- Investment required at care facilities, industry figures say, so patients can see out their last days in familiar surroundings rather than hospital
- Privately-run homes, which do not receive subsidies, have to renovate, add new equipment and staff, before offering hospice support, experts warn
Elderly care home resident Lee Kwok-ying, 83, thinks of the day when she will take her last breath and says: "The most important is to die comfortably, without being attached to numerous tubes."
The widowed mother of two and grandmother of two, who has stayed at the private care home for more than 13 years, adds: "I've seen some residents pass away while watching television after breakfast " I hope I leave that way too."
Rebecca Chau Tsang, chief executive officer of the home in Tai Kok Tsui, hopes that residents like Lee will be able to live out their last days there, surrounded by familiar faces.
Over eight years of working in the elderly care sector, Chau has seen terminally ill residents of care homes being sent to hospital, a practice that is common but which may not be best for them.
"Elderly people in their final stage of life are usually very frail and should not be sent back and forth between home and hospital," she said. "Those who have lived long enough in a care facility do consider it their home, and many care workers are like family to them."
The Food and Health Bureau launched a three-month consultation in September on proposed legislation to improve end-of-life care in Hong Kong. The proposals include giving patients a choice of where to spend their final days, if they prefer not to die in hospital.
Hong Kong needs creative solutions to elderly care
To allow the terminally ill to die in elderly care homes, the government has suggested amending the Coroners Ordinance to exempt homes from having to report a death to the Coroner if the resident was seen by a doctor during the preceding 14 days.
About 62,000 people live in 747 elderly care homes, according to official figures. More than 73 per cent of the homes are private facilities, most of which do not receive government subsidies.
Even if the proposed laws are passed, homes like the one run by Chau will have to overcome a number of obstacles before they can give residents the choice of "dying in place" instead of being sent to hospital.
This is because the homes will have to take special care when they provide hospice services and start dealing with deaths on their premises.
Chau's 10,000 sq ft home, which can take in 99 residents, occupies part of the ground floor and the entire first floor of a 16-storey building which also has business units on the ground floor and private apartments in other floors.
The home currently has an isolation room for residents with infectious diseases. Although it is ideal to convert into a hospice room, renovations will be needed to close off the common corridor outside so that dead bodies can be removed discreetly.
Hong Kong must do more to care for the elderly
"When a van comes to take a body away, we don't want to affect the other elderly residents or the overall atmosphere in the home," Chau said.
But creating the right environment for the dying will come at a cost.
Chau said the home will have to give up space enough for 17 beds and that means forgoing more than HK$220,000 in earnings, about a fifth of its monthly income.
It will also have to equip the hospice room with new medical equipment and hire additional staff to tend to the dying.
As a private outfit which does not receive government subsidies, she said, a drastic cut in earnings could threaten the home's sustainability.
Then there is the question of what other tenants in the building will say to having a hospice facility there. Some tenants are already unhappy at having to share the lift with elderly people in wheelchairs.
Chau asked: "Would others in the building allow us to transfer bodies in that lift?"
Professor Yeoh Eng-kiong, director of Chinese University's school of public health and a former health minister, said the government should provide homes with more support to encourage them to introduce dying-in-place measures.
"After the legal issues have been taken away, other support must be enhanced," he said. "Without upgrading the care homes, patients might still end up being sent to hospital."
Noting that medical support for elderly care homes is generally insufficient now, he said primary care doctors could step in to help if they receive training in caring for the terminally ill.
The need to improve care for the elderly is urgent
"If we want to give people a choice of where to die, there must be some primary palliative care teams," said Yeoh, adding that Hong Kong lacked such teams now.
He said more could be done to offer palliative care in the community if the city's primary care doctors could tend to the terminally ill at elderly homes and certify deaths too.
With the first government-initiated district health centre opened in Kwai Tsing and more coming up gradually in other districts, Yeoh floated the idea of getting doctors in the community who work with these centres to also offer palliative care.
Executive Council member Dr Lam Ching-choi, who is chairman of the Elderly Commission, agreed that the government should provide subsidies to care homes that lack the resources to offer end-of-life care services.
"Everything needs money " training and hiring of staff, as well as operating the end-of-life care room," Lam said.
"If we can achieve dying-in-place, we will also be able to reduce how much hospitals spend."
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