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Hong Kong

  HONG KONG HUMAN RIGHTS COMMISSION

United Nations Committee on
Economic, Social and Cultural Rights

On the First Periodic Report in respect of Hong Kong Special Administrative Region of the People's Republic of China under Articles 2 to 16 of the International Covenant on Economic, Social and Cultural Rights

January 2001

SoCO:Society for Community Organization
Hong Kong Human Rights Commission

Chapter 1. Right of Abode

1. 1 Right of Abode Case and the Judiciary and Legal System

The Court of Final Appeal (CFA) was created on July 1, 1997 to replace the U.K.s Privy Council as Hong Kong's highest court. The Basic Law provides that the courts of HK shall be vested with independent judicial power with jurisdiction over all cases except “acts of state such as defense and foreign affairs' (article 19), and exercise judicial power independently, free from any interference (article 85).

In January 1999, the CFA issued rulings in three cases relating to the right of abode. The ruling declared some HK immigration regulations, that is the Certificate of Entitlement (COE) Scheme, inconsistent with the ICCPR and confirmed that all children of HK residents had right of abode in HK, whether their parents had HK citizenship at the time of their birth or not. The ruling also asserted the Court's right of judicial review over not only the Basic Law, but also over acts of the National People's Congress (NPC) as they affected HK. However, in response to criticism from Mainland officials and legal scholars, the HK Government requested an unprecedented "clarification' from the CFA of its own judgement in February. This set a dangerous precedent.

Moreover, the HK Government asked the Standing Committee of NPC to interpret two provisions of the Basic Law (article 24(2)(3)) relevant to the part of the CFA's right of abode ruling in May. The purpose was to deny right of abode of mainland-born children born before at least one parent had become a HK permanent resident and requiring mainland-born children to first obtain documents issued by the HK Government (COE) and PRC Government (One-Way Exit Permit) before they can formally get their right of abode. Hundred of HK lawyers who viewed the request as a post-judicial remedy which undermined the authority and independence of HK's judiciary, marched in protest.

Finally, on December 3, 1999, the CFA ruled in a right of abode case that the NPC had authority to interpret the Basic Law, that the NPC's June interpretation of the Basic Law was thus binding, and that the interpretation upheld the Government's previous documentation and time of birth requirements. After this, concern on the rule of law and autonomy of HK's judiciary are expressed both at local and international level. Meanwhile, the Government refused to rule out entirely the possibility of a future request for interpretation on the Basic Law again though officials said such request would be exceptional. Undoubtedly, it creates uncertainties on an independent judiciary and protection of human rights. It seems the Government need not follow a proper procedure in seeking NPC interpretation on Basic Law.

On the other hand, the interpretation also deprives people of the right of abode and right to family unity. Most mainland-born children of HK residents who benefit from the January 29 verdict were forced to return across the border and apply for residency in HK in the previous way. But many of them have applied the One-Way Permit for more than 10 or 20 years but failed because of the forever changing mainland policy, which means there is no workable and reasonable mechanism for them to get the right of abode through the existing policy and thus unable to reunite with their parents.

1. 2 Translation into Domestic Law

Although it is stated in article 39 of the Basic Law that the provisions of ICESCR shall be implemented through the laws of Hong Kong, the provisions continue to be excluded from the domestic law of Hong Kong. There is no law protecting workers from long working hours and extremely low wage which affect the right to just and favorable conditions of work; no law regarding elimination of racial, age and sexual orientation discrimination; no law related to housing rights, no official poverty line; no laws protecting people from forced evictions, and so on. Your committee have also raised these question in the previous hearings but was ignored by the Government.

1. 3 Consideration of recommendations by Committee on ICESCR

It is highly appreciated that the Committee produced a comprehensive and thorough concluding observations after the hearing in 1994 and 1996. However, many recommendations were ignored by the Government and remain unresolved, for example: to develop a fair and open one-way permit approval mechanism in order to facilitate the rapid family reunification, to take effective measure for the retraining of those who have lost employment as a result of economic restructuring, review policies relating unfair dismissal, minimum wage, maximum hours of work and so on, total eradication of cage-homes, review services provided to persons of mental illness and disability, measures to integrate children of immigrant families from China, review the living standard of the welfare recipients and so on.

1. 4 Human Rights Education

Although the Committee on the Promotion of Civic Education under the Home Affairs Bureau did carry out human rights education in the past few years, their focus was more on civil and political rights. Generally speaking, people would not regard economic, social and cultural rights as basic human rights, not to say knowing the principles of indivisibility and interdependence between the two sets of rights. The government officials may also possess the same viewpoint. This may explain the reason why does the Government refuse to translate the provisions of ICESCR into domestic law as that of the ICCPR.

1. 5. Recommendations

      1.   To urge the HK SAR Government to rule out future request for interpretation on the Basic Law from the Standing Committee of National People's Congress (NPCSC) on internal affairs.

      2.   To urge the HK SAR Government to work out a reasonable and workable mechanism with the PRC Government for mainland-born children of the HK residents to apply for the right of abode.

      3.   To urge the HK SAR Government to giver back the right of abode to those mainland-born children being benefit from the January 29, 1999 verdict of the Court of Final Appeal (CFA).

      4.   To urge the HK SAR Government to translate the provisions of the ICESCR into domestic law.

      5.   To urge the HK SAR Government to promote economic, social and cultural rights through formal and informal education.

Chapter 2. Poverty in Hong Kong

2.1 Poverty in an affluent city

Hong Kong has long been regarded as an international and prosperous city and one of the wealthiest societies in the world in terms of per capita GDP, which was HK$189,000 (USD24,500) in 1998. However, the general public cannot share the fruit of the economic growth and the economic re-structuring led more unemployed and under-employed people living in poverty. Worst still, the government got rid of its responsibility and did not take any active measures for ameliorating poverty.

2.2 Increase the number of the poor

According to a survey conducted by Oxfam (Hong Kong), more than 1,300,000 people live below the poverty line and they included low-income families, working elderly and the new immigrants from the Mainland China. 

From 1996 to 2000, the number of low-income families, which household income was less than HK$4,000 (USD 512.8), doubled from 87,500 to 180,000. Moreover, the number of Comprehensive Social Security Assistance (CSSA) recipients was doubled in 2000. The families became poor because of the fall of real household income.

Here are some significant figures that reflected the poor situation:

      -  1,250,000 people earned HK$9,000 or below

     -    the number of employed persons monthly income with HK$5,000 or below was sharply increased to 30% from 1997 to 1999. (see Table 1)

    -  In 1999, the lowest income 10% households lived on HK$3,000 per month while the highest income 10% household enjoyed HK$70,000 instead. (The average means-tested public assistance rate for a 3-member family is HK$7,800 per month in 1999)

    -    From 1990 to 1999, the real monthly employment income of the highest income 200,000 households increased by 28% while that of the lowest income 200,000 households was down also by 28%. (see Table 2)

   -     The monthly household income of 2 million people (in real terms) in 1999 was lower than that in 1990. 80% of the households in Hong Kong saw their real earnings in 1999 lower than that in 1996.

