An analysis of the decision-making process within households in relation to the residential care services for the elderly in Hong Kong

Abstract

Background Population ageing is a major public health concern globally as older people with disabilities or suffering from chronic diseases are expected to live longer. The demographic shift in Hong Kong is particularly pronounced and increasing resources on elderly healthcare will add substantially to the government’s financial burden. Research has shown the importance of better understanding the healthcare challenges posed by an ageing population in order to promote informed choice, align policy with need, and deliver effective, efficient and sustainable health services. Objectives This dissertation explores the circumstances and factors that influence a household’s decision to place an elderly person in a care home. It considers the decision-making process in the contexts of the interactions and negotiations that take place within and between household members; a key objective is to examine the extent to which the elderly are themselves participants in this decision-making process.

Description of the sample The researcher interviewed a total of nine Hong Kong Chinese residents from two private nursing homes. They were between 63 and 92 years of age at the time of the interview and had been residing in a care home for an average of 2.5 years.

Methods This is a qualitative research study in which primary data were gathered through face-to-face, semi-structured interviews. The research focused on subjects with high-functional status. An inductive approach to thematic analysis was adopted.

Results The majority of the subjects had been admitted to hospital as a result of an acute health incident. They were subsequently transferred to the care home directly from the hospital. The subjects drew a direct link between the health incident and their placement in the care home. It became apparent in the course of the interviews, however, that other contextual factors had played an important role in the decision-making process, determining how the subjects themselves retrospectively rationalized their relocations. Over the course of data analysis, family relations, assumed gender roles, perceptions of self-identity, and practical constraints were identified as themes that impacted upon the decision-making process in relation to placement decision within a household setting. The findings suggested the degree to which the broader context of the subjects’ past life experiences permeated the decision-making process. It also underscored the importance of the roles and responsibilities assumed by the elderly.

Conclusion By examining how the elderly themselves discuss their experiences and justify their choices, the study sheds light on the cultural assumptions, conventions and traditions that shape how subjects perceive norms of behaviour, expectations and responsibilities.

Future studies might extend the scope of research further to incorporate the views of household members, who are also potential caregivers. Given that the subjects were admitted to care homes after an acute health episode, which resulted in hospitalization, it would also be worth exploring alternative options in relation to the discharge arrangements for elderly persons. This study would also benefit from further research into the comprehensive long-term care system in Hong Kong, including the provision of services, long-term housing, healthcare choices, and the financing of long-term care.