Financial Financial and Employment and Employment Impacts Impacts - - PowerPoint PPT Presentation
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
Department of Social Work and Social Administration The University of Hong Kong
Background
Objectives
Findings
Pre-planning in Hong Kong
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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)
(Census and Statistics Department, 2009)
Whether had chronic diseases Number of chronic diseases
Older persons (60+) residing in domestic households
Chronic disease (2015)
20.40% 24.10% 39.80% 15.70% 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 Level 2 1-2 Level 3 3-4 Level 4 5-6
(Census and Statistics Department, 2009)
Level of ADL impairment (2009)
98.7% 96.9% 95.2% 85.2% 1.0% 1.8% 2.8% 9.2% 0.8% 1.9% 0.9% 1.3% 3.7%
75% 80% 85% 90% 95% 100% 60-64 65-69 70-74 75 or above
Older persons by level of ADL impairment and age
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)
(Census and Statistics Department, 2009)
92.8% 88.5% 78.6% 57.1% 6.1% 8.6% 13.6% 18.4% 0.6% 1.3% 3.4% 9.7% 0.5% 1.6% 4.4% 14.8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 60-64 65-69 70-74 75 or above
Older persons by level of IADL impairment and age
1 to 2 3 to 4 5 to 7
Population Ageing (2011 – 2066)
Adults aged 65 and older
(Roughly 280,500) of community-dwelling older adults require assistance in daily living Adult children as key caregivers in Hong Kong, especially daughter
133,400 caregivers
(Census and Statistics Department, 2009, 2017)
Impacts - Working-age Caregivers
Lost income Lowered productivity Increased monetary expenses
(Canadian Caregiver Coalition, 2010; Evercare & National Alliance for Caregiving, 2007; Lai & Leonenko, 2007; MacCourt & Family Caregivers Advisory Committee, 2013) (Chari, Engberg, Ray, & Mehrotra, 2014; Colombo, Llena-Nozal, Mercier, & Tjadens, 2011; Metlife Mature Market Institute, 2011) (Chari, Engberg, Ray, & Mehrotra, 2014; Colombo, Llena-Nozal, Mercier, & Tjadens, 2011; Metlife Mature Market Institute, 2011) International policies
Sweden Australia United States Korea Government
workers Government
system
workers Government
counselling
workers Government
workers Community
education
Community
education
Community
education
Community
education Workplace
(average 80% of wage) leave
care leave Workplace
/care leave
leave (emergency) Workplace
to 12 weeks
arrangements Workplace
agreement on flexible work arrangements
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 education Counselling
Limited respite care (37 centres; 12 vacancies) Limited flexible work arrangements
(Social Welfare Department, 2017)
Objectives
Domestic helper Workplace accommodative measures Financial impacts Employment impacts
Caregiving
Jul Aug Sep Oct Nov
Methodology
Focus Group
an adult older than 65 years old in the past 6 months
Telephone Survey
University of Hong Kong (HKU POP)
method
an adult older than 65 years old in the past 6 months
27.9% 72.1%
Male Female
Caregivers
Gender (N=451)
31.9% 68.1%
Male Female
Care recipients
Demographics of Caregivers
Age
19.8% 50.4% 29.8% 40-49 years 50-59 years 60-64 years
Living arrangement with care recipients
46.1% 53.9% Co-residing Not co-residing
Caregiving Hours per Week
36.9% 21.3% 6.4% 6.9% 6.2% 3.4% 1.4% 0.9% 16.5% 0% 5% 10% 15% 20% 25% 30% 35% 40% 4-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 40 or above
HK$9,300 HK$50,000
HK$0 HK$10,000 HK$20,000 HK$30,000 HK$40,000 HK$50,000 HK$60,000 DH or community services (N=112)
median of out-of-pocket expenses in the past 12 months among caregivers with and without domestic helper
Without DH With DH
Range: $1,200 - $5,000 Range: $1,900 - $10,000
41.5% 37.3% 11.2% 10.0%
Without DH (n=316)
