Financial Financial and Employment and Employment Impacts Impacts of Family of Family Caregivers Caregivers in Hong in Hong Kong Kong Dr. Vivian W.Q. LOU Department of Social Work and Social Administration The University of Hong Kong
T ABLE OF C ONTENTS Background 1 Objectives 2 Findings 3 Pre-planning in Hong Kong 4 Join hands for a better world! 5
Background
Population Pyramid (2001) Hong Kong Population (2001) (Census and Statistics Department, 2012)
Population Pyramid (2016) Hong Kong Population (2016) (Census and Statistics Department, 2016)
Chronic disease (2009) Older persons (60+) residing in domestic households Whether had chronic diseases Number of chronic diseases (Census and Statistics Department, 2009)
Chronic disease (2015) 15.70% 20.40% 24.10% 39.80% 50 - 59 60 - 69 70 or above Other age groups (Census and Statistics Department, 2015)
Level of ADL impairment Level of ADL impairment Number of ADL that could not be performed independently Level 1 0 Level 2 1-2 Level 3 3-4 Level 4 5-6 (Census and Statistics Department, 2009)
Level of ADL impairment (2009) Older persons by level of ADL impairment and age 100% 1.3% 1.0% 0.9% 3.7% 0.8% 1.8% 2.8% 1.9% 95% 90% 9.2% 98.7% 96.9% 85% 95.2% 80% 85.2% 75% 60-64 65-69 70-74 75 or above Level 1 Level 2 Level 3 Level 4 (Census and Statistics Department, 2009)
IADL impairments Meal preparation Ordinary house work Managing finance Managing medications Phone use Shopping Transportation (Census and Statistics Department, 2009)
IADL impairments (2009) Older persons by level of IADL impairment and age 0.5% 1.6% 100% 0.6% 4.4% 1.3% 6.1% 3.4% 8.6% 14.8% 90% 13.6% 80% 9.7% 70% 18.4% 60% 50% 92.8% 88.5% 40% 78.6% 30% 57.1% 20% 10% 0% 60-64 65-69 70-74 75 or above 0 1 to 2 3 to 4 5 to 7 (Census and Statistics Department, 2009)
Population Ageing (2011 – 2066) Adults aged 65 and older • 13.3% of Hong Kong’s total population in 2011 • Projected to reach 36.6% in 2066 37.3% 2.5% (Roughly 280,500) of 133,400 Adult children as key community-dwelling older caregivers caregivers in Hong Kong, adults require assistance in especially daughter daily living (Census and Statistics Department, 2009, 2017)
Impacts - Working-age Caregivers Lost income Lowered productivity (Chari, Engberg, Ray, & Mehrotra, 2014; Colombo, Llena-Nozal, Mercier, & Tjadens, 2011; Metlife Mature Market Institute, 2011) Increased (Chari, Engberg, Ray, & Mehrotra, 2014; Colombo, Llena-Nozal, Mercier, & Tjadens, 2011; Metlife Mature Market Institute, monetary 2011) expenses (Canadian Caregiver Coalition, 2010; Evercare & National Alliance for Caregiving, 2007; Lai & Leonenko, 2007; MacCourt & Family Caregivers Advisory Committee, 2013)
International policies Sweden Australia United States Korea Government Government Government Government • • • • Carer allowance Carer payment Tax credit Foreign care • • Foreign care system Cash and workers • workers Carer allowance counselling • • Foreign care Foreign care workers workers Community Community Community Community • • • • Training and Training and Training and Training and education education education education • • • Respite care Respite care Respite care • • • Counselling Counselling Counselling Workplace Workplace Workplace Workplace • • • • Partly paid 10 days personal Unpaid leave up Collective (average 80% of /care leave to 12 weeks agreement on • • wage) leave 2 days unpaid care flexible work flexible work • 100 days terminal leave (emergency) arrangements arrangements care leave
Family caregiving policies in HK Carer allowance (low income families) (pilot scheme) (Oct 2016 – Sep 2018) Community care service vouchers (pilot schemes) (Sep 2013 – 2018) Foreign domestic workers (328,000 in eligible households)
Community supports and Workplace accommodative measures Training and Counselling education Limited respite care (37 centres; 12 vacancies) Limited flexible work arrangements (Social Welfare Department, 2017)
Objectives
Objectives Domestic helper Financial impacts Caregiving Employment impacts Workplace accommodative measures
Findings
Methodology Focus group Jul Aug Sep Oct Nov Survey
Focus Group - From July to September, 2016 - Six groups conducted in six districts - Participants: N=37 (5-8 participants per group) - Recruitment method: purposive sampling - Inclusion criteria: • Aged between 40-64 • Cantonese-speaking • Providing care for at least 4 hours a week to an adult older than 65 years old in the past 6 months - Duration: 1.5 – 2 hours
