Aging population: The rise of elderly living alone

Friday, August 19, 2011
Issue 1388, Page 2 – 4
Word count: 2742
Published in: Macau Daily Times

By Poyi (Natalie) Leung & Vítor Quintã

Macau has the second best demographic profile in the world, as the working age population is far greater than dependents, but this profile might change dramatically in coming years, as the rapidly aging population will place a greater burden on future generations.

At the end of 2010 there were about 44,200 elderly people living in Macau, accounting for eight percent of the total population, but there are currently just 19 elderly homes operating in the territory, with only 1,330 openings, that can accommodate not more than three percent of all elderly residents.

Most are left with the option of sharing a home with their families or living on their own, benefiting from the government’s social housing scheme. But that is not an easy option, some elderly residents tell the Macau Daily Times.

Nonetheless, the number of cases may rise in the future as the MSAR could have the oldest population in the world in less than 40 years, according to a United Nations report.

The government says it is racing against time to implement feasible solutions and aside from increasing aged care homes, the Social Welfare Bureau pledges to help “applicants who don’t yet require full-time care” receive home treatment or find a place in day care centres.

Chau, the lonely soul

Chau Kuok Veng is reluctant to talk about his daughter and son, who are both married and have children. “It’s the best to live by myself, I can do whatever I like and I don’t like to quarrel with people,” the 71-year-old says in his home in Fai Fu Building, which is dedicated to single-living elderly people and one of the two towers that form the Fai Chi Kei Social Housing completed in late 2009.

Chau only moved into this open-style flat in early June after having been placed on the waiting list for nearly eight years. Before that, he lived with his daughter, her husband and their two sons in an affordable housing unit in Iao Hon, Macau’s northern district, for over three decades.

He still misses and likes spending time in Iao Hon, even though he has to change buses three times to get there from where he is living now.

“I don’t quite like living here, the transportation is inconvenient and things in Fai Chi Kei are much more expensive [than those sold in Iao Hon]. People living in this building mostly don’t have good financial conditions,” he tells the MDTimes, in his living room where a wooden double-deck bed sits about two steps away from the front door.

“But I didn’t want to live with them [his daughter and her family]. Her two sons are growing up and I don’t want to play gooseberry [be an unwanted third person who is present when his daughter and son-in-law want to be alone].”

Therefore Chau submitted an application for social housing, in spite of his deep attachment to the neighbourhood in Iao Hon.

Nevertheless, he says he has become accustomed to living alone, as he also had to take care of himself when living with his daughter.

“She has her own family and I have my own things to do,” he adds.

Chau keeps repeating the very same routine almost all year round. After waking up at around 7am, he watches some television, then goes downstairs to do simple exercises in the greening area and watches people fishing.

At about 10am he returns home and later has lunch delivered by a nearby elderly day care centre. He usually spends the afternoon at the Caritas elderly activity centre located on the 7th floor of the building where he lives, having a foot massage then playing mahjong with neighbours, Chinese chess or computer games. Each night he goes to bed after dinner and watching some more television at around 10pm.

Despite suffering from diabetes, heart disease and high blood pressure, Chau likes spending time outside and joining one-day tours to China held by social organisations.

“I hope the [Caritas elderly] centre can organise more activities for us to go out to play, but I understand it has limited resources and it’s not easy to bring a large group of elderly people out,” he says.

The 71-year-old left his hometown in mainland China and came to Macau about 40 years ago. He understands mostly what people say in Cantonese but prefers to talk in Mandarin.

He had several different jobs when he was young, from a coolie, who moved kerosene between places to knitting woollen clothing and lastly transporting liquefied petroleum gas bottles after receiving his truck license in the 1980s.

Chau’s retired life is now supported by around MOP 3,000 he receives from the Social Welfare Bureau every month.

Asked if the money is enough for his daily expenses, he replies: “What do you think?”

Although the rent is only MOP 66 per month, Chau says the electricity bill can get as high as over MOP 400 in summer.

“My children don’t give me money. When I moved into this flat, I used all the government’s cash handouts to buy furniture,” he says.

Si’s broken heart

Si Un Lan lives on another floor in Fai Fu Building. At 85 years old, she still has a good memory and is able to recall the story of her early life. Teary-eyed, she recalls how her life has changed after moving into this one-bedroom social housing unit in November 2010.