Professional services (N=155) Home modifications (N=58) Special aids or devices (N=73) Transportation, travel or accommodation (N=132) 50.3% 25.1% 15.1% 9.5%
With DH (n=135)
Professional services (N=77) Home modifications (N=35) Special aids or devices (N=39) Transportation, travel or accommodation (N=66)
Financial Impact - Out-of-pocket Expenses
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)
Voices by Caregivers
Financial impact - Perceived Cost of Care
28.8% 19.9% 18.5% 14.8% 11.1% 8.3% 6.3% 9.5% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Dipping into savings Give up necessities Cannot afford little extras Caring CR is too expensive Agree Strongly agree
Financial impact - Differences among Income Groups
47.7% 41.9% 16.1% 0% 10% 20% 30% 40% 50% 60% Below $10,000 (N=132) $10,000 - $29,999 (N=155) $30,000 or above (N=93)
cost of care index among three income groups
Financial impact - Perceived Additional Burden by DH
18.2% 56.0% 0% 10% 20% 30% 40% 50% 60% Without burden (N=82) With burden (N=52)
cost of care index among caregivers with and without additional burden created by hiring DH (n=135)
25.4% 35.8% 29.9% 9.0% 0% 5% 10% 15% 20% 25% 30% 35% 40% Not at all Very Little Somewhat To a great extent
additional burden created by DH (n=135)
Employment Impact
29.0% 25.8% 20.9% 19.5% 15.0% 14.2% 12.2% 8.0% 6.7% 4.7% 3.5% 0% 5% 10% 15% 20% 25% 30% 35% Took paid leave of absence (N=130) Decreased hours of work (N=116) Adopted flexible working arrangement (N=94) Quit working (N=88) Took unpaid leave of absence (N=67) Retired early (N=64) Turned down job offer or promotion (N=55) Opened a home business (N=36) Increased hours of work (N=30) Take up one more job (N=21) Dismissed, terminated or asked to resign (N=16)
Workplace Accommodative Measures
30.8% 6.9% 7.6% 5.3% 5.2% 5.3% 3.2% 11.7% 6.9% 4.8% 8.5% 3.0% 18.4% 7.4% 6.3% 8.3% 5.3% 0% 5% 10% 15% 20% 25% 30% 35%
Compassionate leave Paid care leave Flexible working hours Part-time working arrangement Unpaid care leave Re- employment program Home-working arrangement Counselling service Information on caregiving Medical benefits covering parents of employees
Formal Discretionary
Employment Impact – Workplace Accommodative Measures
18.8% 15.2% 20.7% 35.9% 24.5% 11.7% 0% 5% 10% 15% 20% 25% 30% 35% 40% Took paid leave of absence (N=27) Adopted flexible working arrangement (N=22) Retired early (N=30)
employment impact among caregivers with and without workplace accommodative measures
Without Workplace Accommodations (n=145) With Workplace Accommodations (n=196)
Domestic Helper
70.1% 29.9%
hire domestic helpers (n=451)
No Yes
6.3% 11.9% 0% 2% 4% 6% 8% 10% 12% 14% Opened a home business
employment impact among caregivers with and without DH
Without DH (n=316) With DH (n=135)
Employment Impact – Perceived Additional Burden by DH
9.8% 8.5% 1.2% 34.6% 32.7% 7.7% 0% 5% 10% 15% 20% 25% 30% 35% 40% Quit working Retired early Take up one more job
employment impact among caregivers with and without additional burden created by hiring DH (n=135)
Without burden With burden
Enduring Power of Attorney (EPA) Enduring Powers of Attorney Ordinance (Cap. 501)
capable), to appoint an attorney(s) to take care of the donor’s financial matters in the event that he/she subsequently becomes mentally incapacitated
(Department of Justice, 2017)
Why EPA?
General power of attorney
incapacitated
Enduring power of attorney
mental incapacity
to continue the donor’s financial affairs
Estimated 333,000 persons aged 60 or above would be suffering from dementia in 2039 EPA is of special significance
(Department of Justice, 2017; LegCo, 2017)
Key advantages
Right to choose Avoid court proceedings Efficient and cost-effective Eases the difficulties and distress
Join hands!
