Subsistence Life and Aging Agony: A Case of Cultural Affluence in Hong Kong

Number of People, Age Distribution, and Gender of the Cases

There were a total of 72 people in these 50 cases, including the spouse and adult children (Table 1). In terms of age distribution, the oldest was 96 years old. In the age range of 99–70 years, there were 45 people, and in the age range of 69–24 years, there were 27 people, with the youngest being 24 years old. Relatively speaking, people comprising this study were older. A total of 31 persons were born between 1925 and 1946. They had experienced World War II and civil war in China.

In this study, there were more men than women, with 53 males and 19 females. The predominant male ratio explained that there were a total of 20 family and couple households. One household comprised only son-in-law and father-in-law and no female member. Yet out of 26 individual cases, 24 of them were males. Another explanation is that individual older males were less home-bound and were the outgoing-type, while their female counterparts were home makers which in this study were fewer in number. The gender and the types of cases are shown in Table 2.

Suicide and “Mercy-killing”

While examining suicide cases in Hong Kong between 1997 and 2003, it was pointed out that there was a 50% increase in suicides as compared to the past. Socioeconomic adversities seem to have played a relatively important role in the increasing suicide rate in Hong Kong (Chan et al., 2006). Yip, Wong, Cheung, Chan, and Beh (2009) examined the homicide-suicide cases between 1989 and 2005 and found that among 231 deaths in 98 episodes, 68.7% were males and their age range was 30–49 years. In other words, suicide rate had increased during the first 5 years of the HKSAR government, and homicide-suicides among older couple became a new phenomenon starting from 2006.

It seems that housing and home relocation (case 1 and 2) and home admission (case 3 and 4) suicides were avoidable if the concerned authority were more attentive to the needs of the deceased. Owing to large number of applicants and long waiting list, an administration tended to speed up the admission process, and therefore an indecision on the part of applicants would increase stress.

For older people who lived in public housing estates, they had to abandon their public housing unit tenancy when they entered an aged home. If they found that aged home living is not suitable, then they were left with no choice but to stay there. For relocation cases, it would be more difficult if the compensation deal was not acceptable. According to a newspaper report, the man who committed suicide was in conversation with someone and became emotional. In order to show his intentions to stay, he jumped from the building. This emotionally charged behavior could also be found in the case of jade street-trader (case 5), who also committed suicide by setting himself on fire inside the magistrate court once his goods were confiscated. This kind of suicidal behavior is a form of resistance as noted by Lee and Kleinmen (2003) and Wang (1999).

In similar act of resistance, a retiree (case 8) attempted suicide by set fire to himself outside the office of the Appeal Board for Social Security Assistance Scheme to protest the delay of his payment. Luckily, the sprinkler system was switched on by smoke of the fire and he was saved from burning (Cartland, 2014 p. 259–260). Most of the time, it is the quest for efficiency than the needs of service user that sparks off outrage.

There are also cases of tragic couple homicides/suicides (case 12, 13, 15, 16 & 17). In response to case 17 of which a 80-years old man murdered his stroke-suffering 76-years old wife, Lau Sui-Lai, a member of the Legislative Council raised questions about the victim’s inability to withstand the pressure arising from prolonged caring of his old wife (case 17), the inadequacy of the services provided by the government, and the support for carergivers (ISD, 2017). The government representative replied in writing and descriptively outlined the community support provisions for older people, their caregivers, and the amount of funding allocated. However, the written reply did not mention about the position of the government regarding family tragedy. This gave people an impression that the government was indifferent to the tragedy and the written response was just a normalizing action.

In the editorial column More must be done for care of elderly of South China Morning Post, (16 July 2017, p.11), Lam Ching-Choi (2017), Chairman of the Elderly Commission, wrote that the incident reflected a severe shortfall in community-based support for elderly caregivers, and a fresh look at the support network for the tens of thousands of elderly caregivers was necessary.

When the victim-husband (case 17) was released from prison after serving his 2-year sentence, he talked to HK01News (2019), a Chinese medium digital newspaper. He said that he cared for his wife for 3 years on his own, including her daily body cleaning, every day meals, and medical consultation visits. She had a stroke and stayed in a private nursing home afterwards. He ran out of money after her staying there for 10 months. The home fee was exorbitant and he was too poor to support her. He continued to say that

he was afraid to talk about his wife’s situation with anyone, even his relatives. The public housing estate (where he lived) is like an isolated island. When his neighbors saw him and his frail wife, they can only show their sympathy and not doing anything. My inability to seek help, and that would be good if I did so (in seeking help) now that I failed (not knowing how to seek help), the society had a strong reaction (murder of his wife) that already raised the alarm, the future society (especially elderly service) should have good performance. (HK01News, 2019)

The other two “mercy-killing” cases (case 15 and 16) were carried out by their sons. In Case 15, a 47 years-old son with depression pushed his wheelchair-bound father into the sea. In Case 16, a 50-years old son threw himself and his 83-years old mother into the harbour, were similar to the above-mentioned case, as they both want to end the miserable conditions of their physically impaired parents, thus releasing their unbearable burden of care; perhaps they were performing the duty of filial piety.

