Housing and Ageing Policies in Chinese and Global Contexts: Trends, Development, and Policy Issues (Quality of Life in Asia, 15) 9819953812, 9789819953813

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Quality of Life in Asia Volume 15

Series Editors Alex C. Michalos, University of Northern British Columbia, Prince George, BC, Canada Daniel T. L. Shek, Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hunghom, Hong Kong Doh Chull Shin, University of California, California, MO, USA Ming-Chang Tsai, Department of Sociology, Academia Sinica, Taipei, Taiwan

This series, the first of its kind, examines both the objective and subjective dimensions of life quality in Asia, especially East Asia. It unravels and compares the contours, dynamics and patterns of building nations by offering innovative works that discuss basic and applied research and emphasizing inter- and multi-disciplinary approaches to the various domains of life quality. The series appeals to a variety of fields in humanities, social sciences and other professional disciplines. Asia is the largest, most populous continent on Earth, and it is home to the world’s most dynamic region, East Asia. In the past three decades, East Asia has been the most successful region in the world in expanding its economies and integrating them into the global economy, offering lessons on how poor countries, even with limited natural resources, can achieve rapid economic development. Yet while scholars and policymakers have focused on why East Asia has prospered, little has been written on how its economic expansion has affected the quality of life of its citizens. This series publish several volumes a year, either single or multiple-authored monographs or collections of essays.

Terence Chun Tat Shum · Charles C. L. Kwong Editors

Housing and Ageing Policies in Chinese and Global Contexts Trends, Development, and Policy Issues

Editors Terence Chun Tat Shum School of Arts and Social Sciences Public and Social Policy Research Centre Hong Kong Metropolitan University Hong Kong, Hong Kong

Charles C. L. Kwong School of Arts and Social Sciences Public and Social Policy Research Centre Hong Kong Metropolitan University Hong Kong, Hong Kong

ISSN 2211-0550 ISSN 2211-0569 (electronic) Quality of Life in Asia ISBN 978-981-99-5381-3 ISBN 978-981-99-5382-0 (eBook) https://doi.org/10.1007/978-981-99-5382-0 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Paper in this product is recyclable.

Acknowledgments

This edited volume was organized with the support of the Public and Social Policy Research Centre, which had been established and supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (UGC/IDS16/18). The editors would like to thank Karen Liu, Cathy Wong, Jade Ho, Fran Wong, and Ivy Chan in the School of Arts and Social Sciences at Hong Kong Metropolitan University for their administrative supports. We also extend our gratitude to the anonymous readers from Springer Nature for their careful reading and throughout suggestions for revisions, as well as to our senior editor Alex Westcott Campbell, for her patience and support for seeing this book to publication.

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Contents

1

Housing and Ageing Issues: Key Developments and Concerns . . . . . Terence Chun Tat Shum and Charles C. L. Kwong

2

Shifting Approaches to Housing Wealth and Welfare Security in Ageing Societies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Richard Ronald

3

4

5

6

Overseas Housing for Elderly Hongkongers? Comparing the Key Factors Influencing Retiree Migration Between Japan and Hong Kong . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Edward Loke Min Foo

1

9

27

Successful Ageing: The Novel Perspectives and Experiences of Vietnamese Migrants in Australia . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hien Thi Nguyen, Loretta Baldassar, and Raelene Wilding

53

Population Ageing and Community-Based Old Age Care Supply in China . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bingqin Li

79

China’s Ageing Population: Policy Implications for Economic Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Charles C. L. Kwong

97

7

Redesigning Urban Neighbourhood Space Under the Open Community Policy in Mainland China . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Qian Tang, Muhammad Azzam Ismail, and Nikmatul Adha Nordin

8

A Spiral, Stage-Sensitive Model of Grief in Dementia Caregiving—A Qualitative Study of Caregiver Experiences with Hospitalised Patients with Dementia in Shanghai, China . . . . . 145 Changyi Shen, Shijie Jing, and Phyllis Solomon

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9

Contents

‘Home Sweet Home’: Making the Discourse of Housing Space and Quality in Hong Kong 1930s-1990s . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Lok Yin Law and Ming Hin Cheung

10 The Informal Carer in Old Age Care: Observations in Hong Kong Through the Lens of Critical Discourse Analysis . . . . . . . . . . . . 201 Beatrice Oi Yeung Lam and Wai Leung Chan 11 Perceptions of Transitional Housing: Voices of Residents Living in Subdivided Units in Hong Kong . . . . . . . . . . . . . . . . . . . . . . . 225 Lok Wo Chow, Ivy Lok Yiu Chan, Wai Man Lam, and Terence Chun Tat Shum 12 Employment Experience of Marginalized Older People Who Use Drugs in Hong Kong . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247 Vincent Shing Cheng and Florence Kayan Lapto Epilogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265

Editors and Contributors

About the Editors Terence Chun Tat Shum is Assistant Professor in the School of Arts and Social Sciences and Deputy Director of Public and Social Policy Research Centre at Hong Kong Metropolitan University. His areas of research cover international migration, refugee studies, identity, home and home-making, ageing and care, and multiculturalism. His publications appear in international journals and books. He is the author of Asylum-Seeking Journeys in Asia: Refugees in Hong Kong and Bangkok (Routledge, 2019). e-mail: [email protected] Charles C. L. Kwong is Dean and Professor of Economics, School of Arts and Social Sciences at Hong Kong Metropolitan University, where he concurrently serves as Director of the Public and Social Policy Research Centre. His research interest focuses on topics pertaining to institutional changes, economic development and the political economy of China. He is author of The Chinese Economy and Its Challenges: Transformation of a Rising Economic Power (2020). His publications appear in international journals and academic books. He has been a regular media commentator on issues related to the Chinese economy. e-mail: [email protected]

Contributors Loretta Baldassar School of Arts and Humanities, Edith Cowan University, Perth, Australia Ivy Lok Yiu Chan School of Arts and Social Sciences, Hong Kong Metropolitan University, Hong Kong, China Wai Leung Chan School of Arts and Social Sciences, Hong Kong Metropolitan University, Hong Kong, China

ix

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Editors and Contributors

Vincent Shing Cheng Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China Ming Hin Cheung School of Arts and Social Sciences, Hong Kong Metropolitan University, Hong Kong, China Lok Wo Chow School of Arts and Social Sciences, Hong Kong Metropolitan University, Hong Kong, China Edward Loke Min Foo Institute of Ageing and Professional Care, New Era University College, Kajang, Malaysia Muhammad Azzam Ismail Faculty of Built Environment, University of Malaya, Kuala Lumpur, Malaysia Shijie Jing East China University of Political Science and Law, Shanghai, China Charles C. L. Kwong School of Arts and Social Sciences, Hong Kong Metropolitan University, Hong Kong, China Beatrice Oi Yeung Lam School of Arts and Social Sciences, Hong Kong Metropolitan University, Hong Kong, China Wai Man Lam School of Arts and Social Sciences, Hong Kong Metropolitan University, Hong Kong, China Florence Kayan Lapto Deparment of Sociology, The University of Hong Kong, Hong Kong SAR, People’s Republic of China Lok Yin Law School of Arts and Social Sciences, Hong Kong Metropolitan University, Hong Kong, China Bingqin Li Social Policy Research Centre, University of New South Wales, Kensington, Australia Hien Thi Nguyen School of Arts and Humanities, Edith Cowan University, Perth, Australia; School of Allied Health, The University of Western Australia, Perth, Australia Nikmatul Adha Nordin Faculty of Built Environment, University of Malaya, Kuala Lumpur, Malaysia Richard Ronald Department of Geography, Planning and Development Studies, University of Amsterdam, Amsterdam, The Netherlands Changyi Shen East China University of Political Science and Law, Shanghai, China Terence Chun Tat Shum School of Arts and Social Sciences, Hong Kong Metropolitan University, Hong Kong, China Phyllis Solomon East China University of Political Science and Law, Shanghai, China

Editors and Contributors

xi

Qian Tang Faculty of Built Environment, University of Malaya, Kuala Lumpur, Malaysia Raelene Wilding School of Humanities and Social Sciences, La Trobe University, Melbourne (Bundoora), Australia

List of Figures

Fig. 3.1

Fig. 3.2

Fig. 3.3 Fig. 3.4 Fig. 3.5 Fig. 3.6 Fig. 3.7

Fig. 3.8 Fig. 3.9

Fig. 3.10

Fig. 4.1 Fig. 5.1

Conceptual Model for Overseas Relocation of Japanese Retirees: The Main Factors, Government Role, Choice of Locations, and Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Proposed Conceptual Model for Overseas Relocation of Hong Kong Retirees: The Main Factors, Government Role, Choice of Locations, and Processes . . . . . . . . . . . . . . . . . . . Population Structure of Adults Aged 65 and above–Japan vs. Hong Kong, 2020 (Source: World Bank) . . . . . . . . . . . . . . . . . Population Structure of Adults Aged 65 and above–Japan vs. Hong Kong, 2040 (Source: World Bank DataBank) . . . . . . . . Hong Kong vs. Japan–Life Expectancy at Birth (years old), 1960–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hong Kong vs. Japan–Population ages 0–14 (% of total population), 1960–2019 (Source: World Bank) . . . . . . . . . . . . . . Unemployed Persons in Malaysia (Source: Department of Statistics Malaysia (Reproduced from Department of Statistics Malaysia, 8 July 2021)) . . . . . . . . . . . . . . . . . . . . . . . Unemployed Persons by Age Group in Malaysia, 2010–2020 (Source: Department of Statistics Malaysia) . . . . . . . Top 10 countries of origin of MM2H participants (2002–2019) (Source: The Edge Malaysia, Malaysia My Second Home) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conceptual Model for Overseas Relocation of Hong Kong Retirees: The Main Factors, Government Role, Choice of Locations, and Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vietnamese Perceptions of Successful Ageing . . . . . . . . . . . . . . . Income group and aging trend (Sources: UN Population Division (Median Age) (2017), chart drawn by the author using OurWorldinData.org/age-structure) Note: 1950 to 2015 show historical estimates. From 2016 the UN projections (medium variant) are shown . . . . . . . . . . . . . . . . . . . .