   -   the Gini Coefficient of Hong Kong increased from 0.48 in 1991 to 0.52 in 1996, which was even higher than the developing countries.(see Table 3)   

Table 1. Employed Persons by Monthly Employment Income (1997 - 99)

Source of Information: Quarterly Report of General Household Survey, Jul-Sept 1998 and Oct-Dec 1999, Census and Statistics Department, HKSAR Government.

Table 2. Household Monthly Income in Hong Kong, 1990-99

Source: Census and Statistics Department, HKSAR Government, 2000.

Table 3. Comparison of Gini Coefficient in Different Regions in the 1990s

* Higher Gini Coefficient denotes higher income inequality.

Source: World Bank (1997) Everyone's Miracle? Revisiting Poverty and Inequality in East Asia, Washington D.C.

2. 3 Inapt governmental policies to assist different groups of the poor

             The SAR Government has been adopting an over-simplified logic of the neo-classical economics and believed that overall economic growth will trickle down to the whole society, including each and every group. In face of the economic transformation and the increasing number of the poor, the government merely rendered impractical and insufficient retraining programs to the middle-aged workers that inevitably brought out more low-income families. 

Working elderly

Moreover, due to the lack of central provident fund and a comprehensive pension scheme, more and more elderly become poor and depends on social welfare. Worst still, those elderly living with their families were not qualified to apply for the CSSA , whose right to social welfare was exploited. In order to be self-supported, more than a million of elderly needed to work in poor working conditions with meager salary (their median income is HK$5,000, half of the median monthly income in Hong Kong). Worse still, they were excluded from the Mandatory Provident Fund (MPF) scheme and without any retirement protection.

New Immigrants from the Mainland China

The problem of poverty is also serious among new arrivals from the Mainland China. Social discrimination and exclusion from the local people were the common obstacles for work. Government figures showed that near two-third of new arrivals whose monthly employment earnings was HK$4,000 to HK$7,000, while only 5.1% earned $15,000 and over. Even worse, the employed new arrivals generally had lower income than those of the local people as a whole (see Table 4). This led more new immigrants inevitably became the low-income families.  

Table 4. Monthly employment earnings of Employed persons from the mainland China having resided in Hong Kong for less than 7 years

Source of Information: Quarterly Report of General Household Survey, Jan-Mar 2000, Census and Statistics Department, HKSAR Government.

Housewives and single-parent families

Housewives and single-parent families are another hidden group of the poor. Like the working elderly, housewives are not entitled to the MPF scheme. Divorced or separated women have to either accept low paid work or rely on CSSA. Moreover, single parents having CSSA have to work when their children reach the age of 15 by the introduction of new CSSA policy in 1998.

2.4 Deduction of Social Security

It is doubtful whether the rates of assistance paid through the Comprehensive Social Security Assistance (CSSA) Scheme provide for a decent standard of living for its recipients, as also concerned by the Committee. Although the Government stated in the report that “To ensure the allowances maintain the purchasing power of the recipients, the standard rates are revised annually to take account of inflation. The level and scope of the special grants are also reviewed periodically to ensure that they keep pace with the actual costs of the items covered and meet the changing needs of recipients (para. 145), the reality is not so.

In December 1998, the Social Welfare Department reviewed the CSSA Scheme and recommended slashing family allowances and encouraging single parents to find jobs. Finally, the standard rates of a three-person or above family have to cut 10% to 20%, most of the special grants including dental treatment and telephone bills were scrapped, and the annual long-term supplement for healthy adult and children were also cut. According to the Secretary of Health and Welfare, the idea was to tackle abuses in the system and encourage people to stand on their own feet. However, it seems the true motive was to cut welfare expenses. Before the announcement of the proposal, the Government tried to portray poverty as laziness and misfortune as shame. The welfare recipients are look upon as parasites and wasting resources of the society. As a result, the families who received CSSA have to further cut their already limited expenses on food and clothing. They cannot afford any entertainment or social life and had to face discrimination from the society. All these seriously affect their self-esteem and health and can hardly say they are able to lead a decent living standard.

2.5 Lack of Poverty line and policy to assist the poor

The SAR Government turned its blind eye to help the poor. It rejected to establish a poverty line to monitor the situation. The poor are inevitably suffered by the cancellation of various welfare grants. In the absence of long-term policy, the day for eradicating poverty was not clear.

2.6 Recommendations

1. To ensure the basic standard of living of retired persons, low-income families and the unemployed persons, the Government should review its comprehensive social security  system. The Government should resume the special grants to the welfare recipients.

2. The Government should eliminate the age limit of the Mandatory Provident Fund (MPF) so those employees’ ages over 65 are included. Furthermore, housewives and the self-employed persons should be included into the scheme and a universal retirement scheme should be established for all citizens.

3. Definitions and indicators of the Poverty Line should be drawn by the SAR Government in collaboration with the NGOs. Moreover, the Government should form a committee, which continuously carries out research on poverty and provides recommendations for reduction of poverty.

4. The SAR Government should improve the labor retraining programs and create more jobs by developing more industries in the community such as environmental protection industry. Furthermore, it should provide subsidy for those employ re-trained workers and provide tax exemption for the self-employed workers.

5. Minimum wages should be introduced through legislation in order to ensure the basic standard of living of low-income workers. Furthermore, the Government should establish a committee to tackle the widening of poverty gap and put the issue of poverty as the its highest agenda so that the economic, social and cultural rights of the low-income families guaranteed by the Covenant can be ensured.

Chapter 3. Discrimination against New Immigrants

3.1 Institutionalized Discrimination against New immigrants from Mainland China

Although 54,000 new immigrants from Mainland China came to Hong Kong every year, representing near 1% of the whole population.  The Hong Kong Special Administrative Region (HKSAR) Government however has yet have any population or new immigrant policy to guide this flow.  Neither is there any social and economic policy to address the needs of these newcomers.  The lack of affirmative action towards these new arrivals not only hinders their equal participation, but also contributes to the building of social tension in community.

New immigrants have been made the scapegoat for incompetent government actions to improve the living standard of the poor people during economic recession.  They have been blamed for increasing the taxpayers' burden and competing social resources with the locals.  Negative public opinion has become an excuse of the government to neglect the needs of the new immigrants.  Their main source of problem is discriminative social policies.   We considered this as a violation of Article 2. 2” The States Parties to the present Covenant undertake to guarantee that the rights enunciated in the present Covenant will be exercised without discrimination of any kind as to race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.”  