In an analysis of relationship between terminal illness and depression in Canada, Bourget, Gagne, and Whitehurst (2010) noted that “terminal illness in a spouse (the victim) and depression in the other spouse (the perpetrator) maybe the risk factors for homicide suicides in old couples.” This may also apply to other two couples’ murder-suicide cases (case 12 and 13). In both cases, husbands died right after murders, but little information was made available to readers. However, they were of younger age (case 12 [67/70 years] and case 13 [58/56 years]) than the “murder and report to the police” case (case 17 [80/76 years]). In case 9, a 67-year-old man frightened by the death of his spouse was in a state of sudden burst of separation anxiety, standing on a high platform of building, shouting and crying. In case 11, couple (both aged 80 years) committed suicide because of long-term illness, and in case 10, 62-year-old person attempted suicide because of long-term illness. Another couple (case 14) failed to kill themselves after taking drugs and burning charcoal. Without medicine or proper care or both would be contributory cause of suicide among long-term illness sufferer. The Hospital Authority of the HKSAR implemented a drug formulary since 2005 to ensure equitable access by patients to affordable drugs (ISD, 2015). Some cancer-treatment drugs are not listed in the drug formulary and is a key concern among patient’s rights groups.

Aging Parents and Adult Sons, Mentally Ill, Drug Addict, and Alcoholic

Case 18, 19, 20, and 21 involved adult sons who were mentally ill. Three of them lived with their mothers while one of them with his father. In case18, a 63-year-old son killed his demented 90-year-old mother. The other three cases (case 19, 20, and 21), although not fatal but no less brutal, involved slightly younger dyads: 58/85, 24/76, and 44/72. One of the cases (case 22) was about a drug addict son stealing money from his 96-year-old father who was a public allowance recipient.

The last case (case 23) was of an alcoholic son who went street-begging with his wheelchair-bound mother. They travelled for an hour on a bus to the business area for street-begging. After collecting money, the son bought alcohol and drank, sitting beside his aged mother. Later he was arrested and jailed for a few weeks.

The drug addict case (case 22) was quite similar to the mentally ill cases. It was a variation of another type of mental “manifestation,” but with less social and cultural stigma attached to it. The alcoholic case was a different kind of domestic violence or abuse. From the view point of caring and family responsibility, the bizarre behavior would be a “protest” loud and strong, an expression showing either a reluctant acceptance of taking up the caring role of his mother or to show to the world that he is a filial son. Eventually, the government arranged for mother to stay in a nursing home. The two cases also involved parents of advanced age, one was 96-years-old (case 22) and the other was 85-years-old (case 19). On the aspect of family relationship, the advanced age of parents, who were probably their caregivers, also had long-term illness. Perhaps they were living together all along, although in early days they were able to fend themselves and never felt hurt. Their becoming old with insufficient support from government could be a source of these tragedies.

Social Isolation, Care Work, Accident, and Death

In this section, there were four cases in group (a). The first two cases were of older couples (case 24 and 25) and the last two (case 26 and 27) were of living-alone elder persons. In group (b), the first case (case 28) involved a couple, the second case (case 29) an elderly man with his son-in-law who was his caregiver, and the third case (case 30) an autistic son with her mother. In group (c), the first case (case 31) was a 47-years old daughter caring for her 80-years old father, and the second case (case 32) was about an 82-year-old mother and her 60-year-old wheelchair-bound son. These nine cases, except the two cases in group (c), shared the similarity of lacking of rescue or appropriate action when the older people encountered life-threatening accident.

In a newspaper article titled “The tragedy of 450,000 singleton elderly and co-living older couples,” Chow (2019), Professor of social work and social administration, expressed his grief and anger about the death of a spouse of an older couple, with the surviving husband mourning by wife’s side without leaving her for a month. The grief and anger was because under the present aging policy of community care/aging-in-place, provisions of service were seriously inadequate, still no attention was paid to the needs of the increasing aging population. He further stated that the waiting time for meals-on-wheel and escort services for medical consultation was about a year.

