As Hong Kong's ageing population trend persists, there continues a strong demand for residential care services. However, a long wait for subvented places may make it necessary for the elderly needing care to be admitted into private Residential Care Homes for the Elderly (RCHEs). In view of this, the Consumer Council surveyed 46 private RCHEs which have not joined the Enhanced Bought Place Scheme (EBPS), including their basic monthly fees, other charges, termination procedures, and care staff arrangements, etc. It was found that aside from a difference of over 12-fold in basic monthly fees, most homes charged additional fees for a wide range of services and daily consumables, and they were calculated by the homes’ own methods according to the quality of facilities and type of rooms, while deposit and move-out policies also varied considerably. Apart from accommodation and meals, elderly residents’ physical needs have a direct impact on other expenses, and overall cost could increase substantially. Therefore, consumers should check charge lists and details in choosing a care home for their elders, and assess affordability in light of the actual needs of the elderly resident. In addition, the ratio of carers to residents varied drastically among homes, with individual homes having a staff ratio of only 1:30, which posed a possibility of manpower shortage if most residents require a high or medium level of care. The Council anticipates the Government to review existing elderly service policies and RCHEs standards in a timely manner, and if necessary, relax the ceiling for labour importation quotas to help elderly citizens receive care services at reasonable and affordable prices.
The Council sent questionnaires to 297 private and non-EBPS RCHEs and ultimately received only 40 fully completed replies, reflecting the lower level of information transparency of the industry. Among the districts with a relatively low response rate, Council staff also randomly selected 6 private RCHEs which did not respond to the questionnaires, and obtained partial information by posing as consumers. All care homes surveyed had “high level” care capabilities, offering from 19 to 229 resident places. 33 homes indicated that the minimum age of the residents was 60 or 65, while 2 homes set an upper admission age limit of 95 and 100 years old respectively. Furthermore, 21 homes required residents not to have infectious diseases, mental illness and/or AIDS, and self-harm or violent tendencies.
Beware of Wide Range of Other Charges and Varying Methods of Calculation
May Account for Lion’s Share of Total Payment
The cost of an elder’s stay in a RCHE is a substantial expenditure for the average family, so it is crucial to pay attention to all expense items when choosing a care facility. The care homes charged a series of monthly fees according to the level of care required, type of room, district of location, and the environment and facilities of the homes, etc. of which the basic monthly fees could range from $6,000 to $82,000, a difference of over 12 times. This basic monthly fee included accommodation and 3 meals per day, and some homes also provided refreshments or late night snacks. Particular homes charging higher basic monthly fees also provided medication management, regular visits by or consultations with doctors or dieticians. Most of these homes required a deposit payment equivalent to 1 month’s basic fee prior to admission, while some homes charged half a month’s basic fee or a flat rate of $1,000.
In addition, 30 homes charged an administration/bedding fee for the first move-in, ranging from $500 to $4,000, a 7-fold difference, while more often the charge was below $1,000. Other expenses included electricity, with 7 homes charging between $150 and $200 per month, and 9 other homes charging for each item of electrical appliance. 39 homes generally charged $100 to $650 per month for air-conditioning from May to October, with 1 charging $200 per month for heating from December to February, and 1 charging a flat fee of $220 per month for air-conditioning throughout the year.
During their stay in the care home, an elderly resident would need to use various daily consumables each day, and some may need medical services. All these items in most cases are separately charged, including patient escorting, delivery service, blood glucose tests, wound cleansing, and daily consumables such as diapers, toilet paper, and nutritional milk powder.
Regarding medical related services, with patient escorting service as an example, care homes usually charged a flat rate for the first 2 to 4 hours, followed by an additional hourly rate; or an hourly rate with a minimum of 2 to 4 hours’ service; while some care homes charged on a per visit basis. In addition, the charges may also vary according to the type of consultation, urgency, the time of the day, or district of visit. Charges for collection of medication or delivery of test samples were usually calculated on a per visit basis, ranging from $50 to $450, or from $90 to $250 per hour, with some homes charging a minimum of 1 to 4 hours of service.