3.2 Discriminative Housing Policy

Hong Kong ranks top three in the world league of housing rent.  New immigrants from the mainland China are desperately in need of subsidized housing.  They suffer great financial hardships and can only afford to live in old and dilapidated private tenements, usually sharing a unit with 8 to 10 other families or with dozens of other dwellers in a cagehome.  These immigrant families can only pin their hopes to improve living conditions on public housing.  Yet most of them cannot meet the criterion for queuing for allocation of public housing, which requires half of the family members to have at least 7 residence in Hong Kong.

3.3 No Equal Education Right

Despite there are average about 22,200 school-age immigrants from Mainland China coming to Hong Kong every year.  Most of them want to further their studies.  However, the Government has not developed a comprehensive policy to help them to integrate into the Hong Kong education system and the society.  Many of them have difficulties in finding a placement in schools and in adjusting to the new environment. We considered this as a violation of right to education according to Article 13 “The States Parties to present Covenant recognize the right of everyone to education”, as their access to proper education are unnecessary deprived due to faulty policy.

Every year, over 80% of the 19,000 young immigrants at the age from 6 to 15 have to down their grade because of the lack of appropriate assessment mechanism.  Most of them are forced to down two grades.  It made them elder than their classmates.  Their self-esteem and self-image are upset by this unreasonable arrangement.

For the young immigrants who aged above 15 would not be allocated by the normal channel. In Hong Kong, secondary school placement is centrally coordinated after the students have completed Secondary three.  The Education Department does not see that they have the obligation to assist the young immigrants to be allocated in subvented day schools.  The Education Department only recommends young immigrants’ aged above 15 to study in evening school or take adult course although most of them are very keen to continue their education in a regular day secondary school. 

Consequently, only about 60% young immigrants are able to be admitted to schools, but 70%of them only got places in private schools.  The others are forced to give up their studies and go out to work.

3.4 No equal welfare rights

As Hong Kong's economy has continued to be gloomy, many new immigrant families encounter economic difficulty, but they are not entitled to apply for public assistance unless they fulfil the one-year residence requirement.  Even though most of new immigrant children are the children of Hong Kong Permanent residents, they have right of abode in Hong Kong.  It is understandable that the initial period would be when assistance is most needed.   We considered this as a violation of right to social security according to Article 9 : The state parties to the present Covenant recognize the right of everyone to social security, including social insurance.”

3.5 No recognition in qualification from mainland and residency requirement

The qualifications gained in mainland are not recognized by most employers as the Government takes no initiative to ratify the qualifications.   Even worse is that the Government herself requires some of its vacancies be filled by people of over 7 years’ residency.  New immigrants were being discriminated in the labor market.  They took up the most unwanted jobs such as cleaning and dish washing, yet their wages were much lowered than the local people and had to work longer hours.  The monthly median wage of them is about $6,000(USD770), which is 40% less than that of the local workers (HK$10,000 or USD1,280). 

We considered this as a violation of right to education according to Article 7 “ The States Parties to the present Covenant recognize the right of everyone to the enjoyment of just and favorable conditions of work”

3.6 Recommendations

1. The government should immediately stop making any discriminative comments against new immigrants from the Mainland China and distort the perception of the general public. Furthermore, it should review all existing social policies and extract any factor of discrimination in order to ensure all people are being equally treated without any kind of discrimination as to race, color, sex, language, religion, political or other opinion, national or social origin, etc.

2. Apart from the three anti-discrimination ordinances (i.e. Family Status Discrimination Ordinance, Sexual Discrimination Ordinances, Disability Discrimination Ordinance), the Government should extend the coverage of anti-discrimination ordinance into all kinds, including discrimination against ethnic minority, in order to protect the rights of every race in the society. At the meanwhile, the power of Equal Opportunity Commission should be strengthened so that it can handle any complaints related to any form of discrimination.

3. To eradicate discrimination by the professionals, the government can co-operate with different professional bodies by preparing procedural manuals against discrimination and disqualifying the professional qualification of the professionals, who has discriminated against citizens of any ethnic minority in their daily practice. The professionals included the doctors, lawyers, social workers, etc.

4. Codes of practice should be formulated in different governmental departments and bodies and the curriculum of anti-discrimination should be included in the course of staff training of civil servants.

5. Most importantly, the concept of anti-discrimination should be delivered in the formal school curriculum, which designated for the respective age and level of students. Moreover, complaint channels should be made popular to the public and community education should be rendered actively in order to eliminate all forms of discrimination.     

Chapter 4. Split Families

4.1 Spilt families between Hong Kong and the Mainland China

In Hong Kong, there are approximately100,000 split families composing of parents and their children separated between Mainland China and Hong Kong as a result of erroneous policy . Their prospect of reunion is not regulated by a reasonable queuing system but procedures that subject them to bureaucratic manipulation and corruption. Such act constitutes a violation of Article 10 of the Convention, which stipulates that "The widest possible protection and assistance should be accorded to the family, which is the natural and fundamental group unit of society”. In light of this, we sincerely urge the Committee to pay attention to this problem and protect the rights of these separated families.

Since China has adopted the open door policy in late 1970s, the number of Hong Kong single males returning to their homeland to get marry has grown rapidly.  Nevertheless, according to existing policies, their wives and children have to stay in Mainland China to apply for One-way Entry Permits from the PRC Government before they are allowed to join their husbands/fathers in Hong Kong. 

The One-way Permit system has been commonly criticized as unfair, ineffective, as well as lacking a transparent and uniform standard. Different provinces in mainland China now operate their own system to allocate their share of the 150 daily quota and the applicants have no way of knowing the eligibility of applications, the assessment criteria nor the waiting time. We understand from the PRC government that One-way Permits are not approved on family but individual basis.  In most cases, mothers and children have to wait for their turns in separate queues, resulting in prolonged and unnecessarily family separation. The worst scenario is that in some parts of China, children are absolutely denied the right of application thus causing split families of a permanent nature. For the spouse queue, in some cities, applicants have to wait for at least 15 years, while in others, the waiting time can be as short as one year. 

Worse still, the problem is aggregated by widespread corruption. Many applicants have reported that they have to pay a bribe ranging from HKD 60,000 to HKD 200,000 i.e. USD 7,692 to USD 25,641 to the responsible district officials or they run the risk of being disqualified. As a result, families who cannot afford to pay a bribe are forced to take the risks of taking dangerous and illegal entry routes to Hong Kong. In most cases, mother who have to take care of young children have no alternatives but to turn to smugglers to bring them to Hong Kong while young children who needs motherly care are also subject to the risk of illegal entry from Mainland China.