30

31 33 34 35 35

44 44

46

49 59

82 xiii

xiv

Fig. 5.2 Fig. 5.3 Fig. 5.4 Fig. 5.5 Fig. 7.1

Fig. 7.2

Fig. 7.3 Fig. 7.4 Fig. 7.5 Fig. 7.6 Fig. 7.7 Fig. 7.8

Fig. 7.9 Fig. 7.10 Fig. 7.11 Fig. 7.12 Fig. 7.13

Fig. 7.14 Fig. 7.15 Fig. 7.16 Fig. 7.17 Fig. 7.18

List of Figures

Regional inequality of growing old before being rich (Source: Census, 2020.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Household size in China (2009–2019) . . . . . . . . . . . . . . . . . . . . . . Different types of care facilities (Data source: Ministry of Civil Affairs, Statistical Yearbook, various issues) . . . . . . . . . Community- based care facilities and the number of users (Data source: Ministry of Civil Affairs) . . . . . . . . . . . . . . . . . . . . Comparison of urban road network density between Xiamen Hexiang (left) and Paris (right) within one kilometre of a unified scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Comparison of commuting distance between the sparse road network in the big block (left) and the dense road network in the small block (right) under the same scale . . . . . . . Comparison of urban road networks under the same ratio . . . . . . Comparison of streets without human scale (left) and humanised streets with appropriate scale (right) . . . . . . . . . . Ten years of changes in an old city area in Tianjin from 2010 (left) to 2015 (right) . . . . . . . . . . . . . . . . . . . . . . . . . . . Comparison before and after demolition and reconstruction of Lianban Mingfa commercial plaza in Xiamen . . . . . . . . . . . . . Residential districts lacking differences and detailed considerations under unified planning and construction . . . . . . . . Gulangyu Island in Xiamen (left), and the ancient city of Lijiang, Yunnan (right): the visible urban texture and the invisible urban memory . . . . . . . . . . . . . . . . . . . . . . . . . . . Monotonous street space blocks outside the fence of a gated community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The internal functional partitions of the compound as shown in the past . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Schematic of the common internal functional areas in modern communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A space with hidden safety hazards outside the iron fence of an apartment and community in Xiamen . . . . . . . . . . . . . . . . . Traditional community (enclosed by walls with one or two main entrances only for people who live there). Open community (without enclosed walls and with more open roads between buildings) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Transfer traditional community to open community . . . . . . . . . . . New model to organise the traditional communities . . . . . . . . . . . Schematic diagram of transformation . . . . . . . . . . . . . . . . . . . . . . Improvement of neighbourhood relations after the opening of the neighbouring spaces on the ground floor . . . . . . . . . . . . . . Schematic diagram of the transformation of the spatial relationship between the buildings . . . . . . . . . . . . . . . . . . . . . . . . .

82 83 86 86

123

124 125 125 126 127 127

128 129 130 130 133

135 135 136 137 138 139

List of Figures

Fig. 7.19 Fig. 7.20 Fig. 7.21 Fig. 7.22 Fig. 7.23 Fig. 8.1 Fig. 9.1

Fig. 9.2

Fig. 9.3 Fig. 9.4 Fig. 9.5

Fig. 9.6

Fig. 9.7

Fig. 9.8

Fig. 9.9

Fig. 9.10

New building size specifications and their relationship with existing buildings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Main Road design method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . One-way lane design method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Avoidance branch road design method . . . . . . . . . . . . . . . . . . . . . Narrow street design method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A Spiral, Stage-Sensitive Model of Grief in Dementia Caregiving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The plan of a typical tenement house in a congested district, built before 1903. Note: Around 30 adults and children lived in one tenement house in the space of 500 sq. ft. (Source: Owen 1938: plan no.1) . . . . . . . . . . . . . . . Plan of a typical tenement house after 1903 (Source: Owen 1938: plan no.2) Note: The windowless cubicles, poor daylight, and ventilation in the living portion . . . . . . . . . . . . . . . . Advertisement of apartments to let in 1934 (Source: ‘Apartments to Let’ 1934) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A newspaper advertisement of the storey to let mentions the location and rents (Source: “Jilou zhaozu,” 1937) . . . . . . . . . Typical plans of tenement houses have developed following the regulation of the Building Ordinance 1935 (Source: Owen 1938: plan no.3). Note: The width of the building has widened slightly due to the change of material from Chinese fir to reinforced concrete. The living cubicles in the room have been reduced after the control of maximum depth from the window . . . . . . . . . . . . . . . . . . . . . . . Floor plan of flats proposed by W.H. Owen served with staircase or balcony access showing the design of flats with a private kitchen and toilet connected by a communal corridor or shared staircase. The flat with balcony access type has been widely adopted in early settlement blocks and public housing (Source: Owen 1938: plan no.4) . . . . . . . . . . Floor plan of Mark I resettlement block showing the regular design of flats and the shared toilets and kitchens (Source: Commissioner for Resettlement 1955) . . . . . . . . . . . . . . . . . . . . . A newspaper clip discussing the relationship of high rent and housing shortage, the emergence of partition by sale of a property in 1952 (Source: Xinlou jianzhu 1952) . . . . . . . . . . A newspaper clip discussing the rise of mortgage monthly payment and comparison with renting a flat in the early 60s (Source: Zhong xiaceng 1964) . . . . . . . . . . . . . . . . . . . . . . . . Dimensions for setbacks stipulated under Building (Planning) Regulations 1956 (Source: Wing Wah Building 1957) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

xv

139 141 141 142 142 163

171

172 173 173

175

176

177

178

179

180

xvi

Fig. 9.11

Fig. 9.12 Fig. 9.13 Fig. 9.14 Fig. 9.15 Fig. 9.16 Fig. 9.17 Fig. 9.18 Fig. 9.19 Fig. 9.20 Fig. 9.21 Fig. 9.22 Fig. 9.23 Fig. 9.24 Fig. 9.25

List of Figures

A typical floorplan of the composite buildings between 1956–1966. Note: The commonly used nowadays prototype of the 1-bedroom apartment with standard kitchen and bathroom (Source: Alhambra Building 1958) . . . . . A typical flat configuration in the composite buildings between 1956–1966 (Source: Author’s work) . . . . . . . . . . . . . . . . The architect’s illustration of Champagne Court by Eric Cumine (Source: Champagne Court, Kowloon 1955) . . . . . . . . . Floorplan of Champagne Court (Source: Champagne Court, Kowloon 1955) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Advertisement of Champagne Court (Gankua 1955) . . . . . . . . . . Advertorials of Kiu Kwan Mansion in The Kung Sheung Daily News (Lougao 1963) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lido Apartment and its 999-year least lot (Source: Beijiao 1957) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mei Foo Sun Chuen Stage 6A Sales brochure (Source: Private Collection) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Poster of Real Estate Exhibition in 1977 (Source: Qiqi nian 1977) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Advertisement of Henderson Development (Source: Hengji louyu 1977) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sale Brochure of Kingswood Villa (Source: Private Collection) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction of the club houses and leisure spaces in Kingswood Villa (Source: Private Collection) . . . . . . . . . . . . . Introduction of the commercial center in Kingswood Villa (Source: Private Collection) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction of the features of Kingswood Villa (Source: Private Collection) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Locations of the mentioned property (Retrieved from Hong Kong Special Administrative Region 1:200 000 Topographic Map, https://data.gov.hk/en-data/ dataset/hk-landsd-openmap-b200k-topographic-map-ofhong-kong, and reproduced by Joyce Ho) . . . . . . . . . . . . . . . . . . .

180 181 182 183 184 184 184 186 189 190 193 194 194 195

196

List of Tables

Table 3.1 Table 3.2

Table 3.3

Table 3.4

Table 3.5

Table 3.6

Table 3.7

Table 3.8

Table 3.9 Table 3.10

Ageing Population in Japan and Hong Kong, 2020–2050 (Source: The World Bank DataBank) . . . . . . . . . . . . . . . . . . . . . Number of Residential Places Offering Elderly Care Services in Hong Kong, as at 30 June 2021 (Source: Hong Kong Social Welfare Department) . . . . . . . . . . . . . . . . . . Number of Applicants Listed in the Central Waiting List for Subsidized Long Term Care Services as at 30 June 2021 (Source: Hong Kong Social Welfare Department) . . . . . . Average Waiting Time for Subsidized RCS for the Elderly in Hong Kong as at June 2021 (Source: Hong Kong Social Welfare Department) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Caregivers Shortage in Hong Kong, 31 July 2017 (Source: Social Welfare Department, Government of the Hong Kong Special Administrative Region, 2017) . . . . . Quarterly Survey of Employment and Vacancies for RCS in Hong Kong, December 2016 to March 2021 (Source: Quarterly Survey of Employment and Vacancies, Hong Kong Census and Statistics Department) . . . . . . . . . . . . . . . . . . Number of Households that Have Employed Domestic Helpers and Foreign Domestic Helpers, October 2019 to January 2020 (Source: Thematic Household Survey Report No. 72, Hong Kong Census and Statistics Department) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Type of Domestic Helpers Employed by Household Type (Source: Thematic Household Survey Report 2019/20, Hong Kong Census and Statistics Department) . . . . . . . . . . . . . Cost of Housing–Hong Kong vs. Japan (Source: Numbeo, as at June 2021) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Socioeconomic and Demographic Profiles of Hong Kong and Malaysia (Source: World Bank) . . . . . . . . . . . . . . . . . . . . . .

32

36

36

36

37

37

38

38 40 42

xvii

xviii

Table 3.11 Table 3.12 Table 3.13 Table 3.14

Table 3.15

Table 4.1 Table 5.1 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Table 8.1 Table 9.1

Table 12.1

List of Tables

Population Ages 15–39 in Malaysia, Hong Kong and Japan, 2030–2050 (Source: World Bank) . . . . . . . . . . . . . . Rent Per Month of Apartments in Hong Kong and Malaysia (Source: Numbeo, as at June 2021) . . . . . . . . . . . Prices of Apartments in Hong Kong and Malaysia (Source: Numbeo, as at June 2021) . . . . . . . . . . . . . . . . . . . . . . . Population Density by Country (Source: Countries By Density 2021, World Population Review by World Bank (https://worldpopulationreview.com/country-rankings/ countries-by-density)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minimum Purchase Price for Property Purchased by MM2H Applicants (Source: Malaysia My Second Home; Invest Selangor (Reproduced from Propsocial.my 2018)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Selected demographics of the research sample . . . . . . . . . . . . . . Labour supply (2018) (Data source: Ministry of Civil Affairs (2019)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . China’s Birth Rate, Death Rate and Natural Growth Rate of Population 1978–2019 (per 1000 people) . . . . . . . . . . . . . . . China’s Life Expectancy at Birth . . . . . . . . . . . . . . . . . . . . . . . . . Projected Proportion of Population Aged 60 and Above in China, U.S., and Japan (%) . . . . . . . . . . . . . . . . . . . . . . . . . . . China’s Labour Force 1978–2019 (10,000 persons) . . . . . . . . . China’s Labour Productivity and Real Wage Growth 2008–2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Total Investment in Fixed Assets (TIFA) 1995–2019 (100 million yuan) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Debt-to-GDP Ratio 2006–2020 (per cent) . . . . . . . . . . . . . . . . . Participant Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Numbers of Domestic Households by Monthly Household Income in 1971 and 1971 (Source: Census and Statistics Department 1978, reproduced by author) . . . . . . Participant information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

43 45 45

45

47 57 91 99 100 101 102 103 104 111 150

187 253

Chapter 1

Housing and Ageing Issues: Key Developments and Concerns Terence Chun Tat Shum and Charles C. L. Kwong

Abstract This collection reviews current research in the multidisciplinary and global fields of housing and ageing. An array of scholars in economics, history, psychology, sociology, social policy and urban studies has been assembled to contribute chapters on their respective areas of interest to furnish a comprehensive reference work. The volume has a wide geographic scope, including the most recent perspectives on housing and ageing issues in various societies in Asia, Asia–Pacific and Europe. This chapter describes the motivation for the book and discusses the main topics covered by papers in this edited volume.