Family caregiving brings financial & employment impacts! Financial impacts: low income families shall be targeted Employment impacts: advocate for workplace accommodative measures Pre-planning: Enduring Power of Attorney
Acknowledgement
This research was financially supported by Public Policy Research (PPR) Funding
research programme. We thank HKUPOP for conducting the telephone survey. We would also like to show our gratitude to Caritas District Elderly Centre – Yuen Long (Caritas Hong Kong), Sha Tin Rhenish Neighbourhood Elderly Centre (Chinese Rhenish Church) , Hong Kong Association of Gerontology, Institute of Active Ageing, Yau Ma Tei Multi-service Centre for Senior Citizens (The Salvation Army), The Women’s Foundation, Yan Oi Tong and Ellen Li District Elderly Community Centre (Hong Kong Young Women’s Christian Association) for helping to recruit family caregivers for the focus group. We are also immensely grateful to all the participants for sharing their experiences and views with us during the course of this research.
References
Canadian Caregiver Coalition. (2010). Submission to the House of Commons Standing Committee on Finance: Caring for the family caregiver. Retrieved May 19, 2015, from http://www.ccc-ccan.ca/media.php?mid=310 Census and Statistics Department. (2009). Thematic Household Survey Report No. 40: Socio-demographic profile, health status and self-care capabilities of older persons. Hong Kong: Census and Statistics Department. Census and Statistics Department. (2012). Hong Kong populations projections (2012-2041). Hong Kong: Census and Statistics Department. Census and Statistics Department. (2013). Population census - thematic report: Older persons. Hong Kong: Census and Statistics Department. Chari, A. V., Engberg, J., Ray, K. N., & Mehrotra, A. (2014). The opportunity costs of informal elder-care in the United States: New estimates from the American Time Use Survey. Health Services Research, 50(3), 871-882. Cheung, S., Yip, P., Chi, I., Chui, E., Leung, A., Chan, H., & Chan, M. (2012). Healthy longevity and health care service needs: A pilot study of the centenarians in Hong Kong. Asian Journal of Gerontology and Geriatrics, 7, 26-32. Colombo, F., Llena-Nozal, A., Mercier, J., & Tjadens, F. (2011). Help wanted? Providing and paying for long-term care. OECD Health Policy Studies, OECD Publishing. Evercare & National Alliance for Caregiving. (2007). Evercare study of family caregivers: What they spend, what they sacrifice. Retrieved May 19, 2015, from http://www.caregiving.org/research/impact-of-caregiving/ Gordon, J. R., & Rouse, E. D. (2013). The relationship of job and elder caregiving involvement to work-caregiving conflict and work costs. Research on Aging, 35(1), 96-117. Kim, J., Ingersoll-Dayton, B., & Kwak, M. (2013). Balancing eldercare and employment: The role of work interruptions and supportive employers. Journal of Applied Gerontology, 32(3), 347-369. Lai, D. W., & Leonenko, W. (2007). Effects of caregiving on employment and economic costs of Chinese family caregivers in
MacCourt, P., & Family Caregivers Advisory Committee. (2013). National guidelines for a comprehensive service system to support family caregivers of adults with mental health problems and illnesses. Calgary, AB: Mental Health Commission of Canada. Metlife Mature Market Institute. (2011). The MetLife study of caregiving costs to working caregivers: Double jeopardy for babyboomers caring for their parents. Westport, CT. National Alliance for Caregiving, & AARP. (2009). Caregiving in the U.S.: Executive summary. Bethesda, MD & Washington, DC: NAC & AARP. Pavalko, E. K., & Henderson, K. A. (2006). Combining care work and paid work: Do workplace policies make a difference? Research on Aging, 28(3), 359-374. Social Welfare Department (2017). "Day Respite Service for Elderly Persons." from http://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_csselderly/id_dayrespite/.
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