We are concerned with the detrimental effects of long term separation on the affected families. Not only marital relationship suffers, but also children's normal development is seriously affected due to deprivation of parental care and nurture. Mothers are often imbued with a sense of guilt that they cannot fulfill their roles as wife and mother while their young children's physical and emotional development are adversely hampered by the prolonged separation.

We are disappointed that both the HKSAR Government and the Chinese Government still overlook the problems of the One-way Entry Permit system after the change pf soverenigty. We are alarmed at the lack of active cooperation and coordination between the two Governments to improve the existing system. 

4.2 Recommendations

1. We strongly urge the Hong Kong SAR Government and the People's Republic of China Government to have better coordination to ensure that One-way Entry Permits are approved on a family basis, so as to allow mothers and children to settle in Hong Kong at the same time. 

2. We strongly urge the Hong Kong SAR Government and the People's Republic of China Government to ensure the transparency of the criteria and procedure of the migration applications. It is essential that monitoring mechanism be built into the system to enable public scrutiny and sanction.

3. We strongly urge the Hong Kong SAR Government and the People's Republic of China Government to provide a reasonable and clear time limit to each split family in order to let them whenever they can reunion.

4. We strongly urge the Hong Kong SAR Government to exercise its discretionary power on humanitarian ground to the widows, who come from the Mainland China and their Hong Kong husbands were death before reunion, to resettle at Hong Kong in order to look after their children.

Chapter 5. Housing Rights 

5.1 Violation of Housing Rights in Hong Kong

While the government is proud of its economic prosperity and huge economic surplus, many housing problems of disadvantageous groups are still being neglected.  The priority target of government's land or housing policies is not to fulfill the housing needs of households living in inadequate housing, such as cage lodgers, roof-top hut dwellers, sub-tenants of old private housing and squatters residents.  In 1999, the number of inadequate housed households in non-self contained units or non-permanent structures is 140,000 households that means around one million people are living in sub-standard housing.

5.2 The cage-home problem is still a shame in Hong Kong

The indecent conditions of cage-homes have been concerned in recent years.   Though the number of cage-homes with full license has greatly decreased from 153 in 1997 to 52 in 2000, academic and Housing Authority reports indicate that as many as 10,000 single people living in cage homes.  The cage home problem is a solid example of violation of housing rights by the government, as it fails to provide adequate housing for the cagemen despite of its piling up of huge financial reserves.  The government repeatedly stated that cage homes, as a kind of cheap housing, has a strong demand among the lower class. 

In the Third Periodic Report submitted to the Committee by the Hong Kong Government, it stated that it's policy is not to phase out or outlaw this type of accommodation but to ensure, through legislation, that bedspace apartments do not endanger the lives of the persons living in them.”  In 1994, the Bedspace Apartment Ordinance was passed which requires operators to renovate their apartment to meet the fire-safety standard before 1 July 1998.  The ordinance brings little improvement in the living environment of the tenants, but the landlords use it as an extenuation of forced eviction or rent increases. 

Almost 100 cage homes have closed down in the past four years and many tenants have become homeless.  Without an adequate rehousing programme, the dwellers have to live in more appalling and unidentified cage homes.  Our observation and experiences in urban slums run an alarming figure of 40 bedspace apartments run on illegal basis. Thousands of small cubicles with inhumane living standard can easily be found in slum areas.  

5.3 Discriminatory Housing Policy Against Singletons

One of the main reasons of cage home phenomena is that the government refuses to look after the housing needs of singletons.  Whereas there are 36,000 singletons aged below 60 cramping around the cage homes, cubicles and cocklofts, the government turns a blind eye to their urgent housing needs.  From 1994-1999, there are only 370 public rental flats available yearly for them.  From official figures, the singletons have to wait about 6 to 9 years for public rental housing, which is particularly long waiting time compared with the families and elderly.  The housing policy discriminates against the low-income singletons.  For example, singletons are only allowed to apply for public housing until 1985. 

For 10,000 single cage lodgers, the rehousing policy of cagemen disappointingly victimizes them.  In according to the existing policy, only cagemen at the age of 60 or above are qualified for applying for the scheme of rehousing for public rental flats.  For those below 60, the only alternative is to move to singleton hostels.  However, the open space design of hostels has been criticized that ignores the privacy of the tenants.  Due to the undesirable conditions of the hostels, the occupancy rate of singleton hostels remained as low as at 30% when the ordinance took effective on 1 July 1998.

5.4 Dumping ground for most deprived groups

According to Society for Community Organization's (SoCO) cage-home survey conducted in 1997, more than 40 percent of the tenants were chronically ill, a quarter were ex-convicts and 10 percent were former mental patients.  Some of them were abandoned by their families.  Some became homeless and even some were introduced by social workers to live in cage homes when they left rehabilitative hostels or penal institutions.  The government has little concern on their rehabilitation and housing needs, cage homes become their only refuge. 

5.5 Inadequate housed households in private housing

According to official figures, there are around 120,000 households living in sub-standard, partitioned cubicles in tenement buildings in 1999.  Although the Government promises to relieve their living hardship by public housing policies, the number of cubicles in slum areas and the condition of tenants remain unchanged.  With reference to SoCO's private inadequate housed tenant's survey conducted in 2000, the average living space of the interviewed households was 2.8m².  For the family households, each person even cramped in only 1.9m².  43.3% respondents were living with 10 or above households in the area of around 700 square feet.  On the average, they shared with 13 and 15.4 people in one toilet and kitchen respectively. 

Most of the residents in old urban slums are middle-aged folks fallen into the prey to the restructuring of the economy.  Being suffered from structural unemployment and wage reduction, the median monthly household income of private housing residents is only HK$8500(US$1090) with the amount of HK$17,400(US$2231) of HK median monthly household income. Worst, tenants in inadequate housing also face spiraling rents under huge demand of cheap accommodation even though the prices and rental indices of private domestic flats have fallen from 422 to 242 and 198 to 141 respectively from the end 1997 to the end 1999.  The median rent to income ratio of private inadequate housed households has raised from 20% to 26.2% from 1996 to 2000.  In accordance to SoCO's research, the average rent per square feet of cubicles was $31 and the highest one, as expensive as the rent of famous commercial buildings in the city heart, was over $60 per square feet. 

Despite the adverse condition of lodgers in inadequate housing, the government has no positive action to relieve their hardship, but just let them queue up the long waiting list for public rental flat. 

5.6 Urban poor in public housing

The unskilled labour become the victims of economic downturn and economic restructuring.  The decline of revenue from public housing residents directly shows the difficulties of urban poor.  The median monthly household income has dropped from $15000 in 1998 to $12500 at the end of 1999.  The number of public assistance recipients doubles from 60,000 households in 1995 to 115,000 in 1999, which composesaround 20 percent of public housing households.  However, only around 2,500 households out of 70,000 eligible families have benefited from the rent reduction, since the introduction of this rent assistance scheme for hardship residents in September 1992.  It is because the eligibility criterions for the application of rent assistance are very harsh and complicated that residents benefiting from the scheme are required to move to cheaper flat after two-year subsidized period or to quit the scheme.