1.1 Introduction In the 21st century, the changing shape of global societies has given rise to a substantial number of policy concerns that should be investigated from the academic lens. Crucial among these concerns are housing needs and socioeconomic issues arising from ageing populations. This book is the result of a concern among academics who desired to assemble empirical research on the international experiences confronting housing and ageing issues in various societies in Asia, Asia–Pacific and Europe. A key question addressed in this volume is what progress is being made on the formulation and implementation of policy strategies for people who need housing support and old-age care. This question is critical for three reasons. First, housing needs are a global concern afflicting major cities in both developing and advanced economies (Wetzstein 2017). The failure of policy strategies to accommodate the housing needs of the citizens can be seen in the proliferation of poorly serviced neighbourhood space. Second, most of the world is ageing (Harper 2014). Between 2015 and 2050, the proportion of the world’s population over 60 years old will nearly double from 12 to 22%. (World Health Organization [WHO] 2022). The rapid ageing of global populations presents an extraordinary set of policy challenges to governments around T. C. T. Shum (B) · C. C. L. Kwong School of Arts and Social Sciences, Hong Kong Metropolitan University, Hong Kong, China e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 T. Chun Tat Shum and C. C. L. Kwong (eds.), Housing and Ageing Policies in Chinese and Global Contexts, Quality of Life in Asia 15, https://doi.org/10.1007/978-981-99-5382-0_1

1

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the world including increased expenditure on health and long-term care, labour-force shortages and potential problems with old-age income security. Third, both housing and ageing issues have prevalent economic and social implications. The shortage of affordable housing has the greatest impact on low-income families and older adults as they cannot afford to live in market-rate housing. As a result, many of them are trapped in housing poverty and are forced to live for long periods in unfavourable living conditions. The rapid ageing of the global population has given rise to increasing demands on elderly homes, pensions, health care and caregiving services. Some underprivileged older adults may experience ageism and marginalisation problems in their everyday life. To further inform policy analyses and formulation, these housing and ageing-related issues deserve detailed academic discussion. In 2021, an international conference was held in Hong Kong to draw scholarly attention to housing and ageing issues and review empirical data and new ideas regarding housing and ageing policies in different societies. The initiative for the project derived from the limitations of most current studies to either housing or ageing issues in a single academic discipline. We seldom hear about housing and ageing policy research in global or Chinese contexts employing multidisciplinary perspectives. We began by examining housing and ageing issues in Hong Kong and brought together an international research effort from various academic disciplines to relate these two pressing social issues of Hong Kong to wider global concerns of policy implementation and governance. This book offers both general and academic readers the following benefits. 1. A better understanding of current developments and concerns regarding housing and ageing issues in various societies in Asia, Asia–Pacific and Europe; 2. A clearer picture of the approaches adopted by various governments in these regions to address housing and ageing issues; 3. A comprehensive review of the factors (macro, meso and micro) that contribute to the challenges facing the people who need housing support or old-age care services in their society; and 4. An overall evaluation of implementation and governance in housing and ageing policies and its implication to inform future policy analyses and formulation.

1.2 Policy Implementation and the Process of Governance: International Experiences in Dealing with Housing and Ageing Issues The domain of social and public policy is vast, including most of what society collectively does to protect marginalised and disadvantaged groups, but it also must meet the social needs of all people. Social and public policies are concerned with the methods societies employ globally to provide services and support across the life course from childhood to old age. Housing and ageing are two main challenges for

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the global economy. Maintaining a good quality of life across the life course is a central aspect of human well-being. Many great concerns accompany life’s journey, such as the affordability of housing, accessibility of health care services, and stigmatisation and discrimination, among others. Governments have urgent requirements to implement relevant policies addressing critical needs of marginalised communities for security, health and well-being at different stages of life. ‘Policy implementation’ refers to the mechanisms, resources and relations that connect policies with program actions. However, policies are not always implemented as envisioned and do not necessarily achieve the intended objectives (Bhuyan et al. 2010:1). Some services are offered with limited attention to how such activities fit into or contribute to wider policy goals. Therefore, assessing the policy implementation ‘opens up the “black box” to provide greater understanding of why programmes work or do not work and the factors that contribute to programme success’ (Love 2003:4). Implementation is often perceived as a linear process that proceeds directly from the instructions given by the official to the policy-makers, then to implementation and policy outcomes (Meier 1991:45). While this process might sound simple, policy implementation can be highly complex. In fact, policy implementation is a series of activities and operations undertaken by diverse stakeholders towards the achievement of objectives defined in an authorised policy (Bhuyan et al. 2010:1). Implementation involves an ongoing process of decision-making by major stakeholders who work in complex policy and institutional contexts and manage pressures from interested as well as opposing parties (Bjorkman 1994:370; Calista 1994:32). Therefore, policy implementation is at least as political as it is technical, which is complex, highly interactive and requires consensus establishment among stakeholders. Therefore, policy implementation is not merely a management problem confined to processes within a single institution. Rather, implementation stretches across spheres of a multiplicity of actors within three broad groups: the government (local, regional and national levels), the private sector and civil society (in particular nongovernmental organisations) (Minnery 2007). Governance is a key element along the policy-to-action continuum. Partnerships, conflicts and consensus, and the need for negotiation and coordination are elements that characterise the process of governance (Healey 1997). This work follows the definition provided by Minnery (2007:333), who understands governance as ‘processes of direction-setting, policy making and implementation that incorporate the roles and responsibilities of government, the private sector and civil society in urban settings, as well as the partnerships and conflicts amongst them’. Housing and ageing policies are the main themes of this book. Housing policy signifies the actions of the government that have both a direct and indirect influence on the housing supply and availability, housing standards and neighbourhood planning. Through laws and regulations, the allocation of resources, taxation and housing policy can also affect house prices and affordability, together with the availability of an adequate supply of rental housing. Housing policies can also result in support for alternative types of rental housing (such as transitional housing in Hong Kong). Indeed, boosting housing affordability and stimulating the overall supply of affordable housing is considered a principal housing policy objective for many societies.

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Governments could do more to boost the supply of affordable housing not only to the people who live in poverty but also to older adults. However, as the contributors of this volume will demonstrate in their research, many societies experience hurdles to expanding the supply of affordable housing. The global population is ageing. Enabling a larger portion of older adults to stay active and healthy has become key for the future sustainability of ageing policies in various parts of the world. According to the United Nations Economic Commission for Europe (2012), active ageing can be understood from four perspectives: focus, process, enabling factors and domains. First, the focus of active ageing is not simply placed on individuals but on groups and populations as well. Second, active ageing is not merely a state that may be achieved by a few, but rather it is a continuous undertaking to improve ageing trajectories. Third, enabling factors and societal structures shape ageing processes, including personal, social, behavioural, environmental and institutional factors. Finally, active ageing covers broad domains of life that are vital for the quality of life, including health, integration and participation. Understanding the determinants helps in designing policies and programs that can appropriately address socioeconomic and health issues relating to ageing. This book examines how governments in various societies confront housing and ageing issues as well as the progress being made on the formulation and implementation of policy strategies for people who need housing support and old-age care services.

1.2.1 Organisation of the Book This book comprises of eleven chapters. The first three chapters examine housing and ageing issues in the UK, Japan, Malaysia, and Australia. In Chap. 2, Richard Ronald examines the relationship between home ownership and pension systems and explores how this has shaped welfare regimes and relations. Ronald’s research demonstrates new patterns of socioeconomic inequality that are inter- and intragenerational. These patterns threaten the longer-term complementarity between home ownership and pension arrangements. Ronald attempts to explore growing conflicts between the social and economic objectives of housing policies in ageing societies, which presents a challenge for policy-makers. In Edward Foo’s chapter, he looks into the housing problems facing retirees in Japan and Hong Kong. Japan and Hong Kong are both experiencing growing numbers of ageing persons, a serious caregiver shortage and high housing costs. Foo references an experimental project where the Japanese elderly care infrastructure and service ecosystem were replicated in Malaysia – a country with a population that is far less aged. Malaysia has a relatively young labour force that can be trained to become caregivers and also has affordable housing for retirees. Foo’s chapter explores the possibility of replicating care facilities and services in Malaysia and relocating Hong Kong retirees there. Chapter 4 explores the perspectives of a group of Vietnamese migrants in Australia on successful ageing. In the chapter, Hien Thi Nguyen and her colleagues argue that

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contrary to the western notion emphasising individual achievement, the successful ageing of Vietnamese migrants was multifaceted with three main dimensions: family fulfilment, individual achievement, and social interaction and protection. Although the Vietnamese migrants try to preserve family harmony and happiness in transnational migration, Nguyen found that their perception towards successful ageing has been influenced by the more individualistic culture of the host country. She argued that subjective understandings, including self-definitions, are critical elements facilitating the conceptualisation of successful ageing for various populations based on their specific cultural and institutional contexts. Chapters 5–8 analyze the issues in China. In Chap. 5, Bingqin Li reveals key features of the Chinese ageing society and the challenges facing the old-age care system in the country. Li found that the majority of older people cannot afford private services without any special financial arrangements or support. In the chapter, Li argued that although an old-age care system is gradually taking shape with community-based care taking the lead, the current system continues to face the challenges of a lack of sustainable business models for private and social providers and an insufficient quality of labour supply. Li’s chapter points to future directions related to ageing policy reform. In the following chapter, Charles Kwong uses China as an example to examine the relationship between the ageing population and economic growth. While China experienced rapid economic growth in the 1980s and 1990s, Kwong argued that China’s comparative advantage in labour-intensive production has been hampered by three factors, namely a sharp decline in rural surplus labour, population ageing, and a decline in the birth rate. Regarding how the Chinese government should address the problem, Kwong points out that the government should increase human capital investment, particularly in higher education, and resources should be diverted to higher-return sectors rather than state sectors. Moreover, institutional barriers should be removed that limit the access of migrant workers’ children to local education and public services. Kwong concludes this chapter by examining the possible development of property market under population ageing, together with shrinking productivity growth. Qian Tang and her colleagues examine different community problems arising from a gated community in the context of China’s urban development. Since the Chinese government introduced ‘Healthy China 2030’ as indicators for healthy construction, including health levels, healthy lives, health service guarantees, a healthy environment, and a healthy industry, Tang attempts to explore how the ‘open community’ mandate can help in realising a healthy China. Due to China’s growing ageing population, this chapter also explains why ordinary residential communities will become the main place for future ageing, and the quality of the neighbourhood environment will directly determine ageing quality. The ageing population is a key challenge facing Chinese society. Ageing has raised both socioeconomic and health concerns at the community level. In their chapter, Changyi Shen and colleagues found that dementia is one of the most serious public health problems in China. Due to the influence of family-oriented culture, most older adults with dementia are cared for at home. Family members who are the primary

