Understanding informal caregiving in Hong Kong : a public health perspective on the negotiation between traditional values and modern living

Abstract

Introduction Having a caring family is an important resource to any older person, not only does it provide a great source of care and support when they require others’ help and assistance in performing daily activities, it also serves to alleviate the burden of welfare system and balances health care expenditure.

The traditional paradigm reinforced the idea that healthcare is and should be provided by doctors, nurses and health professionals within the healthcare settings (e.g. clinics and hospitals), although family members for centuries had provided care, support and assistance to each other in time of illness. The role of informal care provided by family members was often overlooked.

Hong Kong, like many other advanced economies in the world, is facing this care challenge at all levels, including not limited to family, community and institutions as population ages rapidly. The proportion of the population aged 65 or older is estimated to reach a whopping 28% in 2034 from the current 13%, as a result of increased longevity, low fertility rate and the ageing of baby‐boomers. This extends the parent‐child relationship and thus would significantly prolong the extent of care to be provided by adult children. In addition, the majority of older persons in Hong Kong prefer to live and age at home than being institutionalized, implying that a large proportion of long‐term care burden of older persons, of which 74% of them live with multiple chronic diseases, would fall upon informal caregivers within family.

Objectives This qualitative study was convened against this background and the purpose of this qualitative study was to develop a better understanding and more comprehensive description of the complicated, fluid, and multidimensional caregiving experience among Chinese caregiving adult children, especially daughters, who assume most responsibilities in caregiving tasks and work a greater number of hours in delivering care as compared to male caregivers by addressing the following three objectives:

(1) Capturing more accurately the interaction among different factors that influence their caregiving identity, experiences and subsequent practices; (2) Highlighting the needs and gaps in support services that would allow caregivers to continue caring, working and managing other aspects of their lives; and (3) Adding to the range of perspective towards informal caregiving by conducting a case study of male caregivers.

It was hoped that these efforts would enable us to understand the commonalities or essences of the subject matter being investigated and deeper insights could be developed to inform and orientate policies and services, and to make informal caregiving more gender equitable.

Findings Nineteen women and two men were interviewed during the study. Their stories highlighted the diverse, wide‐ranging and dynamic nature of informal caregiving experiences. Regarding the study objectives, nine predominant themes were invoked from the participants’ narratives, including: (1) Self-identification with the identity of being an informal caregiver being gradually and socially constructed process through recognizing and acknowledging the roles constituting informal caregiving; (2) Positive and negative feelings occur simultaneously but positive ones are important motivator that keep informal caregivers in their role; (3) Support services remained largely unavailable and inaccessible to informal caregivers; (4) Team approach to caregiving as the flexible solution to family care; (5) Psychosocial support and taking occasional breaks from caregiving duties to get recharged; (6) Influences of family values, living arrangements, time resources, and social expectations towards informal care provided by adult family members; (7) Men focused more on tasks and facts instead of emotions; (8) Men are more assertive when expressing themselves to the care‐recipients and authority figures; and (9) Men were more reserved and less likely to open up and talk about feelings and emotions.

Recommendations These themes reflected efforts for understanding informal caregiving in Hong Kong in terms of the forming of identity, the positive and negative experiences of being caregivers and the communication among different values in driving filial behavior among family members in Hong Kong. These had marked the beginning of the long journey to recognizing, supporting, and protecting these unsung heroes and heroines through policies and practices. Three potential directions for future development in regards to adult‐child‐parent caregiving were also discussed, which included: (1) framing informal caregiving as a public health issue; (2) understanding, promoting and celebrating male caregiving; and (3) stocktaking, need‐matching and review of support services.