5.7 Recommendations

       1. The Hong Kong government should eradicate the phenomenon of a cage home and ensure that all cagemen and deprived singletons are provided with adequate and affordable housing.

        2. The Hong Kong government should stop all forms of discrimination against single people in assess to public housing.

        3. The Hong Kong government should actively identify illegal run cage home and study the housing or service needs of residents in old urban slums.

       4. The Hong Kong government should provide adequate housing and enough social services to inadequately housed households and provide more hostels for singletons in urban area.

       5.The Hong Kong government should provide adequate housing with rehabilitation services to those deprived groups such as mental ill patients, ex-prisoners and chronically ill patients.

        6. The Hong Kong government should provide rent subsidies scheme for financial hardship families with affordable public or private housing and increase the supply of public housing.

         7. The Hong Kong government should open channels to enable citizens to participate in policy-making with regards to land and housing.

APPENDIX 1：Households Living in Inadequate Housing

Chapter 6. Street-sleepers

6.1 Increasing number of Street-sleepers

The phenomenon of street sleeping has been existing for a long time in Hong Kong.  Street-sleepers have no place to live, not even temporary accommodations.  After the first local study of street-sleepers in 1977, street-sleepers have become the concern of non-governmental organizations (NGOs).  However, not until the end of the eighties did the Hong Kong Government give more concern to the issue.  Regrettably, besides conducting superficial surveys and giving limited resources to services related to street-sleepers, the Government has not taken further positive actions to solve the problem of street-sleeping in these years. 

According to the Government surveys, the population of street-sleepers is around 1000 and the figure decreased to 726 and 819 in the survey in 1998 and 2000 respectively.  This figure is in doubt since in our observation, the number of street-sleepers seemed to be increased after the economic downturn in 1997.  Also, in SoCO's research, nearly half of the respondents had not been contacted by any Government officials and street-sleepers outreaching teams.  Therefore, the real figure may be a double of that provided by the Government.

Leave behind the disagreement over figure and even if the Government figure is correct, it does not necessary mean that street-sleeping is a minor problem.  In fact, for many years, the right of adequate standard of living of street-sleepers is being violated.  According to SoCO's research, street-sleepers are in great need of housing.  Some very basic needs of them, e.g. clothes and food were not satisfied as well.  Poverty is one of the reasons leading people to street-sleeping.  In addition, inappropriate government policies and inadequate services keeps street-sleepers remain in their present situation.

6.2 Unemployment resulting in street-sleeping

Unemployment is one of the main factors leading to street-sleeping.  The unemployment rate was rising after the economic downturn in 1997 and the rate hit highest at 6.3% in 1999.  People who are low-skilled workers with low education level were affected most.  Jobs with low income and low job-security such as construction work are the only choice of these people.  Therefore, once unemployed, their have financial difficulty and cannot afford the rent.  These people thus end up in street-sleeping. 

It should be noted that there seems to be a trend that more “productive” people who are young and have high education level sleep in the street.  This trend poses a critical challenge to the policy assumption of the Government in dealing with street-sleepers.

6.3 Mismatching government policy

The Government policy can be seen in a working group report published in 1993.  In the report, it states that:

The policy of Social Welfare Department is to render appropriate help to street-sleepers who are regarded as disadvantaged and vulnerable group.   Special attention is given to those who are elderly, disabled, sick, the mentally ill, or are suspected to be drug addicts or alcoholic

In other words, street-sleepers who are young and healthy are expected to meet their needs on their own.  Indeed, people can have their needs satisfied through the labour market system.  However, given the present economic situation of Hong Kong, the labour market does not function as well as before.  The trend of increasing “productive” street-sleepers gives an alarming signal to the Government to review the policy dealing with street-sleepers.

Another way to satisfy people's need is through the family system, which is always encouraged by the Government.  However, the vast majority of street-sleepers is singleton and has none next-of-kin in Hong Kong.  Therefore, street-sleepers cannot find family support to help.  Again, the Government should not assume that the family system works to prevent people from street-sleeping.  In other words, the Government need to review its policy deal with street-sleepers and based it on a deep understanding of the situation of street-sleepers.

6.4 Out-reaching service: 1 to 125 worker-client ratio

Out-reaching service is one of the main street-sleepers services.  Workers in out-reaching teams are responsible to contact street-sleepers, establish relationship with them for further assistance.  There is a serious shortage in out-reaching teams workers.  Now, there are formally four out-reaching teams in Hong Kong, three of them from the Government and one from NGOs.  Previously, there is one more pilot out-reaching team having a registered nurse for conducting on-site assessment on suspected mentally ill street-sleepers.  However, this team was put to an end due to insufficient resources as subvention terminated by the Government. 

Totally there are only eight workers to serve nearly 1000 street-sleepers all over Hong Kong.  In other words, 1 worker has to serve 125 clients.  No wonder why there was nearly half of respondents in SoCO's research had not been contacted by any out-reaching workers.  The result of shortage of out-reaching workers is that street-sleepers can hardly access to the welfare system for help.

6.5 Inadequate quantity and quality of shelters and hostels

There is a serious shortage in shelter/hostel service for street-sleepers.  There are total 403 bed-spaces in shelter/hostel for street-sleepers.  Only 28.8% of all bed-spaces are subsidized by the Government.  The average utilization rate of street-sleepers shelter/hostel was more than 90%.  In addition, the lowest admission age for these shelters is usually at 55.  Thus street-sleepers aged below 55 found it hard to move in.  The service availability for the middle aged and younger people is highly restricted by the present policy.

There is no helping program and counseling services offered in many shelters/hostels.  69.2 per cent of bed-spaces have no social workers responsible for providing professional service.  There is also no rehabilitation program offered to those who are suspected to be drug addicts, alcoholics, and mentally ill patients.  Also, even for those who have no problem, they cannot easily get back on track to restart their lives without any professional help from social workers.  Therefore, the service quantity and quality of shelters/hostels services are have to be improved definitely.  Furthermore, all the shelters/hostels should have basic necessities, such as lockers, telephones, cooking facilities, so as to attract street-sleepers to move in.  The helping process can be furthered in the shelters/hostels when they are settled in there.

6.6 Walk for an hour to have a free meal

Hunger is common among street-sleepers.  The Government does not provide any free meal service by itself but subsidize only one NGO to provide free meal to people in need.  To have free meal, one must get the approval from the Social Welfare Department and duration of having free meal is for only one month.  Some street-sleepers may need to walk for an hour to get there to have a free meal. 