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caregivers experience a variety of losses that result in diverse grief experiences, which influence not only physical and mental health but also the quality of care provided. Shen and her colleagues proposed a spiral, stage-sensitive model of grief for dementia caregiving to examine the relationships between loss, grief response and coping strategies among a group who care for older adults with dementia in China. The remaining chapters explore both issues in Hong Kong. In Chap. 9, Lok Yin Law explores how the concept of an idealised home space is imagined and transformed into an everyday context in post-war Hong Kong. Law uses a new culturalhistorical perspective to deconstruct examples of private housing space and quality through various newspapers, sales brochures, government reports and TV advertisements in Hong Kong. His approach can shed new light on the influence of imagination and social discourse on urbanised society in the late twentieth century. As Hong Kong population is ageing, Law argues that government should provide incentives in encouraging private sector investment in elderly-friendly housing development. In the following chapter, Lam and Chan adopt critical discourse analysis to explore how meanings underlying relevant policy and advocacy discourses in Hong Kong can be interpreted within the neoliberal policy context. Lam and Chan reveal how discursive practice masks political and economic interests underlying the transfer of responsibility for old-age care from the public sector to individual families under the policy framework of ‘ageing in place’. This chapter discusses housing and urban planning and development issues within the Ageing in Place framework. In Chap. 11, Lok Wo Chow and his colleagues examine the current living conditions among a group of residents living in subdivided units in Hong Kong and their expectations for transitional housing and an ideal home. Due to expensive flat rental fees, low-income families living in subdivided units are trapped in housing-led deprivation. Using a bottom-up approach, Chow’s chapter provides policy recommendations for operating the transitional housing programme in Hong Kong as well as enhancing the conditions of residents living in subdivided units. This chapter also highlights how ageing housing problems have imposed negative impact on the well-being of family living in sub-divided units in Hong Kong. In gerontology studies, the employment experience of older people who use drugs is less examined. In Chap. 12, Cheng and Lapto use the concepts of competence and warmth stereotypes as well as soft and hard discrimination to reveal the problems that older people who use drugs in Hong Kong experience in both the legal and illegal markets. They also illustrate how social stigmatization and discrimination prevent the older people and people who use drugs from having decent living conditions. Cheng and Lapto argue that implementing policies and programs involving communication and interaction between the general public and stereotyped groups can reduce negative stereotypes.

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References Bhuyan, A., Jorgensen, A. and Sharma, S. (2010). Taking the pulse of policy: The policy implementation assessment tool. Washington, DC: Futures Group, Health Policy Initiative, Task Order 1. Bjorkman, J.W. (1994). Implementation and development policy: Major problems, small steps. Public Enterprise, 14(3-4), 368–378. Calista, D. (1994). Policy implementation. In Nagel, S. (ed.) Encyclopaedia of Policy Studies, pp. 117–155. New York: Marcel Dekker. Harper, S. (2014). Economic and social implications of ageing societies. Science 346(6209), 587– 591. Healey, P. (1997). Collaborative planning. Shaping places in fragmented societies. London: Macmillan Press. Love, A.J. (2003). Beyond the black box: Strengthening performance measurement through implementation evaluation. Presentation to the Canadian Evaluation Society national capital chapter, November 26, 2003. https://www.evaluationcanada.ca/distribution/20031126_love_arnold.pdf. Meier, G.M. (1991). Politics and policy in developing countries. San Francisco: International Center for Economic Growth, Institute for Contemporary Studies Press. Minnery, J. (2007). Stars and the supporting cast: State, market and community as actors in urban governance. Urban Policy and Research, 25(3), 325–345. United Nations Economic Commission for Europe [UNECE] (2012). Active ageing and quality of life in old age. New York and Geneva. https://www.dza.de/fileadmin/dza/pdf/2012_Active_Age ing_UNECE.pdf. Wetzstein, S. (2017). The global urban housing affordability crisis. Urban Studies, 54(14), 3159– 3177. World Health Organization (2022). Ageing and health. https://www.who.int/news-room/fact-she ets/detail/ageing-and-health#:~:text=At%20this%20time%20the%20share,2050%20to%20r each%20426%20million.

Terence Chun Tat Shum is Assistant Professor in the School of Arts and Social Sciences and Deputy Director of Public and Social Policy Research Centre at Hong Kong Metropolitan University. His areas of research cover international migration, refugee studies, identity, home and homemaking, ageing and care, and multiculturalism. His publications appear in international journals and books. He is the author of Asylum-seeking Journeys in Asia: Refugees in Hong Kong and Bangkok (Routledge, 2019). [email protected] Charles Che Leung Kwong is Dean and Professor of Economics, School of Arts and Social Sciences at Hong Kong Metropolitan University, where he concurrently serves as Director of the Public and Social Policy Research Centre. His research interest focuses on topics pertaining to institutional changes, economic development and the political economy of China. He is author of The Chinese Economy and its Challenges: Transformation of a Rising Economic Power (2020). His publications appear in international journals and academic books. He has been a regular media commentator on issues related to the Chinese economy. [email protected]

Chapter 2

Shifting Approaches to Housing Wealth and Welfare Security in Ageing Societies Richard Ronald

Abstract In recent decades, home ownership as both a financial buffer and an ‘income in kind’ has come to assume a central position in both household strategies and state policies as a means to offset future retirement incomes. This chapter examines the relationship between home ownership and pension systems and explores how this has shaped welfare regimes and relations. Recent shifts in approaches to housing wealth and in particular their emerging salience as both a global investment class and as vehicles for achieving individual and household welfare security are also explored. Specifically, access to home ownership has recently diminished and distributions of housing assets have shifted in line with intensifying flows of capital seeking new kinds of (increasingly rent-based) returns from housing. The analysis illustrates new patterns of socioeconomic inequality that are inter- and also intragenerational in nature, that threaten the longer-term complementarity between home ownership and pension arrangements. These inequalities present a challenge for policy makers faced with growing conflicts between the social and economic objectives of housing policies in ageing societies.

2.1 Introduction Even though housing wealth, like other kinds of asset wealth, was once heavily concentrated at the top of society, in the latter part of the twentieth century, the expansion of home ownership generated a much wider distribution across income classes (Arundel and Ronald 2021; Doling and Ford 2003; Kurz and Blossfeld 2004; Ronald 2008). Moreover, since the late 1990s, along with the deeper financialisation of the economy, an increasing flow of money (and debt) has been channelled into the housing sector, stimulating extraordinary increases in residential property values (see Aalbers 2016; Fields 2018). Across most developed economies, many low to middle R. Ronald (B) Department of Geography, Planning and Development Studies, University of Amsterdam, Amsterdam, The Netherlands e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 T. Chun Tat Shum and C. C. L. Kwong (eds.), Housing and Ageing Policies in Chinese and Global Contexts, Quality of Life in Asia 15, https://doi.org/10.1007/978-981-99-5382-0_2

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income households—especially those who acquired housing property in the 1990s or earlier when prices were historically low—have consequently accrued significant equity in their homes. Indeed, global housing wealth is currently estimated to be worth approximately US$220 trillion, with real estate exceeding, by almost one-third, the total value other asset classes combined.1 In the early decades of the twenty first century, housing wealth has thus come to not only assume a more pivotal position in the economy, but also in both individual strategies and national policies as a means to offset future retirement incomes. The relationship between housing wealth and retirement income has been conceptualised in a number of ways (e.g. Castles 1998; Conley and Gifford 2006; Crouch, 2009; Doling and Ronald 2010a; Kemeny 1981; Van Gunten and Kohl 2020; Watson 2009). All approaches, nonetheless, emphasise the potential of owning your own home and living in it. This enhances welfare self-provision – especially in retirement – and offsets welfare state retrenchment. The social distribution and market features of owner-occupied housing markets have thus become critically connected to issues of public welfare and social ageing, not only to the extent that housing practices and private housing assets can offset retirement needs, but also the implicated shift in the fiscal burden of an ageing society from the state to the individual. In the decade since the Global Financial Crisis (GFC), housing has assumed an even more central role in wealth accumulation processes with economic growth across diverse contexts, increasingly driven in and around real estate investment (Aalbers 2016; Beswick et al. 2016; Wijburg et al. 2018). This trend has been ostensibly untroubled, if not intensified by, the Coronavirus pandemic.2 This chapter examines changes in housing, housing systems, and welfare practices involving shifting approaches to housing assets, practices, and tenure structures with an empirical focus on the UK as an iconic ‘homeowner society’ (Saunders 1990). A particular concern is the changing characteristics of owner-occupied homes as a global asset class, a target of social and economic policy, and family centred mechanism for achieving welfare security. While housing policy has consistently focused on increasing access to home ownership, rates have recently diminished across high income economies (Lennartz et al. 2016). Moreover, in more economically liberal contexts like the UK, home ownership rates fell from over 70 percent to around 63 percent of all housing between 2005 and 2018 (Department for Levelling Up, Housing and Communities, & Ministry of Housing, Communities & Local Government 2019). Since the turn of the century, the distribution of housing wealth has again become more socially and geographically uneven with housing assets, and even access to the tenure, becoming increasingly concentrated among the wealthy and urban middle classes (Arundel and Ronald 2021; Causa et al. 2019). Furthermore, investment activities involving housing assets have also shifted in line with intensifying flows of capital seeking new kinds of returns (increasingly rent-based) 1

According to Savills’ 2019 report, How Much is the World Worth https://www.smartowner.com/ blog/savills-report-how-much-is-the-world-worth/. 2 House prices in 2020 and 2021 have increased ahead of market expectations https://www.thegua rdian.com/money/2021/sep/03/uk-enjoys-property-sales-boom-amid-covid-19-pandemic.