Regarding singleton elderly who passed away unnoticed, Bauhinia Foundation Research Centre (2019), a think tank, raised the question of lonely death (kodokushi, Japanese equivalent of lonely death). It said that Hong Kong may face challenges arising from lonely deaths, given the number of elders who were single and lived alone was increasing. It implied the view that social provisions should be increased to address the needs of older people.

Dementia Issues

There were three cases of dementia (case 33, 34, and 35). The first two cases involved leaving home, but because of dementia they lost their way back to home. The third case was more worrying because of its violent nature. A dementia male, resident of an elderly home, lost his temper and seriously hurt two of his co-residents. As mentioned above, there were two other cases involving dementia persons. In one of the murder-suicide couple case, wife was the victim of dementia illness (case 13). Another one (case 18) involved domestic violence in which 90-year-old woman having dementia was killed by his mentally ill son.

In a study on caregiving to older people with dementia and their families, authors observed that “caregivers expressed great concern about bothering their family members when there is a desperate need for help” (Au, Shardlow, Teng, Tsien, & Chan, 2013). The study also examined the cultural context of the issue and the social stigma attached to it. Services for dementia patients were limited and expensive. Although government paid attention to the issue, not much of actual provisions were provided. The symptoms of dementia are distressing not only for patients but also for caregivers, and delayed diagnosis is often seen in Hong Kong (Cheng, 2018). Although a supplementary allowance for the caregivers is available there is a fixed quota for the number of applicants and the amount of the supplement is meagre (LCS, 2020). Aged homes, especially private aged homes, are not well-equipped to handle dementia cases.

Others: Arson Attack, Shop-lifting and Robbery, Call for Police, Sexual Assault, Welfare Fraud, and Radio Phone-in Program

There were eight cases in this group. The first two were arson attacks (case 43 and 44) carried out by two mentally ill persons. These were serious crimes and one of them was sentenced to life imprisonment. He said the government owed him money, and since his name was the same as that the given name of a mass transit railway (MTR) station that he set the station on fire. The third case (case 45) involved stealing a pack of pork ribs worth HK$12 (equivalent to about US$1.5). Not much information was available about this case in news reports. This would be either because of forgetfulness to pay or not having enough money to purchase the product.

The fourth case (case 46) involved robbery of a convenience store using a knife. The victim said the social security office mismanaged his case and stopped his social security payment. As a result, the hungry man out of desperation robbed the shop, but was unsuccessful. He showed remorse and felt guilty of what he had done. Similar situation was found in one of the individual attempted suicide cases. In case 8, instead of robbing a shop, the man attempted suicide. He said he had been unfairly treated by the social security office.

The fifth case (case 47) involved a 90-year-old man who called police because the meals-on-wheel service was suspended on a holiday, which he was not aware of. In terms of meeting the needs of a client, the nature of this case was quite similar to the robbery case (case 46), as both of them were out of food. The sixth case (case 48) on sexual assault in an elderly home raised the concern of safety and security inside the home as residents were vulnerable, and lack of privacy in some homes was a cause of fear. The seventh case (case 49) was about a social security allowance; recipient was hiding his savings in order to be qualified for the allowance. Reasons for fraud of welfare allowance could be many, and in the present case, the man said the money saved was for his daughter’s university education.

The last case (case 50) was of a retiree expressing his views about the asset-check for the application of old age allowance in a radio phone-in program (Lee, 2015, p. 151). This was an everyday morning radio program providing a channel for all citizens to express their views about Hong Kong and government policies. In Hong Kong, people who were aged 70 and more were eligible for the Old Age Allowance (OAA, also known as fruit money) and there was no need for checking assets. OAA is a noncontributory allowance; however, if one is aged 65–69, he/she, in order to be eligible, has to go through an asset-check. The person who called the phone-in program was 69 years old and he asked to abolish the asset-check so that he could have the allowance before attaining 70 years of age.

Summarizing, these 50 cases urged us to take a serious look at the problem. There is no doubt that their social support network, as well as the resources they can use, were limited. They were facing precarity of their own livelihood. In other words, they were socially isolated and what they had experienced was the reality of an informal insecurity welfare regime, rather than an informal security welfare regime. In relation to aging carer, some of the cases echo what Ikels observed in the 1980s of Hong Kong society about an aging mother tending her disabled daughter that ‘the family gets little respite from the constant attendance such a person may require. Not surprisingly many old people live in dread of becoming such burdens’ (Ikles, 1983:134).