6.7 Recommendations

1. The Hong Kong SAR Government should conduct a more comprehensive survey to identify the number and needs of street-sleepers and review the existing policy to help them re-integrating into the society.  The problem of street-sleeping should be given in a higher priority in the government agenda.

2. Since unemployment is the one of the main reasons leading to street-sleeping, The Hong Kong SAR Government should formulate appropriate labor policy and social security policy to prevent people falling into street-sleeping.

3. Integrated service should be the mode of street-sleeper service.  Such service should include outreaching service, day centre service, hostel service, counseling, rehabilitation services (such as drug and alcohol abstaining services) as well as employment counseling service.  These services would be better to be operated by NGOs under the subvention of Government.  Hostels of integrated service should be located in the urban areas so that street-sleepers can easily get access to the service.

4. More outreaching teams, including medical professionals, should be established to serve all the street-sleepers in Hong Kong.

5. The Hong Kong SAR Government should standardize the facilities provided in all shelters.  Such standardized facilities should include telephone, kitchen, private locker, and air-conditioning.  Shelters should not be closed in the daytime.  Moreover, the Government should subvent shelters to improve its facilities

Chapter 7. Mentally Ill

7.1 Increasing number of mentally ill

According to the Hong Kong Rehabilitation Programme Plan (98/99-02/03), the estimated number of people suffering from mental illness rose from 882,039 in 1994 to 1,203,188 in 1998 while the attendance of psychiatric out-patient clinic multiplied from 320,495 in 1995/96 to 432,069 in 1999/00.  Article 12 of the International Covenant on Economic, Social and Cultural Rights recognizes 'the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.”  However, there are a lot of problems and acute inadequacy in the existing service for the mental illness and all of it deprives the health right of people who suffer from mental disorders. 

7.2 Low percentage of using new anti-psychotic drugs

Mental ill patients in Hong Kong are prescribed drugs that most western countries abandoned to use decades due to their side effects.  Anti-psychotic drugs invented in the 60's such as Largactil, Haloperidol are still commonly used.  Hospital Authority, which manages public medical institutions, only spent around 6.1 % in 1998 of its medication budget on using new drugs in psychiatric services.

In order to save costs, public doctors use outdated anti-psychotic drugs even though the destructive side effects of traditional medicine are well known.  Therefore, patient will trend to refuse having any medical treatment.  The government concerns how to save costs instead of how to enhance their quality of life.  Due to improper medical treatment, the health rights of mental ill patients are absolutely ignored.    

7.3 Short consultation time but during long queuing

Follow-up consultations in outpatient psychiatric services are important to detect early signs of relapse or to offer proper diagnose.  Deplorably, the consultation time for patients is seriously inadequate.  From 1999-2000, the average number of patients in three-hour consultation session in outpatient clinic was 14.2 that meant psychiatrists could only spend less than 10 minutes on each patient.  For the newcomers, they needed to wait around two months for their first consultations. 

7.4 Poor Community Psychiatric Services

To avoid prolonged institutionalization, the shifting of medical services from hospital-based to community-based is necessary.  Unfortunately, the government only shows its half-hearted concern on the issue of imbalance between hospital-based and community-based medical services.  In fact, there were only 62.5 community psychiatric nurses for all outpatients in 1998/1999.  The number of placements in Day Hospital slightly increased from 550 in 1992/1993 to 639 in 1999/2000.  Poor community psychiatric services fails to address vicious cycle of relapse and even worsens the situation.

7.5 Inadequate rehabilitative residential services

Residential facilities under respectable therapeutic treatment ironically contribute to the rehabilitation of former mental patients.  There are three types of residential placements in Hong Kong that are halfway houses, long stay care homes and supported hostel for semi-independent living.  Halfway houses and supported hostel are based on the rational of community-based rehabilitation while long stay care homes are more institution-based. 

Although the government admits the urgent need of residential services, the estimated demand of those facilities by the government has never met.  According to Hong Kong Rehabilitation Programme Plan (98/99-02/03), the shortfalls for placements of halfway houses and long stay care homes were 691 and 1667 in 1999-2000 respectively.  Worse still, the situation will remain unchanged in the following years. 

To prevent relapse and readmission of dischargees of the halfway house, an alternative residential facility has been recommended by academics and even government officials.  In the 1995 White Paper stated the Supported Hostel for Semi-independent Living or Supported Housing for Independent Living” to serve those dischargees that are important for patients to integrate into the community.  Nevertheless, the government only provides 20 placements for supported hostel.  The only supporting housing with 24 placements in Hong Kong is provided by a non-governmental organization without any government subvention.     

7.6 Poor counseling and after-care services

Follow-up counseling service for mental patient or formal mental patients is provided by requiring them actively contact medical social workers in hospitals and clinics.  However, the medical social workers are already overburdened by their very heavy caseloads.  With reference to the recommendation by the former Medical Development Advisory Committee, the manning ratio is one medical social worker to 250 out-patient psychiatric cases.  Such ratio is impossible to provide in-depth services and assure the quality of social rehabilitation.   

7.7 Mentally ill dumping in cage homes

There is a phenomenon that some of ex-mental ill patients and severe mental patients are dumped in cage home or tenement cubicles in old urban area.  According to Society for Community Organization's (SoCO) cage-home survey conducted in 1997, 10 percent of tenants were ex-mental ill patients.  With a lack of comprehensive rehabilitation policy, they become homeless after a short stay in hostels or discharge from medical institutions.  As they have difficult to be employed, most of them have to rely on Comprehensive Social Security Assistance.  They can receive only a scanty rental allowance of $1,505 per month.  With that meagre amount, they can only rent a bed in a cage home.  The poor living conditions have aggravated their illness which restraint their rehabilitation and reintegration into the community.

7.8 Inadequate Vocational Rehabilitation Services

In accordance to a Baseline Survey on Employment Situation of Persons with a Disability in Hong Kong 1997, the unemployment rate of mentally ill (31.4%) was the second highest compared with other disability groups.  However, the general unemployment rate of Hong Kong in 1997 was 2.2%.  As the government's half-hearted concern on the vocational needs of all disabled groups, unemployment rate of the whole population of the disabled job seekers has never officially been recorded.  Besides, the government takes no positive action to improve current vocational rehabilitation services in order to enhance the employment rate of ex-mental patients. 

As stated in 1995 White Paper, to meet the goal of full participation and equalization of opportunities in the context of employment and vocational rehabilitation, the objective is to ensure that people with a disability have an equal chance to participate in productive and gainful employment in the open market.  Vocational rehabilitation enables people with disabilities to secure, retain and advance in suitable employment and thereby to further their integration into society.”  Most common vocational rehabilitation services are sheltered workshops, supported employment services and selective placement services.  Despite the government has stated the excellent objectives, it has done little on that. 