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from housing (Fields 2018; Forrest and Hirayama 2015; Ronald et al. 2017; Wijburg et al. 2018). The analysis in this chapter begins by conceptualising the role of owner-occupied housing and housing wealth in ageing societies, especially the seemingly ‘really big trade off’ between pensions and home ownership initially identified by Kemeny (1981), and demonstrated by Castles (1998). It goes on to consider the role growth in home ownership has played in welfare state restructuring in the twenty-first century. In particular, the increasing prominence of housing wealth in political and economic relations. The analysis then turns to new patterns of socioeconomic inequality being driven by shifting practices related to housing investment as a means to offset retirement needs, and the growing conflicts between the social and economic objectives of housing policies in ageing societies.

2.2 The Home as a Pension With growing distributions of property ownership and housing wealth across societies, the understanding and function of housing and housing policy has drifted away from concerns related to the satisfaction of shelter needs, and towards commodity and asset relations. Indeed, since the 1970s, academics have increasingly focused on the influence of different types of housing and tenure practices on social and economic development. Saunders (1990) drew particular attention to the rise of home ownership among middle income households in the UK in the decades following World War Two, especially the economic benefits enjoyed by the growing number of households in which mortgages had been paid off on approaching retirement. Kemeny (1981, 1992, 2005) framed this more effectively in terms of the ‘front-end loading’ of household lifetime housing expenses for home buyers. He observed that in countries where home ownership dominates, most people start their adult lives (when their incomes are lowest), aiming to save money for a large down payment for a home. This is followed by a prolonged period of mortgage repayment, the costs of which diminish over the life-course as salaries increase and mortgage costs are undermined by inflation. By retirement, with the mortgage repaid, housing costs are minimal, allowing individuals in the household to live more comfortably on a small pension. Put more simply, housing can be seen as having welfare effects with individuals benefitting from the imputed ‘income in-kind’ achieved by paying off a mortgage debt and then living rent-free. For Kemeny, the implications were socially far reaching, with higher home ownership rates embedding more resistance to higher taxation and public welfare spending (see also Ansell 2014). This was due to demands on households to first save, then service an initially high mortgage burden and, finally, rely on private property consumption in retirement. Kemeny (1992) further connected majority homeowner societies with a social orientation toward individualism and privatism, in contrast to more collective regimes with large social or low-cost rental sectors with, accordingly, more generous welfare states and elderly welfare cover.

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This association between housing systems, wider policy, and economic structures was empirically explored by Castles (1998) by demonstrating a ‘really big trade off’ across a range of industrialized economies between the size of home ownership sectors and public pension programmes, with growth in the former diminishing the necessity of the latter. This correlation was further explored in the 2000s by Delfani et al. (2014) who establish a more specific association between home ownership and pension systems in countries structurally geared around this relationship. More recently, the relationship is argued to have shifted over time with the growth of government and private debt allowing owner-occupation to expand more ubiquitously and, in the case of high-income countries, to sustain high home ownership alongside broader pension cover (Van Gunten and Kohl 2020).

2.3 Home Ownership and the Welfare State This conceptualization of housing as a pension has significant implications for understanding the workings of different ‘welfare regimes’. Esping-Andersen’s (1990) ‘Worlds of Welfare Capitalism’, for example, has been critical in understanding the advance of, and differences between different regimes – which can be considered constellations of welfare institutions and practices – within which the welfare state is just one, albeit particularly significant part. Within this model, housing, despite its centrality in the welfare conditions of families, plays a rather unclear role (Kurz and Blossfeld 2004). Following Kemeny’s understanding of the potential welfare effects and political biases resulting from high home ownership rates, however, housing systems can help shape different kinds of welfare regimes. While tenure patterns corelate with neither social democratic nor economically liberal welfare constellations directly, they do seem to shape welfare arrangements and modify welfare outcomes more broadly. The most obvious relation lies with the connections between the prevalence of privatized housing consumption and small welfare states, and socialized housing and more generous welfare provision. Schwartz and Seabrooke (2008) subsequently refined the relationship by focusing on the extent to which home ownership relies on mortgage finance and is therefore more commodified in each country. A key factor shaping the growing salience of the ownership of housing assets in ageing societies in recent decades has been the broader restructuring of welfare states and welfare relations. Specifically, political support for large, high spending welfare states has waned (Taylor-Gooby 2008). Not only has welfare spending been cut, in many societies the logic of social policies has also shifted away from a traditional protection function towards proactive ‘social investment’ strategies to prevent social risks and welfare dependency. Accordingly, the privatisation of social goods in favour of market actors does not simply imply welfare state retrenchment but rather a shifting logic in which welfare states become vehicles to further state transfers of wealth to private investors (Dowling 2017; Lennartz & Ronald 2017). Increasing the economic capacity, and thus self-reliance, of individuals by facilitating greater private wealth

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accumulation in the family home, has proved an attractive policy ambition. Especially in context of the hollowing out of state welfare services and the shift in welfare policy logic towards social investment. Moreover, in recent years, as majority home ownership based housing systems have become more common and the reach of housing financialisation more ubiquitous, variegation in the relationship between housing systems and welfare regimes has faded (Blackwell and Kohl 2018). Critically, the incidence of aging homeowners has become increasingly common across societies, including social democratic regimes like Sweden, for example, making the ‘in-kind incomes’ enjoyed by retired owneroccupiers salient in a wider range of pension and welfare contexts. Essentially, welfare state retrenchment and the expansion of home ownership came into deeper alignment around the turn of the century and is characteristic to a growing group of advanced economies, especially ones featuring ageing populations.

2.4 Home Ownership as a Welfare Mechanism In understanding this realignment of the welfare state, social policy, and the expansion of owner-occupied housing, the notion of Asset Based Welfare has been particularly critical. This analytic concept of social policy realignment envisages the welfare function of the home as more than ‘income in kind’ in later life as understood by Kemeny. The initial concept of Asset Based Welfare forwarded by Sherraden (1990), proposed elevating state supported access to individual investment vehicles that would accrue in value, and thus offset individual dependency on state benefits and enhance household self-reliance. The investment vehicles of Asset Based Welfare vary in nature and in the UK for example, can include state supported, long-term tax-free savings trust accounts for children. However, since the late 1990s, owner-occupied housing became the focus of policy reforms that support the facilitation of individual asset accumulation to enhance welfare self-reliance. Sustained growth of home ownership rates became a target for governments, even left leaning (Labour Party led) ones,3 who welcomed house price inflation in explicit recognition the potential of widespread housing asset ownership as a means to offset state responsibilities (see Ronald 2008). Along with the expansion of the tenure and augmentation of housing property values, home ownership increasingly offered much more than cheaper living costs for older owner-occupiers. Housing assets represented a significant reserve that could be directly tapped into to support welfare needs. This process can be understood through the concept ‘welfare switching’ (see Wood et al. 2013), which involves households drawing wealth out of their homes in order to take care of their own welfare needs by, for example, paying for welfare services privately. Indeed, the asset of the home can, 3

For example, an explicit target of 75% home ownership was set in the May 2005, budget by UK Chancellor Gordon Brown https://www.economist.com/britain/2005/05/26/gordon-browns-housesale.

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in a number of ways (see below), also be tapped into to compensate for a diminished income or even to enhance household consumption in later life. Furthermore, the market value of an owner-occupied property also represents an ‘asset of last resort’ that can be sold off should the household face significant hardship. Households themselves have also become increasingly orientated around their housing wealth as a means to boost their consumption and take care of their own welfare needs (Smith 2008; Lowe et al. 2012; Wright 2016). They have also, arguably, become focused on housing market cycles as means to facilitate augmentation in asset wealth in response to the structural decline in pension resources and the erosion of public welfare provision more generally (Crouch 2009). Thus, in the early 2000s, the idea of Asset Based Welfare from the 1990s largely mutated into a form of ‘home ownership-based welfare’ approach that was more or less explicitly reflected in social and economic policy realignment across a number of national contexts, especially more economically liberal English speaking ones (Doling and Ronald 2010b; Finlayson 2009; Malpass 2008; Montgomerie and Büdenbender, 2015; Stebbing and Spies-Butcher 2016; Toussaint and Elsinga 2009; Walks 2016; Watson 2009). Although the global housing boom of the early 2000s made home ownership a focus of Asset Based Welfare strategies, the GFC at first undermined owner-occupier households. The GFC initially destabilized income and property prices. However, as economic conditions shifted and austerity measures took hold, the GFC reinforced the focus, or even reliance of owner-occupier households on the accumulated wealth held in their homes. In the 2010s, in context of low interest rates, quantitative easing, and poorer yields from financial markets, flows of local and global money began to target housing property more directly (see below), stimulating price resurgence in most cases (Fields 2018; Aalbers 2016; Wijberg et al. 2018). Indeed, in many high-income countries, housing affordability and housing wealth inequality have re-emerged as pressing social and economic concerns (Causa et al. 2019). As such, Asset Based or Home Ownership Based welfare practices have been adapted to emerging circumstances. The outcome has been an emergent form of ‘property-based welfare’ (Ronald et al. 2017), in which government policies and household wealth accumulation approaches have become even more aligned around, and dependent upon, housing markets and property investment. Households have not only intensified their reliance on their own homes as a potential pension ‘in-kind’, but also become more concerned with buying up more housing property as a means of economic security in context of continuing economic volatility and welfare retrenchment. In the following section, we address the key trends that have emerged over the last decade, illustrating both the new context of housing and welfare switching practices. We also focus on how households are shaping, and being shaped by, new market conditions. In the final section we consider the social and economic implications of a world where housing wealth is more deeply embedded in pension and welfare practices as well as the challenges for policy making in societies dealing with increased social ageing.