As for daily consumables such as diapers, most RCHEs would charge on a per-piece, per-pack, or per-month basis. Some care homes offered incontinence care packages including gloves, buttock cleaning and skincare, with monthly fees from $3,000 to $5,000. When charged on monthly basis, the cost of diapers ranged from $1,600 to $3,000; while charging by each diaper used (ranging from $5.4 to $20), assuming that an elderly person uses 8 each day, the monthly cost would range from about $1,300 to $4,800. If consumers are given the option to provide diapers on their own, it is recommended to shop around according to the needs of their elders as this may save a considerable sum in the long run.
Taking the 3 surveyed RCHEs in the Eastern District as an example, other charges (excluding expenses on non-essential items such as patient escorting, delivery service, and nutritional milk powder) paid for elders with high care needs accounted for about 0% to 57% of their basic monthly fees. It is worth noting that in some relatively economical RCHEs, other charges are mostly covered in the basic monthly fee.
Elders with health problems may be admitted into and discharged from hospitals every now and then, and may even pass away during their residency in RCHEs. Policies on fee waiver or refund for hospital stays, termination of residency, or death varied among care homes. 39 care homes indicated that they would not waive the monthly fee for hospital stays as the elderly’s place would still be reserved for them, while 31 care homes would refund on a pro-rata basis or suspend other charges during the hospital stay. If an elderly resident stayed in a hospital for 30 days or more, 4 care homes indicated that the monthly fee could be reimbursed on a pro-rata basis. If an elderly person terminates their residency, most care homes required a notice period of 30 days or 1 month. In the unfortunate event of death of an elderly person during their stay, 28 care homes indicated that they would not refund monthly fees paid, while 12 homes would provide a pro-rata refund of monthly fees, to be paid on the date of departure to within 7 days to 1 month after the date of departure.
Disparate Staff Ratio Calls for Strengthened Monitoring to Ensure Service Quality
Existing policies do not require private RCHEs to have nurses or doctors in-residence on a permanent basis. The survey found that only 13 care homes employed resident nurses, and 2 other care homes had resident doctors.
The day-to-day care of elders in homes is mainly taken up by care workers (CW) and health workers (HW). The surveyed RCHEs each employed 1 to 15 HWs and 4 to 30 CWs respectively, with drastically disparate manpower ratios. The staff ratio of carers to residents was most favourable in homes charging relatively higher fees, with 2 homes having a ratio of 1:3, while the more common ratio ranged from 1:15 to 1:20. However, there were also some homes with a ratio of 1:30 only. Assuming that the number of elders requiring high, medium, and low levels of care in each facility is similar, and based on the manpower ratio of 1:30, it means that each care worker has to change the diapers of 10 elders requiring high level of care 7 to 9 times and spoon feed them 3 times per day, and bathe them every other day, while also taking care of the remaining 20 elders who required medium and low level of care, so workload is demonstrably very heavy.
Nevertheless, under the existing minimum manpower requirements under the Residential Care Homes (Elderly Persons) Regulation, a staff-to-resident ratio of 1:30 or above is still considered acceptable, whereas from 16 June this year, the minimum manpower requirements and minimum area of floor space per resident will both be increased in phases. However, in response to the increasing demand for care homes, the Council reminds care homes to regularly review the staff ratio and put in place a back-up plan to cope with the possibility of manpower shortage. The Government should also strengthen monitoring and review the need to relax the relevant labour importation quota ceiling in a timely manner, so as to enable the elderly to enjoy care services at reasonable and affordable prices.
In summary, consumers are advised to consider the needs of their elders and carefully take into account the miscellaneous fees and charges when selecting suitable RCHEs. They may refer to the following suggestions:
- Before moving in, bring the elder to all shortlisted care homes for in-person inspection of the environment, care workers’ manpower and facilities, and enquire about the calculation of other charges and terms of residency;
- Take the time to visit their elders more frequently after move-in to better observe the actual living conditions;
- Check fees and charges meticulously in every bill to ensure that they are correct and reasonable;
- Keep deposit receipts as evidence for use at termination of residency;
- Search and compare services and fees among different types of RCHEs in Hong Kong on the “SWD Elderly Information Website”.
Download the article (Chinese only): https://ccchoice.org/570elderly
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