Sheltered work is provided in a planned and controlled environment for people with disabilities.  It ultimately aims at moving on to supported and open employment as far as possible.  The shortfall of workshop vacancies has never fulfilled.  In 1999/2000, the shortfall is 3,167.  The time of many capable disabled job seekers has been wasted in prolonged queuing. 

Supported employment service is a kind of employment service for people with disabilities which allows them to work in an integrated open setting with necessary counseling and support services.  Although it is important step to receive training in supported employment before open job seeking, it is only 1070 supported employment places for all disabled people.  Most of the former mental patients are easy to relapse in facing high pressure when they are forced to find open employment without proper counseling.

The Labor Department in Hong Kong is responsible to provide selective placement service to assist people with disabilities in finding open employment.  Nonetheless, its work just confines to job matching and some interview techniques’ training.   Between 1994 and 1999, the Selective Placement Division recorded only 28.1-30% of successful rate for ex-mental ill.  There was only 265 former patients had been offered job through selective placements scheme in 1999.

7.9 Recommendations

        1.  The Hong Kong SAR Government should reform the medical system, by placing more psychiatrists, community psychiatric nurses, medical social workers in order to develop a more comprehensive community-based treatment plan.

        2.  The Hong Kong SAR Government should use its medication budget for buying more new psychotic drugs.

        3.  The Hong Kong SAR Government should fill the service gap between institutionalization and community-based rehabilitation by providing various residential facilities for the mental and ex-mental patients.

         4.  The Hong Kong SAR Government should provide more long-term care residential facilities in order to shorten waiting time of the severe mentally ill.

         5.  The Hong Kong SAR Government should provide follow-up counseling services for the ex-mentally ill in order to help them to re-integrate into the community.

        6.  The Hong Kong SAR Government should improve the coordination between medical institutions, non-governmental organizations and mental ill patients’ families to prevent from re-admission of hospitals and to provide comprehensive services for the patients.

        7. The Hong Kong SAR Government should provide more vocational training and rehabilitation resources for the mentally ill.

Chapter 8: Care for the Elderly

8.1 The Problem of Aging

The population in Hong Kong has been aging. According to Census and Statistics Department, 14.9% of our population now aged 60 and above in 1999. The elderly population will grow a further 2,341,100 by year 2029, when it will constitute 25.8% of the total population.

Aging is associated with disease and disability. Previous studies have shown that about 50% of elderly persons have chronic illness and 20% some form of disability. They are prone to rapid deterioration and fluctuation. Their needs are multiple, including medical care, residential, community care and psychological support.

It is no surprise that elderly persons are heavy consumers of health care resources. In March 1999, about 47.7% of the in-patients using hospital services are aged 65 or more. Besides, those old persons have shared 35% out-patient services in Government's clinic. 60% of the targets using community nursing service belong to the old age group. However, the elderly's quality of life is unsatisfactory in Hong Kong and the suicide rate of the elderly in Hong Kong is deplorably high, up to astonishing 31.2%, which is greater than other Asian counterparts. 

      8.2  The Problem of Health Care Services for the elderly

Compartmentalized Health Care Provision

In Hong Kong, health services are delivered in compartmentalized institutional setting which is characterized by a lack of interface across the different levels of care, including primary care and inpatient care, private sector and public sector, acute services and community services. The Government only provides fragmented health, medical and community care services in different departments including Department of Health (DOH), Hospital Authority (HA) and non-Governmental organizations (NGOs). It is lack of co-ordination with those varied services. As the health authority in H.K., the Department of Health operates a wide range of primary health care services. Owing to poverty problem of the elders, most of them consume comparatively cheap medical services in public sector.

Unbalanced Health Service Development

The Hong Kong SAR Government has not increased the weight of primary health care in local health care system. She injects more resources in the secondary care rather than in primary health care system. Hospitals constitute a major component in Government's public health care expenditure. The budget allocated to HA in 2000/2001 is $28.9 billion. In terms of financial resources, the annual budget of the Department of Health increased by an average of only 4.8% annually in real term from 1992/93 to 1997/98, which was moderately lower than the 5.1% real annual economic growth and significantly lower than the 8.3% real annual growth in subvention for HA over the same period. Thus, the local health care system has not been developed in a healthy way. The primary health care has not been emphasized. It has not received adequate attention. Undoubtedly, the gatekeeper of this health care system is very handicapped. 

8.3        The Problem of Primary Health Care System

Lack of Comprehensive Primary Health Care Policy

Primary health care is participatory care: bad habits increase cost to the community. Primary health care can be promotive or preventive. It covers areas such as health education, family planning, maternal and child health, immunization and the treatment and control of diseases. We are very disappointed that the Government has never planned primary health care policy and implemented comprehensive primary health care services in Hong Kong. Though the Government has published a Report of the Working Party on Primary Health Care in 1990 and the consultation paper on Towards Better Health in 1993, she has not implemented those recommendations in primary health care services.

Short physician time spent with patients and poor patient recordsS

Primary health care services are delivered through a network of clinics and health centres. Primary medical care is also a part of primary health care. It is provided in the from of medical consultation and dispensary services in services in the public out-patient clinics throughout the territory. Dissatisfaction is centered on their services quality. Relatively short physician time spent with patients seems to be the norm in Hong Kong. Their Household Telephone Survey (1998) shows that half of the patients who had visits for a fever/cold/flu saw their general practitioners for 5 minutes or less. It absolutely reflects the depth and intensive of each diagnosis.

42% of respondents in their Patient Satisfaction Study considered consultation times to be too short. Furthermore, there is no accommodation made for the elderly, who comprise a large proportion of public clinic attendees and require more time for consultation. Regular patients at a public clinic noted that often, elderly people who speak slowly do not even have time to finish what they would like to tell the doctors .

Evidently, it seems highly questionable that the physician in out-patient clinics could understand a patient's complaints, diagnose the problem, recommend a treatment, and educate the patient about the treatment within a 5 minutes visit. Besides, the family medicine has not been promoted. There are only 29 family medicine practitioners under Department of Health. Besides, patient records do not routinely follow patients upon discharge. In this regard, there is a serious lack of communication or information exchange between hospital-based and community-based practitioners. On the other hand, medicine and drug prescription also has incompatible problem among HA and DOH. It affects the continuity care for the patients with chronic illness.