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2.5 Towards Housing Property Based Welfare Like many societies, the hollowing out of public welfare provision in the UK has not been even. On the one hand, large cuts were made between 2008 and 2015 in welfare benefits for low-income households (e.g. cuts in housing allowances, especially for younger tenants, and caps on total household benefits). On the other, subsidies for home buyers have actually been extended (in the form of Help to Buy schemes) and the financial position of retired households strengthened by the ‘triple lock’ guarantee on state pensions. These reflect the continued commitment to home ownership as the focus of housing policy and a basis for household self-reliance, but also concern with potential declines in housing asset values. Specifically, there has been both a polarization in access to owner-occupied housing and housing wealth accumulation, and concern with the capacity of people, especially older ones, to actually draw on their homes during times of economic uncertainty or volatility. The overall decline in home ownership rates (from 71% in 2003 to 63% by 2018 according to the English Housing Survey 2019) ostensibly suggests that housing assets as a basis of welfare have diminished. However, this drop belies a significant distributive restructuring. Although the spread of home ownership has fallen, its concentration among older generations has advanced. Indeed, the number of home owning households aged over 55 has advanced from a little over 50% in 1980 to around 77%, since 2010. At the same time, the tenure share among younger cohorts has been falling. Moreover, even though 78% of people aged 35 to 44 where home owners in 1991, this value was 67% in 2009 and just 56% in 2019. Decline in the proportion of adults aged 25–34 owning a home have been even more significant with rates across this age group falling from 55% in 1996 to 34% in 2018(Department for Levelling Up, Housing and Communities, & Ministry of Housing, Communities & Local Government 2019). Moreover, the share and value of housing held outright has improved significantly, especially for older cohorts. For example, while the value of mortgaged property increased from £1.29 trillion in 2002 to £2.5 trillion in 2020, the value of un-mortgaged owner-occupied housing advanced even more substantially4 : from £0.97 trillion to £2.88 trillion. Similarly, rates of unmortgaged home ownership increased from 25% of owner-occupiers in 1991 to 33% in 2020, with approximately two-thirds of those aged 65 and over now owning their homes outright (Savills News 2021). Considerable wealth also leaked into multiple property ownership stimulating a resurgence in the sector share of private rental housing, which increased from 10% of all housing in 2002 to 18% by 2018. In terms of aggregate value, private rental sector property has increased from £0.35 trillion in 2002 to around £1.4 trillion in 2019 (Savills News 2021). Essentially, the capacity of owner-occupied housing to provide an ‘income in kind’ has not been diminished by the Great Recession period, and property values have seen a significant resurgence, especially after 2013. Welfare switching practices, 4

According to Savills (2021) The overall value of housing in the UK meanwhile reached to £7.56 trillion, compared to £2.9 trillion in 2002 (up by 7.5% in 2020).

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however, tell a different story. Money can be released from the home in a number of ways. The most rudimentary way is to let out unused rooms to lodgers. There is little evidence that British owner-occupiers have sought to compensate for declining income in these terms. Nonetheless, the boom in Airbnb and other short-term lettings since 2010 does indicate a growing orientation to the home as a means to generate income. The distribution of such activities is, however, highly contingent and is mostly an option for those living in areas that attract tourists. A more effective means of welfare switching is trading-down, which may involve selling the home and buying a smaller or more cheaply located one, or even moving in with family or rented accommodation. Indeed, it is estimated that those aged 65 and over in the UK, potentially release £7 billion in equity each year via house moves (Savills News 2014). Downsizing, however, may only represent a meaningful option to a limited number of potential welfare switchers as not that many properties are valuable enough to make downsizing attractive. Indeed, the advantages of potential downsizing are heavily concentrated around London and the South East of England. According to Savills’ data (2014), downsizing can release around £123,000 on average. This figure is as high as £400,000 in London, but drops to less than £100,000 in almost half of UK locations. Downsizing activities do not seem to have been enhanced by the crisis period, with life-events and living preferences, such as the desire to move closer to family and young grandchildren, continuing to be more meaningful triggers. In fact, the crisis and subsequent recession may well have had very different effects on the potential to move for many home owners, especially older ones. Critically, the need to support children on the housing ladder often undermines welfare switching practices aimed at improving the living or welfare conditions of older parents. Confounding the moving/downsizing issue has been the rise in younger people staying on in the family home as a result of declining housing and labour market conditions. Around 3.5 million single young adults in the UK are estimated to now live with their parents, with 71% of those in their early 20s, 54% of those in their late-20s, and around a third of those in their early 30s living ‘at home’ (Hill et al. 2020). ‘Boomerang children’ and late nest leavers (see also Arundel and Lennartz 2017) may well increase household pressures, but also re-orientate the family around the use value of the home (the need for space), frustrating potential downsizing or subletting. With the decline in access to credit and diminishing labour market security, adult children have increasingly sought assistance from parents in getting onto the property ladder. While providing a guarantee on mortgage payments has been a popular strategy, there has been evidence of a significant transfer in housing wealth across generations. For example, it has been estimated that the parents of buyers were involved in more than 23% of all property transactions in 2020, representing a total value of parental gifts at around £6 billion a year.5 Historical shifts in housing market and credit conditions seem to have played an important role in both enhancing asset 5

Legal and General (2017) https://www.legalandgeneral.com/landg-assets/adviser/retirement/lit erature-and-forms/articles-and-reports/BoMaD.pdf.

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accumulation and at the same time, undermining the potential of older home owners to draw on their own housing wealth for themselves. Alternatively, ‘…as older cohorts have typically benefited from historic price trends that have helped exclude their children, their assets now appear to provide a primary means by which to assist their progeny’ (Ronald and Lennartz 2018, p148). An increasingly attractive option for those seeking to access the value of their home have been Equity Release Products. Lifetime and Reverse Mortgages, as they are also known, allow home owners to sell a proportion of their property to a financial institution whilst retaining a right to live in it, until death (see Fox O’Mahoney and Overton 2015). Starting with the first ‘reverse income scheme’ in 1965, the UK has one of the most developed home equity release markets in Europe. Sales peaked before the crisis with a total value of £1.2 billion in 2007. This market subsequently dropped in value by 22% (and in customer numbers by 35%) over the following two years. There has since been a remarkable resurgence with an upturn starting in 2014 with total withdrawals reaching over £3 billion by 2017 (Equity Release Council 2021). The average value of individual loans also grew over the last decade from £49,000 to over £70,000. While the revival of equity release suggests that housing wealth has become more liquid again, its role in supporting income and welfare consumption is more questionable. Research has suggested that wealth released from the home was more typically used for consumption and servicing debt than welfare switching (Overton 2010). Indeed, Reverse Mortgage consumers are more typically middle-aged people tapping into housing equity to serve family needs rather than retired people seeking to enhance their living and welfare conditions.

2.6 Towards a New Landscape of Property Distribution The promise of mass home ownership as a pillar of a smaller, leaner welfare state from the late 1990s and early 2000s continues to have some salience in countries like the UK. However, over time, and under the pressures of crisis and post-crisis conditions, a number of flaws with practices of Property or Asset Based Welfare seem to have emerged that are generating new concerns. The first and possibly most contentious, certainly in English speaking countries, has been the polarization of housing wealth accumulation conditions between cohorts. The disparity in housing wealth status between older and younger generations, especially between those born in the initial post-war decades and those born in the 1980s and 1990s, has become a particular point. Increasingly, discussions of a ‘generation rent’ have developed surrounding diminishing housing market access and the challenges younger people face in progressing through an adult life-course (see Hoolachan et al. 2017), in contrast to growing concentrations of housing wealth (and multiple property ownership) among older cohorts (Ronald and Kadi 2018). Rather than providing a simple supplement to a pension income, with the macro scale link between home ownership and public pension provision appearing to wane (Van Gunten and Kohl 2020), housing property has become, by and large, the base of

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family wealth and economic security more broadly, and, moreover, a driver of new patterns of socioeconomic inequality. As identified above, while home ownership levels have declined significantly among younger adults, rates among retired cohorts (especially un-mortgaged owner-occupancy) have continued to advance along with the income protection of this group. Essentially, older home owners have benefitted from an exceptional (and ostensibly unrepeatable) period of house price inflation that has contributed to declining access among new, younger households that have not only been priced out, but also exposed to worsening credit and income conditions (Arundel and Doling 2017). Another remarkable feature of this polarization is the significant number of older households that have mobilized their resources around the purchase of extra housing from which to generate income from rent – derived typically from the same younger households now priced out of home ownership and forced to rent. The private rental sector has long been considered a kind of ‘cottage industry’ in the UK, dominated by amateur landlords owning just one or two properties (Kemp 2015). Since the early 2000s, there has been an explosion in the numbers of such landlords, with the private rental sector almost doubling in size between 2003 and 2015. The sector has grown from around two million to over four million units with the overwhelming majority of new lettings going to households aged under 35. Among UK landlords, around 89% are now private individuals and as many as 78% of them rent out just a single dwelling. There are now an estimated 2.2 million individual private landlords (by comparison, in 1991, the number was around 600 thousand), which equates to around one in eight owner-occupied households in the UK (Ronald and Kadi 2018). According to government figures, the majority of landlords, around 59%, are aged 55 or over and a full third of all landlords are retired individuals (Ministry of Housing, Communities & Local Government 2018). The evidence suggests that among the means available to capitalize on housing wealth, translating savings, and even existing housing equity into an extra property has become more attractive and achievable for a number of reasons. The first lies with deregulation enacted in the late 1980s as a result of declines in private renting over preceding decades (specifically the 1988 Housing Act). Deregulation allowed for the cancelation of rent controls and the standardization of short-term rolling contracts that make it easy to terminate tenancies. The second lies with the shift in the provision of credit from home buyers to landlord investors through Buy-toLet (BtL) mortgages (see Leyshon and French 2009). This segment of the mortgage market, established in 1996, provides potential landlords with more than a 30% equity deposit, a long-term loan in which rental income from the property is incorporated into the affordability calculations. In the 2000s, BtL borrowers began to compete strongly with first time buyers and have had a distinct advantage in terms of their capacity to borrow and outbid regular home purchasers in the post-GFC era.6 A final key factor has been low interest rates (Bank of England Base Rates below 2%) and 6

It should be noted that since 2016 that the UK government has both reduced tax deductions for mortgaged landlords and introduced a surcharge on the purchase of second properties (of 3%) in order to even the playing field between landlords and first-time home buyers.

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low yields in other investment spheres that have made property purchase and rental incomes more attractive. New landlords themselves have been quite explicit about their motivations, which are deeply rooted with late twentieth century commodification of housing and the normalization of welfare switching among multi-property owning cohorts. According to a National Landlords Association survey, for example, four in five private landlords consider their property income as their pension, and almost three in five (61%) plan to live off rental income in retirement.7 Meanwhile, according to the latest government survey, 44% of UK landlords purchased with an explicit view to enhancing their current or future pension income (Ministry of Housing, Communities & Local Government 2018). Growing socioeconomic inequalities derived from housing market access are not confined to cohort categories. Indeed, intergenerational transfers between parents and their adult children, as identified earlier, have also proliferated. It is thus the housing market position of the parents (and even grandparents and extended family) that are determining the potential of younger generations to build up (and, in future, draw upon) housing assets in context of shrinking public services and, more broadly, diminishing access to good quality housing. There are thus important intragenerational inequalities emerging in access to owner-occupied housing that are being enhanced by intergenerational transfers. Parents are not only involved in financial transfers to their children in the domain of housing, but their potential to accommodate adult children for longer periods in the family home also enhances their offspring’s capacity to save and thus enter home ownership earlier (Flynn and Schwartz 2017).