She used to share a government-owned flat with another elderly woman near the Border Gate. Everything seemed fine in the beginning but very soon she found that her ‘flatmate’ has a habit of bringing trash collected from the streets home and didn’t allow anyone to touch or move it even half an inch.

“She made the house very smelly and full of rubbish, and she always scared and shouted at me. One time her body got itchy and she said I must have put poison in her clothes,” Si says.

Suffering from heart disease and high blood pressure, she says she has been rushed to the emergency room three times.

Fortunately a pastor from the church that Si is familiar with helped her write a letter to the Housing Bureau requesting a change in flatmate or to relocate her somewhere she can live on her own.

“I’m much happier now and I’ve even gained weight. There is also an elderly centre downstairs so it’s very convenient and the social workers will always come to check on us,” Si smiles.

Although she has an adopted daughter in Macau, she prefers not to live with her because “my way of thinking is different from that of the young generation” and her apartment is “small”.

Before settling in Macau, Si and her husband, a Cantonese opera singer, lived in Guangzhou. Si says since she was “unable to have children”, she and her husband decided to adopt a child from an orphanage in China’s Nanning city, who later moved to Macau with them.

However, still feeling the guilt of not being able to have her own children, Si tells the MDTimes that she tried to “convince” her husband and the babysitter to have another baby.

That ‘baby’, also a girl, is 58 years old now and has stayed in Guangzhou. Si had tried to apply to the Guangzhou public security authority in the hope to let her ‘younger daughter’ come to reside in Macau to take care of her.

But the result broke the 85-year-old’s heart. The authority said it could not approve the application as Si is not the biological mother.

She doesn’t go out of her building often because she can’t walk much. Therefore the elderly centre on the 7th floor has become her main source of entertainment where she sometimes joins the handicraft or planting workshops.

Also receiving the MOP 3,000 from the government every month, Si says it is basically enough to support her living as every pataca is being carefully used.

A new life for Pao and Kok

Pao Hou has always been single in her 90 years of life and Kok Hang Ieng, at 83, was married but also doesn’t have any children.

Having moved into the charitable association Holy House of Mercy’s elderly home behind the Ruins of St. Paul’s respectively in 1992 and 2003, Kok and Pao tell the MDTimes they have been enjoying their lives and even believe this place is better than home.

“Here we have people serving us, we don’t need to wash dishes and clean. Breakfast, lunch, afternoon tea and dinner are prepared for us every day. I’m very satisfied,” Kok smiles.

There are doctors who come to the facility from Mondays to Fridays every week to provide free consultations to the residents in need, and in-house physiotherapy services are just located in the basement.

The two usually wake up at 5am but Pao spends most of her time during the day watching television and chatting with other elderly people, while Kok goes to yum cha with friends early morning before going back to the centre to also watch television and play mahjong.

There are also quite a lot of activities available for the elderly such as storytelling, reading newspapers, dining at restaurants or excursions.

Pao and Kok were born in mainland China and never went to school. Unable to read and write, they enjoy the time when the in-house social workers relay the news in the daily newspapers.

They say they haven’t been required to pay any fees for living in this care facility until this year where they’re required to pay MOP 1,200 per month because “the government has handed out money [to local people]”.

Nevertheless, they say the arrangement doesn’t cause a financial burden to them. Thanks to the aged pension and special economic aid from the IAS, as well as the government’s cash handouts, they confess that they have nothing to worry about and that they never feel bored.

Calling for nursing homes

At the end of 2010 there were about 44,200 elderly people living in Macau, accounting for eight percent of the total population, 0.3 points higher than a year earlier.

But there are currently just 19 elderly homes operating in Macau, with 10 being privately-run and the remaining subsidised by the government.

In total there are about 1,330 openings, which means only three percent of all elderly residents have a shot at being accepted in an assisted home. In developed countries such as the US the percentage of people over 65 living in an elderly home at any time is much higher, above seven percent.

In order to improve the management of these 1,330 places on August 1 the Social Welfare Bureau (IAS) launched a mechanism for the centralised management of elderly home services.

In the initial stage the mechanism will cover only the 400 openings at the four elderly homes run by charitable organisation Caritas Macau. IAS will be in charge of allocating any room that becomes available.

The elderly – or a representative – will simply need to apply at the bureau’s community centres, at Caritas’s homes or at the existing day care centres.