Long waiting list for specialist out-patient department (SOPD) treatment

Because of the poor general out-patient treatment services, the patients’ services demand are being distorted and flow to specialist out-patient treatment under HA. There is a long waiting list for SOPD treatment, which refers to the time elapsed between requesting an appointment and the actual visit for SOPD treatment. As at 96/97, the average waiting time for specialties in Geriatrics is up to 12 weeks. In addition, not all public hospitals provide the specialties in Geriatrics. Hence, the elderly people living in some certain districts, where have no specialties in Geriatrics, would go to other districts for using the medical services. It caused inconvenience and burden to old patients. Owing to inadequacy of specialties in Geriatrics, those old patients with chronic illness will be transferred to other SOPD treatment. HA data reveals that the median waiting time for first appointment at all specialist clinics for 2000/2001 is 5 weeks

According to the HA Patient Satisfaction Survey revealed that close to half of the respondent were dissatisfied with the queuing time. The results of this survey also depicted that the long waiting times could affect not only patient's satisfaction with medical care but also their health outcomes. It clearly indicated that their health deteriorated during the waiting period. In addition, HA data shows that the average lengths of specialty visits range from 5.5 minutes in ophthalmology clinics to 20.8 minutes in radiotherapy and oncology clinics. The short consultation visits reflect the poor quality services.

8.4             Problems in the Secondary and Tertiary Health Care

Inadequate of Geriatricians and acute and extended care beds in Geriatrics  

             The weakness of primary health care system put increasing strain on acute hospital services. The iron fact that those old persons whose needs are relatively generic and those with multiple medical and social problems. They are usually cared under the co-ordination of geriaticians. However, related to generic medical service practitioners only limited to about 100 generic doctors. The ratio of geriaticians to old people is up to 1:9000. Those requiring continuous medical and nursing care for extended periods of medical rehabilitation are being cared for in extended care settings. As at March 2000, there are 1,114 Geriatric beds and 7,736 Internal Medicine beds. The ratio of acute and extended care beds in Geriatrics to elderly is also up to 1: 808. It totally depicts the great service gaps.

Extremely long waiting list for infirmary beds

In addition, more than 95% of the general infirmary patients are aged over 65. A total of 1950 general infirmary beds was provided as of March 2000. There are at present 5,000 elderly on the central infirmary bed waiting-list. The inadequate beds in Geriatrics and infirmary beds made the frail old patients being forced to discharge without recovery. It increases the burden on the carers and community cares services.

Shortage of community nursing and day hospital in Geriatrics

In order to enhance better continuity of care in the community settings, community nursing and day hospital play the significant role. In fact, the patients aged over 65 who share the majority participation rate in community nursing. As at December 1999, they share 78% visits conducted by community nurses. However, there are only 325 community nurses in 13 public hospitals serving the whole population. The ratio of the old persons to the community nurses is 1:2,769. They cannot meet the uprising service demand of the elderly. In addition, the placements in day hospital in Geriatrics only limited to 415, which definitely could not catch up with the growing up aging population. Whereas those community support services are not sufficient and comprehensive in Hong Kong, it affects those old frail people's health condition and rehabilitation progress. It greatly increases their needs for hospitalization.

8.5 Great Services gaps in Community Care Services for the elderly

Apart from the acute care and treatment for the patients, there are many other programmes initiatives in improving the health and functional status of elderly persons and their quality of life. The Government contracts out the community care services to the NGOs as service providers.

Shortage of residential care services for the elderly

Residential care service is paramount to provide community-oriented long-term care for elderly people who can no longer be cared for at home. Owing to the shortage of placements in subvented day-care centres and Care and Attention Homes, the waiting time have worsened rather than improved. In fact, there are 19,012 elders awaiting for Care and Attention Homes and its waiting time is up to three years. Besides, 7,341 old persons are applying for Home for the Aged and the average time is 18 months. For providing long-term institutional care to low self-care ability senior citizens, nursing homes represent an alternative way to meet their needs. 4,401 people are awaiting for nursing homes and the time is even up to 14 months. Though the Government shifts to buy institutional placements from the private sectors, the prolonged waiting time phenomena still emerged. Whereas those old frail people cannot enjoy residential services and being forced to live at home alone without good care. It absolutely affects their health condition and it increases elders’ hospital readmission rate.

Problems of home-help team services

The home-help team services comprise of meal and home care services. Owing to the great service needs of home-bound and frail elderly, the 163 home-help teams have serious service gaps problem. Prolonged waiting list problem for meal and care services has been in existence for a long time. Currently, for the sake of reducing the cost, the Government contracts out two meal services of home-help team to the commercial sector, which absolutely affects the service quality. According to the previous studies from NGOs, the service users commented the poor food quality, not only the taste, but also the variety is not suitable for the elderly’s appetite. Actually, the previous home-help services conducted by NGOs would pay concern and provide extra services to the clients. But now, in accordance with the fast and efficient principles, the commercial sector only render meal delivery services. 

Limited support and resources for the carers

For a better rehabilitation progress, the carers play vital role to help the patients to recover well. Usually the spouse or the family members act the carer’s role. The Government set up two support and resources centres for carers in 1998. It aims at providing training, education and supportive services for the carers. But it is unbelievable that two centres with limited programmes could meet the needs of the great numbers of carers in the territory. In addition, there is no subsidy or allowance for the carers in H.K., which has been implemented in Britain many years ago. Without sufficient financial and community care services support, it will increase the strain of those carers.      

fordability of the elderly for medical fees and charges

From our estimation, there are 200,000 old persons living under poverty, who are not receiving welfare assistance. Hence, they are not entitled to free medical services or any subsidy. Being as the main service users in medical services sectors, their monthly medical expenditure is very great. No subventions for the frail poor elderly made their financial situation plight. It is regret that the Government does not provide assistance to the old patients with low affordability.   

8.6 Recommendations

1.  The Hong Kong SAR Government should shorten the long-waiting time of the elderly to the subvented hostels to one year.

2.  The Hong Kong SAR Government should increase the residential allowance for the CSSA recipients for the elderly.

3.  The Hong Kong SAR Government should increase the primary health and promote family doctor system.

4.  The Hong Kong SAR Government should increase the number of bedspaces and Geriatricians serving the elderly patients. Moreover, the Government should provide more community nurse to promote rehabilitative service for the elderly.

5.  Last but not least, the Hong Kong SAR Government should provide medical assistance to the non-CSSA, low-income elderly. 

Society for Community Organization
Hong Kong Human Rights Commission
Address: 3/F, 52 Princess Margaret Road, Homantin, Hong Kong.
Tel: 852-2713-9165, Fax: 852-2761-3326
E-mail: soco@pacific.net.hk,  hkhrc@pacific.net.hk
website: http://www. kkhrc.org.hk

LOCOA : Leaders and Organizers of Community Organization in Asia
28-B, Matino cor. Malumanay Street, Sikatuna Village, Brgy Malaya, Diliman,Quezon City, Philippines
Tel : (632) 925-8432,  426-4119, 922-0988 Fax : (632) 426-4118
E-mail : locoa2000@yahoo.com