2.7 Governance and Political Economy A number of institutional factors also need to be highlighted in order to fully frame shifting housing and welfare switching conditions. The first of these lies within the global economy and the changing behaviour of international investment capital. While the GFC derived from increasing cross national flows of wealth into Mortgage Backed Securities (see Aalbers 2016), the post crisis financial landscape has again featured housing as a direct target of investment. While we have already identified intensification in individual level investment in rental property, a parallel trend has emerged among institutional level investors including Hedge and Private Equity Funds, as well as large Pension Funds (Beswick et al. 2016). According to Fields (2018), new digital and financial technologies have proliferated in the last decade that have facilitated ‘new logistics of extraction’. Specifically, the digital management of property and tenancies (typically at distance) have contributed to the rehabilitation of rental housing as the ‘new financial asset class’ of the post-crisis era. New kinds of institutional investors have subsequently entered 7

National Landlords Association (2012). UK Landlord Magazine http://www.landlords.org.uk/ news-campaigns/uk-landlord-magazine/september-october-2012.

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the rental housing market, contributing to increases in both housing prices and rents, and enhancing tensions between housing market insiders and (typically younger) outsiders. The capacity for future generations to enter home ownership, or even save for a deposit, have thus not only been diminished by the expansion of ‘generation landlord’ (i.e. existing home owners buying up property to rent out, but also by the encroachment of global capital into local housing markets. Flows of capital into housing have also been increasingly international with commercial research (Savills News 2019), estimating cross border investments in real estate advancing by around 334% between 2009 and 2015 alone. Related acceleration in house prices in cities like London and New York (see Fernandez et al. 2016), have attracted even further international investment, with growing volumes of international wealth going into ‘buy to rent’ property as well as ‘buy to leave’ (vacant) housing (with a view to later capturing the capital gain). Recently, cities like Vancouver have taken steps to hold back this flow, which has priced out local households, with new tariffs on foreign buyers and taxes imposed on empty property. Larger enterprises have nonetheless been more effective at buying up property in urban locations (often to rent out), and often been encouraged by governments to do so (Nethercote 2020). Critically, in terms of the dynamics and interests of global capital and private capital funds, the globally wealthy are distorting geographies of property value and, more importantly, contributing to the exclusion of younger, middle-income households from housing asset wealth accumulation and the potential ‘income in kind’ derived from home ownership in later life. A final point to make concerning the shifting institutional landscape of welfare switching are the actions of the state and policy makers. During recent periods of house price inflation, governments have come to embrace the idea of mass home ownership and relatively biased policy approaches in which other tenures are only supported to the extent that they sustain the growth of owner-occupation and housing asset wealth (with private renting, for example, representing a ‘waiting room’ for future home buyers). Since the Great Recession of the 2010s, the transition of housing policy from a domain of social to economic policy seems to have been furthered, with subsidies increasingly channelled toward sustaining household flows into home ownership as well as the continued growth of housing prices at the cost of subsidies to low income households, especially those in ‘social’ forms of housing. In the UK, support for Right-to Buy policy established in the 1980s for social tenants (and accounting for well over two million new home owners since then) continues, although since 2011, home ownership has been more effectively supported by ‘Help to Buy’ policies that cover equity loans, subsidized savings accounts and deposit guarantees.8 Nonetheless, sustaining Asset Based Welfare conditions appears quite the paradoxical task as the practice of sustaining price rises has increasingly contributed to undermining broader access. Furthermore, the concern with housing prices and property ownership has detracted from the more fundamental concern of housing policy: providing adequate housing and maintaining levels of welfare and wellbeing. 8

See the UK Government: Own Your Home https://www.ownyourhome.gov.uk/scheme/mortgageguarantee-scheme/.

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2.8 Conclusions In this chapter we have considered the often underestimated role of housing assets as a feature of pension systems and welfare regimes. Both the income-in-kind represented by living in an un-mortgaged home and the buffer of owning a substantial financial asset have become more or less implicit pillars of welfare relations and retirement practices across high income economies. The concept of Asset Based Welfare gave a particular momentum to the gearing of policy around housing assets in the last decade of the last century. In the lead up to the GFC, expanding home ownership investment along with run-away house prices also focused the attention of many governments on housing as a means to deal with public spending obligations and the challenges of an ageing society. Moreover, the growing and largely widespread distribution of housing assets also emphasized how individual households can take care of themselves, especially in later life, by making the most of market advances. While policies often assumed the growing property wealth of older homeowners would provide a strong basis for welfare switching activities, it has actually been difficult for many to capture the wealth in their homes for welfare purposes. Furthermore, in the years since the GFC, housing has assumed an even more central role in economic relations with global capital increasingly targeting real estate investment. While new institutional actors have become more involved in buying up residential property, many owner-occupier households have also become more engaged with getting money from housing. Property Based Welfare has thus acquired new meanings with homeowners buying up more housing to rent out (directly, but also as investors in pension and private equity funds, and Real Estate Investment Trusts), rather than simply relying on the income in kind from their homes or potential welfare switches. While the focus in this chapter has been on the UK, home ownership and housing systems have shaped policy frameworks and retirement conditions across a diversity of societies. Indeed, the economically liberal Anglophone countries are no longer leading ‘homeowner societies’ (Saunders 1990), with home ownership becoming the majority tenure in a growing number of countries since the 1980s. In Europe, for example, post-socialist economies in the East have become, like the South European nations, high home ownership societies with owner occupation often accounting for more than 80% of all housing in countries like Hungary, Romania, Bulgaria, Slovenia, Estonia9 Even in countries with large and well established public and social rental housing systems like Sweden and the Netherlands, owner-occupation and commodified housing markets have come to dominate. These societies are also experiencing social ageing, which has helped shift the salience of housing – from home to commodity – and turned the focus of policy from renting and regulation to ownership and liberalization. In recent years, it has become evident that home ownership as the basis of a pension or welfare regime is limited. In the UK, and also elsewhere (see Lennartz et al. 2016), divisions have emerged between cohorts driven by the growing emphasis on housing 9

See https://www.statista.com/statistics/246355/home-ownership-rate-in-europe/.

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as a means to accumulate wealth and achieve greater economic self-reliance. While increasing demand has affected prices, tighter mortgage debt lending and fewer stable incomes over the last decade or so have also contributed to diminishing access to housing, especially to buy. The consequent declining flow of new households into home ownership has not only held back younger generations from accumulating wealth via their homes, it has also diminished the capacity of older homeowners to draw on their own housing wealth. Most older homeowners are ultimately the parents or grandparents of ‘generation rent’ and have been increasingly required to support their adult children longer, guarantee mortgages or provide financial transfers for offspring to get on the property ladder. Thus, although intergenerational inequalities in housing conditions are becoming characteristic to most wealthy countries (Ronald and Lennartz 2018), this belies a strengthening of intergenerational solidarity and the reassertion of the family base of welfare relations. It also disguises the significance of intragenerational or horizontal social inequalities resulting from distorted housing prices and asset distributions.

References Aalbers, M. B. (2016). The Financialization of Housing: A Political Economy Approach. Routledge. Arundel, R., & Doling, J. (2017). The end of mass homeownership? Changes in labour markets and housing tenure opportunities across Europe. Journal of Housing and the Built Environment, 32, 649–672 Arundel, R., & Lennartz, C. (2017). Returning to the parental home: Boomerang moves of younger adults and the welfare regime context. Journal of European Social Policy, 27(3) 276–294. Arundel, R., & Ronald, R. (2021). The false promise of homeownership: Homeowner societies in an era of declining access and rising inequality. Urban Studies, 58(6), 1120–1140. Ansell, B. (2014). The political economy of ownership: Housing markets and the welfare state. American Political Science Review, 108(02), 383–402. Beswick, J., Alexandri, G., Byrne, M., Vives-Miró, S., Fields, D., Hodkinson, S., & Janoschka, M. (2016). Speculating on London’s Housing Future. City, 20(2), 321–341 Blackwell, T., & Kohl, S. (2018). The origins of national housing finance systems: a comparative investigation into historical variations in mortgage finance regimes, Review of International Political Economy, 25(1) 49–74. Castles, F. G. (1998). The really big trade-off: Home ownership and the welfare state in the new world and the old. Acta Politica, 33(1), 5–19. Causa, O., Woloszoko, N., & Leite, D. (2019). Housing Wealth Accumulation and Distribution: Evidence and Stylized Facts. Economics Department Working Papers, OECD. Retrieved January 7th 2020 from www.oecd.org/eco/workingpapers. Conley, D., & Gifford B. (2006). Home ownership, social insurance, and the welfare state. Sociological Forum, 21(1), 55–82. Crouch, C. (2009). Privatised Keynesianism: An unacknowledged policy regime. British Journal of Politics and International Studies, 11(3), 382–399. Delfani, N., De Deken, J., & Dewilde, C. (2014). Home-ownership and pensions: Negative correlation, but no trade-off. Housing Studies, 29(5), 657–676. Department for Levelling Up, Housing and Communities, & Ministry of Housing, Communities & Local Government. (2019). English Housing Survey. Retrieved Retrieved October 8th 2021 rom https://www.gov.uk/government/collections/english-housing-survey#2019-to-2020.