The mechanism was implemented on a trial basis in 2008 at Carita’s Areia Preta elderly home. “With the experience gained throughout these three years IAS and Caritas Macau reached a consensus to extend the mechanism to all Caritas homes,” the bureau said in a statement.

Also in 2008 IAS began evaluating all elderly residents who applied for an opening in a subsidised elderly home.

The goal is “to evaluate the service needs of the applicants, based on objective criteria, in order to prioritise the requests of those that truly need assistance,” the bureau explained. Elderly people unable to take care of themselves, with mental issues or who require constant assistance “might find an opening in elderly homes soon”.

Carita’s elderly homes charge a monthly fee between MOP 4,500 and 7,000. Poor families can request a non-regular subsidy to cover this fee from IAS.

“In the future, according to the results of the implementation of the mechanism, the bureau will invite more subsidised homes to join the scheme, gradually extending it to more homes,” IAS said.

Extending life span

Currently Macau has the second best demographic profile in the world, only behind Qatar, as the working age population is far greater than dependents (elderly and youngsters).

But this situation won’t last for very long. The rapidly aging population will place a greater burden on both the territory’s still incipient social security system and future generations, the International Labour Organisation warned last December.

By 2050, there will be eight non-working residents – children and elderly – for every 10 active workers in Macau.

The balance will be further strained as life expectancy continues to rise in Macau. In the period of 1995-2000 it was 79.5 years, but between 2005 and 2010 it rose to 81.2 years.

The UN report predicted a population of about 524,000 by 2050. However, according to official data, Macau reached 558,100 inhabitants last June, fuelled by the economic boom since gaming liberalisation in 2002.

However it’s the hiring of non-resident workers, which in June reached almost 85,300 that has fuelled this growth. And imported labour is not included in the social security system.

The system came into effect on January 1 and former Social Security Fund president Fung Ping Kuen assured the financial health of the scheme is secured for at least 50 years.

The ‘2050’ alert

Yet the lack of elderly homes will only get worse because with the local fertility rate one of the lowest in the world – 0.92 births per woman – the population is inevitably going to age fast.

In order to prevent the overall population from aging the fertility rate would have to reach at least 2.1 births, known as the replacement rate.

By 2050 the MSAR could have the oldest population in the world, according to a United Nations (UN) report released in 2007.

The World Population Prospects predicts that by 2050 the local population will be an average age of 55.5 and two out of five residents (42.8 percent) will be 60 or older.

Macau will also be among the four territories worldwide with the highest percentage of elderly aged 80 or older – 14.1 percent.

Authorities claim to be ready for this phenomenon, despite having shelved a plan to open elderly homes in mainland China but run by Macau private institutions. In the next three to five years, the Social Welfare Bureau told MDTimes, five more elderly homes will be built on public land.

These new institutions will provide a total of 874 openings “in response to the need for elderly homes and services,” IAS said.

Alternative services

Aside from increasing homes for the aged, the Social Welfare Bureau pledged to help “applicants who don’t yet require full-time care” to receive home treatment or find a place in day care centres.

Elderly residents have free healthcare at the public hospital Conde S. Januário and health centres also provide free home treatment, the bureau emphasised.

MDTimes asked the Health Bureau (SSM) how many elderly people have taken up free medical assistance at Conde S. Januário and what the cost of the service was but no reply was received despite several attempts at contact.

Many countries around the world already provide free medication for poor, elderly people. MDTimes asked both IAS and SSM if there were any plans to launch a similar service in the territory but received no reply.

Authorities also claimed to support private institutions in creating day care centres and home treatment services.

“Elderly should be able to live in a community that is familiar to them, fulfilling the policy of family-provided care and keeping elderly at home,” IAS said.

But there remains a huge gap between subsidies for elderly people living in assisted homes and those living either alone or with relatives.

Families can ask for a subsidy to help pay the monthly fee at an elderly home and its value is calculated “according to the actual expense and the situation of the applicant and its family,” the law states.

On the contrary the supplementary nursing care grant is only MOP 400 per month for elderly living alone and with no relatives in Macau. If the resident has relatives living in Macau then the grant drops to MOP 300.

Still 59,000 elderly residents – a number that included people living in mainland China – receive a monthly pension and its value was raised to MOP 2,000 just last May.

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