Another aspect of the 50 cases is how different government departments discharged their duties and their related policy and management. Contemporary society is heavily involved with government activities though some are more explicit than the others. Among the 50 cases, 3 common concerns can be identified, and they are government’s policy and management (P), older people employment (E) and care work for the old, frail, disabled or mentally challenged (C). The relationship between these cases and their common concerns are presented in Appendix 2.

Self-reliant and Informal Security/Insecurity Regime, Social Stigma, Help-seeking, and Government Provisions

Three types of mentality regarding consuming social service were found in this study. Firstly, in the case of housing and home relocation (case 1 and 2), aged home admission (case 3 and 4), and jade street trader (case 5), all committed suicide, while social security assistance recipient (case 8) attempted suicide. They all wanted to express their dissatisfaction with the government’s policy decisions. They were the “resistance” type of senior citizens who had tried to defend what they think was correct for them by putting their lives on stake. Cases of convenience shop robbery (case 46) and the radio phone-in program participant (case 50) were good examples to show that they were not silent partners of present society.

Contrary to the individual “resistance” type, the second type representing elements of acquiescence the acceptance of the way they were being treated. Most of the cases (case 12, 13, 18, 19, 20, 21, 24, 25, 26, 27, 28, 29, 30, 31 and 32) involving caring for one’s family members without objection and yet with consent are examples of the acquiescent type. It is especially with cases 18, 19, 20, and 21 that with inadequate support from the government, aged parents with mentally-ill adult child would consider their family situation as personal responsibility and to accept the caring role accordingly. The acquiescent type implied certain amount of self-reliance.

Thirdly, a sense of self-reliance also influenced the use of social services. In this study self-reliance refers to one’s tendency to seek personal problem-solving rather than seeking outside help. Among the 50 cases studied, most of them expressed certain amount of self-reliance. There is the possibility that they are overly self-reliant without considering their own limitations. Besides, in cases relating to work and employment (9 cases), we note of a paradox that for those who continued to work so as not to depend on public assistance, some were charged for violating the laws.

In a study on Hong Kong’s older people, Keith and his associates (1994) observed the ambiguity of elderly regarding government provisions. They noted that “Hong Kong older people, knowing that Hong Kong is not a welfare state, and therefore not expecting many provisions from the government,” but, “they also want the government to offer more if possible” (Keith et al. 1994, p. 256). In other words, Hong Kong older people are not totally passive. Deep in their hearts, there was a desire to have more, because basically material supply or resources were limited. The sense of “ambiguity” influenced social service consumption. In Wong and Lou’s (2012) research on self-reliance in social security allowance users, the authors found that users were ambiguous about the exiting the welfare system and wanted to stay.

There were four other factors that could undermine potential users’ motivation in consuming government provisions. Firstly, social stigma as relating to government provisions would deter potential applicant and enhance social exclusion; second factor was financial affordability; third, the administrative factor, such as the interviewing and screening process, and a long waiting-list would discourage applicants; and fourthly, it was noted that even if services were available, they might not be able to meet the needs of users as experienced by the husband who killed his wife and reported to the police.

However, it would be a fact of life that all these 50 cases were personal tragedies or misfortune of isolated incidents. It would simply be a natural “age pain” as a matter of growing and becoming old. On the other hand, there is no denying that these 50 cases were profound “expression of sufferings generated by an ageist context which maybe compounded by other forms of social suffering” (Pickard, 2016, p. 135). These cases questioned the sustainability of informal security welfare regime. To many of them, they were embedded in an informal insecurity welfare regime as noted above.

The foundation of Hong Kong is built on the principle of fiscal austerity. After long years of practice, 20 years of the government of HKSAR and 150 years of the British colonial administration, it is necessary to reconsider the harmful effects of the market and its related residual welfare system.

Lastly, in the case of aging policy and the practice of fiscal austerity in Hong Kong, Tolstoy’s observation (at the beginning of this article) may take on a twist that “most unhappy families are alike because of the lack of community and residential support services.”

Limitations

There are several limitations to this study. First, the 50 cases represented a wide range of life situations which cannot be fully dealt with in an article of this length. Second, the study of suicidal cases had the difficulty of explaining the etiology of suicidal behavior. The explanation of suicidal causal relationship between macro and micro levels, personal and familial, or the disease and treatment/curing method could be speculative. Third, some of the newspaper reports on suicides were the factual description of cases. For example, in the case of long-term illness, the description was general and not specific. The term “long-term illness” or geriatric disease is a summary description and speaks less of the cases, and at times not even the name of the disease or diagnosis was mentioned. However, it could be a matter of privacy that the information was deliberately provided descriptively.