Telephone Survey - From August to November 2016 - Conducted by Public Opinion Programme, The University of Hong Kong (HKU POP) - Sample size: 451 participants - Recruitment method: random digit dialing method - Inclusion criteria: • Aged between 40-64 • Cantonese-speaking • Providing care for at least 4 hours a week to an adult older than 65 years old in the past 6 months
Gender ( N =451) Caregivers Care recipients 31.9% 27.9% 68.1% Male 72.1% Male Female Female
Demographics of Caregivers Age Living arrangement with care recipients 60-64 years 29.8% 50-59 years 50.4% 40-49 years 19.8% 46.1% 53.9% Co-residing Not co-residing
Caregiving Hours per Week 40 or above 16.5% 36-40 0.9% 31-35 1.4% 26-30 3.4% 21-25 6.2% 16-20 6.9% 11-15 6.4% 6-10 21.3% 4-5 36.9% 0% 5% 10% 15% 20% 25% 30% 35% 40%
Financial Impact - Out-of-pocket Expenses median of out-of-pocket expenses in the past 12 months among caregivers with and without domestic helper HK$60,000 Without DH With DH Range: Range: $1,200 - $5,000 $1,900 - $10,000 HK$50,000 HK$50,000 Without DH ( n =316) With DH ( n =135) HK$40,000 9.5% 10.0% 11.2% HK$30,000 15.1% 41.5% 50.3% HK$20,000 HK$9,300 25.1% HK$10,000 37.3% HK$0 DH or community services Professional services (N=77) (N=112) Professional services (N=155) Home modifications (N=35) Home modifications (N=58) Special aids or devices (N=39) Special aids or devices (N=73) Transportation, travel or accommodation (N=66) Transportation, travel or accommodation (N=132)
Voices by Caregivers Community services “ Home care service is very expensive. The hourly rate of day care service almost used up my monthly salary. ” (FG2/CG15/Female/Full-time) Home modifications “ I changed all the gas stove into induction cooker. Toilet renovation is also needed, bath cubicle is better and safer. ” (FG2/CG11/Female/Not working) Special aids or devices “ It is essential to buy some special devices for my parents to monitor blood pressure and blood glucose level. ” (FG1/CG1/Female/Quitted job)
Financial impact - Perceived Cost of Care 45% 40% 35% 11.1% 30% 25% 8.3% 6.3% 20% 9.5% 15% 28.8% 10% 19.9% 18.5% 14.8% 5% 0% Dipping into savings Give up necessities Cannot afford little extras Caring CR is too expensive Agree Strongly agree
Financial impact - Differences among Income Groups cost of care index among three income groups 60% 50% 47.7% 41.9% 40% 30% 20% 16.1% 10% 0% Below $10,000 $10,000 - $29,999 $30,000 or above (N=132) (N=155) (N=93)
Financial impact - Perceived Additional Burden by DH cost of care index among additional burden created by DH caregivers with and without additional burden created by ( n =135) hiring DH ( n =135) 40% 60% 56.0% 35% 50% 30% 40% 25% 20% 30% 35.8% 15% 29.9% 18.2% 20% 25.4% 10% 10% 5% 9.0% 0% 0% Without burden (N=82) With burden (N=52) Not at all Very Little Somewhat To a great extent
Employment Impact 35% 29.0% 30% 25.8% 25% 20.9% 19.5% 20% 15.0% 14.2% 15% 12.2% 10% 8.0% 6.7% 4.7% 5% 3.5% 0% Took paid Decreased Adopted Quit working Took unpaid Retired early Turned down Opened a Increased Take up one Dismissed, leave of hours of flexible (N=88) leave of (N=64) job offer or home hours of more job terminated or absence work working absence promotion business work (N=30) (N=21) asked to (N=130) (N=116) arrangement (N=67) (N=55) (N=36) resign (N=94) (N=16)
Workplace Accommodative Measures 35% 30.8% 30% 25% 20% 18.4% 15% 11.7% 10% 8.5% 8.3% 7.6% 7.4% 6.9% 6.9% 6.3% 5.3% 5.2% 5.3% 5.3% 4.8% 5% 3.2% 3.0% 0% Compassionate Paid care leave Flexible Part-time Unpaid care Re- Home-working Counselling Information on Medical leave working hours working leave employment arrangement service caregiving benefits arrangement program covering parents of employees Formal Discretionary
Employment Impact – Workplace Accommodative Measures employment impact among caregivers with and without workplace accommodative measures 40% 35.9% 35% 30% 24.5% 25% 20.7% 18.8% 20% 15.2% 15% 11.7% 10% 5% 0% Took paid leave of absence Adopted flexible working Retired early (N=30) (N=27) arrangement (N=22) Without Workplace Accommodations With Workplace Accommodations (n=145) (n=196)
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