), published in 1994, the stance of the Government
still that families should continue to play their part, in conjunction
services provided in the public sector, to enable the elderly to stay, as fa
possible, in their own familiar communities. Instead of calling this "care
community," the Working Party termed it as "ageing in place," th
content-wise, there are indeed not much differences between the two.
Even if one can accept the new term "ageing in place," once has st
ask: What is the kind of "community" or "place" that one refers to
context of supporting the elderly? Does the network of informal ca
support exist naturally in a community or within the family or does it ha
be created? What are the sets of social relationships that exist to provide
elderly with the necessary care and support? What is the relationship be
this network of informal support and the system of formal care? What
role of family care in all these formal and informal networks?
In a report of the Barclay Committee published in the United Kingdo
1982 (Barclay Report, 1982), community was defined as "a network
networks of informal relationships between people connected with each
by kinship, common interests, geographical proximity, friend
occupation, or the giving and receiving of services or various combinatio
these" (1982: 199). As far as Hong Kong is concerned, the netwo
relationships established between the elderly and other people as a re
kinship, geographical proximity and a giving and/or receiving of service
be most applicable. It has been mentioned that the un-extended nuclear f
in Hong Kong has long been the norm rather than the exception, and th

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152 INTERNATIONAL JOURNAL OF SOCIOLOGY OF THE FAMILY

to various reasons, about a quarter of the elderly are either

another elderly person, or in collective households.
Although about two-thirds of the elderly in Hong Kong are eithe
with their unmarried or married children, the fact that the averag
size was just over three persons, the number of family members wh
and willing to help must be very small. In a study on the health situa
elderly, Lee and Chi (1990) found that fewer than two persons were
offer help to each elderly respondents, when sick or injured, and th
mostly family members and close relatives. It appears that the avail
help will only worsen and not improve since the late 1980s when
was conducted. Hence, although kinship relationships still form
element of the community from which the elderly can receiv
support, it is rapidly dwindling in size and is often restricted to
immediate family members (Mulvey, 2005).
If the community of relationship is diminishing in its importance
any possibility for it to provide compensation by the relationships
among neighbors. All data available on the degree of neighborlin
Kong, measured in terms of the frequency of contacts between
indicate that the situation is less than desirable and there is little like
neighbors can replace family members as an important source of he
2003). Furthermore, as mentioned before, since internal migration is
in Hong Kong, as new towns are still being built, it is almost im
neighbors to know each other well and to build up helping relations
than neighbors, there is, of course, another possibility from the fo
networks, comprising the services provided either by the governme
non-governmental organizations, to form the caring community for
But as mentioned earlier, the provision of services for the elderly i
far behind the demand that mainly those elderly who, for one reason
are deprived of other sources of help can have an access to them.
To summarize, the "community that exists in Hong Kong as a
help to the elderly is mainly the family to which the elderly belong.
and service networks only play a supplementary role for those
have no family of their own or are fortunate enough to obtain help f
neighbors or social welfare agencies. While the family in Hong
provides a community for the majority of the elderly, the rapidly
percentage of elderly people living with their grown-up children, o
children of their own, implies that the community, which formulate
of the care in the community approach, or ageing-in-place, is w
strength. It can be concluded that although the family remains
important community within which the elderly can obtain care and
the extent of help available is both limited and diminishing in scope

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AGING AND THE FAMILY IN HONG KONG 153

INTEGRATION OF FORMAL AND INFORMAL CARE

The above examination of the care in the community approach adop

Hong Kong indicates that despite the fact that the family system
formulates the main source of help, there is an increasing demand for f
community support services. However, the two systems are appar
serving two different target groups of elderly persons, with those with f
members mainly receiving support from the latter and those without r
on formal support services, and the two systems have yet to truly integ
with each other (Chow, 1999b). Indeed it is questionable whether form
informal support should be identified as two separate systems. Walker (
once suggested that the rigid division between the formal and informal
should be overcome and it is better to think more in terms of "social su
networks," which "may comprise both formal and informal
professional and nonprofessional personnel" (1987: 381). Bulmer (198
suggested that, in addition to the family, different types of networks sh
built up to provide social support for the elderly: personal, volunteer, m
aid, neighborhood, and community empowerment.
So far as Hong Kong is concerned, it will be a long time before the f
and informal sectors can be fully integrated to enable the elderly to liv
community in dignity (Kwan, 2002). For the majority of them the
continues to be their most reliable source of help. It is therefore import
ensure that family members are not overburdened in their task of caring
old and, hence, forced to give it up by institutionalizing the elderly. Th
already signs that many families are doing exactly this as seen by
mushrooming of private nursing homes in the last decade or so. More ad
provision of formal support services would help to relieve the burden on
family caregivers, and other sources of assistance, like those from frien
neighbors, should also be explored and organized. On the other hand,
who are young should be educated to better prepare for their old age, as
chance for them to receive support from their children would probably b
less than what they are now doing for their elderly parents.

CONCLUSION

What can be ascertained from the above discussion is that with the change
values and the structure of the family system, elderly people in Hong
can no longer take it for granted that family care will be available to supp
them. This is also true for other Asian societies , which are holding si
values and traditions (Yoon & Hendricks, 2005)). Thus the provision of
outside the family is no longer an option, but, rather, must be recognized
playing an equally important role in enabling the elderly to live with dignit
the community.

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154 INTERNATIONAL JOURNAL OF SOCIOLOGY OF THE FAMILY

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