2 Shifting Approaches to Housing Wealth and Welfare Security in Ageing …

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Doling, J., & Ford, J. (2003). Globalisation and Home Ownership: Experiences in Eight Member States of the European Union. Delft University Press. Doling, J., & Ronald, R. (2010a). Home ownership and asset-based welfare. Journal of Housing and the Built Environment, 25, 2, 165–73. Doling, J., & Ronald, R. (2010b). Property-based welfare and European homeowners: How would housing perform as a pension? Journal of Housing and the Built Environment, 25(2), 227–241. Dowling, E. (2017). In the wake of austerity: Social impact bonds and the financialisation of the welfare state in Britain. New Political Economy, 22, 294–310. Esping-Andersen, G. (1990). The Three Worlds of Welfare Capitalism. Polity Press. Equity Release Council. (2021). Equity Release Market Report. Retrieved October 8th 2021 from https://www.equityreleasecouncil.com/news/q2-2021-equity-release-market-statistics/. Fernandez, R., Hofman, A., & Aalbers, M. B. (2016). London and New York as a safe deposit box for the transnational wealth elite. Environment and Planning A: Economy and Space, 48(12), 2443–2461. Fields, D. (2018). Constructing a new asset class: Property-led financial accumulation after the crisis. Economic Geography, 94(2), 118–140. Finlayson, A. (2009). Financialisation, Financial Literacy and Asset-Based Welfare. The British Journal of Politics and International Relations, 11(3), 400–21. Flynn, L. B., & Schwartz, H. M. (2017). No exit: social reproduction in an era of rising income inequality. Politics & Society, 45(4), 471–503. Forrest, R., & Hirayama, Y. (2015). The financialisation of the social project: Embedded liberalism, neoliberalism and home ownership. Urban Studies, 52(2), 233–244. Fox O’Mahony, L., & Overton, L. (2015). Asset-based welfare, equity release and the meaning of the owned home. Housing Studies, 30(3), 392–412. Hill, K., Hirsch, D., Stone, J., & Webber, R. (2020). Home Truths: Young adults living with their parents in low to middle income families. Edinburgh, Standard Life Foundation. Hoolachan, J., McKee, K., Moore, T., & Soaita, A. M. (2017). ‘Generation rent’ and the ability to ‘settle down’: Economic and geographical variation in young people’s housing transitions. Journal of Youth Studies, 20(1), 63–78. Kemeny, J. (1981). The Myth of Home-ownership. Routledge. Kemeny, J. (1992). Housing and Social Theory. Routledge. Kemeny, J. (2005). ‘The really big trade-off’ between home ownership and welfare: Castles’ evaluation of the 1980 thesis, and reformulation 25 years on. Housing, Theory and society, 22(2), 59–75. Kemp, P. A. (2015). Private renting after the global financial crisis. Housing Studies, (30)4, 601–620. Kurz, K., & Blossfeld, H. (2004). Home Ownership and Social Inequality: In Comparative Perspective (Studies in Social Inequality). Stanford University press. Lennartz, C., Arundel, R., & Ronald, R. (2016). Younger adults and homeownership in Europe through the global financial crisis. Population, Space and Place, 22(8), 823–835. Lennartz, C., & Ronald, R. (2017). Asset-based welfare and social investment: competing, compatible, or complementary social policy strategies for the new welfare state? Housing, Theory and Society, 34(2), 201–220. Leyshon, A., & French, S. (2009). We all live in a Robbie Fowler House: Geographies of buy to let in the UK. The British Journal of Politics & International Relations, 11(3), 438–460. Lowe, S. G., Searle, B. A., & Smith, S. J. (2012). From housing wealth to mortgage debt: The emergence of Britain’s asset-shaped welfare state. Social Policy and Society, 11(01) 105–116. Malpass, P. (2008). Housing and the new welfare state: Wobbly pillar or cornerstone? Housing Studies, 23 (1), 1–19. Ministry of Housing, Communities and Local Government. (2018). English Private Landlord Survey. Retrieved January 7th 2021 rom https://www.gov.uk/government/publications/englishprivate-landlord-survey-2018-main-report. Montgomerie, J., & Büdenbender, M. (2015). Round the houses: Homeownership and failures of asset-based welfare in the United Kingdom. New Political Economy, 20(3), 386–405.

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Nethercote, M. (2020) Build-to-Rent and the financialization of rental housing: future research directions, Housing Studies, 35:5, 839-874 Overton, L. (2010). Housing and Finance in later life: A study of UK equity release customers. Age UK. Ronald, R. (2008). The Ideology of Home Ownership: Homeowner Societies and the role of Housing. Palgrave Macmillan. Ronald, R., & Kadi, J. (2018). The revival of private landlords in Britain’s post-homeownership society. New Political Economy, 23(6), 1–18. Ronald, R. & Lennartz, C. (2018) Housing careers, intergenerational support and family relations, Housing Studies, 33:2, 147-159, Ronald, R., Lennartz, C., & Kadi, J. (2017). What ever happened to asset-based welfare? Shifting approaches to housing wealth and welfare security. Policy & Politics, 45(2), 173–193. Saunders, P. (1990). A Nation of Home Owners. Unwin Hyman. Savills News. (2014). Residential property focus, Issue 1–4. Retrieved April 12th 2016 from www. savills.co.uk/researcharticles/141285/189183-0. Savills News. (2019). How Much is the World Worth https://www.smartowner.com/blog/savillsreport-how-much-is-the-world-worth/. Savills News. (2021). UK Housing Hits Record. Retrieved [date] from https://www.savills.co. uk/insight-and-opinion/savills-news/311889-0/uk-housing-value-hits-record-%C2%A37.56-tri llion-high. Schwartz, H., & Seabrooke, L. (2008). Varieties of residential capitalism in international political economy: Old welfare states and the new politics of housing. Comparative European Politics, 6, 237–261. Sherraden, M. (1990). Stakeholding: Notes on a theory of welfare based on assets. Social Science Review, 64(4), 580–601. Smith, S. J. (2008). Owner-occupation: At home with a hybrid of money and materials. Environment and Planning A, 40(3), 520–535. Stebbing, A., & Spies-Butcher, B. (2016). The decline of a homeowning society? Asset-based welfare, retirement and intergenerational equity in Australia. Housing Studies, 31(2), 190–207. Taylor-Gooby, P. (2008). The new welfare state retrenchment in Europe. European Societies, 10(1), 3–24. Toussaint, J., & Elsinga, M. (2009). Exploring ‘housing asset-based welfare’. Can the UK be held up as an example for Europe? Housing Studies, 24(5), 669–692. Van Gunten, T., & Kohl, S. (2020). The inversion of the ‘really big trade-off’: Homeownership and pensions in long-run perspective. West European Politics, 43(2), 435–463. Walks, A. (2016). Homeownership, asset-based welfare and the neighbourhood segregation of wealth. Housing Studies, 31(7), 755–784. Watson, M. (2009). Planning for the future of asset-based welfare? New labour, financialized economic agency and the housing market. Planning, Practice and Research, 24(1), 41–56. Wijburg, G., Aalbers, M. B., & Heeg, S. (2018). The financialisation of rental housing 2.0: Releasing housing into the privatised mainstream of capital accumulation. Antipode, 50, 1098–1119. Wood, G., Parkinson, S., Searle, B., & Smith, S. J. (2013). Motivations for equity borrowing: A welfare-switching effect. Urban Studies, 50(12), 2588–607. Wright, S. (2016). Conceptualising the active welfare subject: Welfare reform in discourse, policy and lived experience. Policy & Politics, 44, 2, 235–52.

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Richard Ronald is Professor of Housing and Chair of Political and Economic Geographies at the University of Amsterdam, Netherlands. He is the current Editor of Palgrave Macmillan’s ‘Contemporary City’ book series and former Editor-in-Chief of the International Journal of Housing Policy. He sits on various funding and scientific advisory boards in Australia, Canada, Germany and the UK. His research, focusing on housing in relation to social, economic and urban transformations in Europe and Asia Pacific, has been funded by the European Research Council, the Australian Research Council, The Dutch Ministry of the Interior, the Japan Foundation and the Japanese Society for the Promotion of Science. [email protected]

Chapter 3

Overseas Housing for Elderly Hongkongers? Comparing the Key Factors Influencing Retiree Migration Between Japan and Hong Kong Edward Loke Min Foo

Abstract This study explores an innovative option for a housing policy for the elderly in Hong Kong by referencing an experimental project wherein the Japanese elderly care infrastructure and service ecosystem were replicated in, and the elderly relocated to, a foreign location. The project involved a Japanese local government and the state government of Malaysia, to whom the author was a lead advisor throughout the project planning, approval, and negotiation stages. By comparing Hong Kong to Japan, this paper presents a preliminary assessment of the need for, as well as opportunities and challenges of introducing such innovation in Hong Kong. A conceptual model was adopted to analyse three key factors, namely growing numbers of ageing population, serious caregiver shortage and high housing costs that drive Japanese retirees toward overseas migration. Similar conceptual model was then being applied to analyse and compare the factors in Hong Kong and Malaysia. Result findings of the three key factors showed that while Japan and Hong Kong are facing mounting pressures on the ageing societies arising from these factors, Malaysia’s population is far less aged, has a relatively young labour force that can be trained to become caregivers, and has affordable housing for retirees. Thus, Malaysia offers a plausible host destination for Hong Kong retirees to relocate for retirement.

3.1 Introduction This paper offers a global perspective on Hong Kong’s housing and ageing policy innovations, particularly referring to an experimental project to relocate Japanese retirees to a purpose-built location in Malaysia. The key factors that drive Japanese retirees toward overseas migration, specifically, ageing population, caregiver shortage, and high housing costs in Japan, will be compared with those of Hong E. L. M. Foo (B) Institute of Ageing and Professional Care, New Era University College, Kajang, Malaysia e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 T. Chun Tat Shum and C. C. L. Kwong (eds.), Housing and Ageing Policies in Chinese and Global Contexts, Quality of Life in Asia 15, https://doi.org/10.1007/978-981-99-5382-0_3

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Kong. The comparison will help assess the readiness of, and a suitable model for, Hongkonger retirees to embrace overseas migration. The ‘super-aged population’ phenomena in Japan led to an experimental project being discussed between a Japanese local government and the state of government of Malaysia, wherein the Japanese elderly care infrastructure and service ecosystem were replicated in, and the elderly relocated to a foreign location. The author was a lead advisor throughout the project planning, approval, and negotiation stages. A conceptual model is developed by reference to the abovementioned experimental project to analyze three key factors that drive Japanese retirees toward overseas migration, specifically, ageing population, caregiver shortage, and high housing costs in Japan, and compared with those of Hong Kong in order to assess whether these factors identified in the Japanese project are applicable to the ageing society faced by Hong Kong. The conceptual model will then be adopted to compare the three key factors in Hong Kong and Malaysia, with the objective of helping to assess the readiness of, and a suitable model for Hongkonger retirees to embrace overseas migration to Malaysia.

3.2 Retiree Migration Historically, particularly in the 1970s, waves of retiree migration were observed from one continent or continental section to another or from one country or region to another in the form of European retirees migrating from Northern Europe to Mediterranean countries within the continent (King et al. 1998). In the United States, retirees migrated from northern states into the “sunbelt” states of the country to pursue a better quality of life after their retirement (King et al. 1998). In the 1990s, Southeast Asia became an attractive destination for retirees in Europe and Japan to spend their lives after retirement in other countries (Hall et al. 2021; Green 2015). Of the countries located in Southeast Asia, Thailand and Malaysia were the main destinations of these retirees (Ono 2008), with Malaysia being the most favoured by the Japanese (Toyota and Xiang 2012; Ono 2008).

3.2.1 Driving Forces There are several driving forces of retiree migration, amongst which, climate plays a key role (King et al. 1998; Williams et al. 2000). Better life quality (Balkir and Kirkulak 2007) and self-actualisation (Wong and Musa 2014) are also among the driving forces. Cost of living is another main factor of retiree migration: retirees move from regions with high costs of living to regions with lower costs of living (Serow et al. 1986; Fournier et al. 1988).

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3.2.2 Role of Government Government policies play an important role in retiree migration. In 7 February 1992, the Treaty on the European Union (TEU) was signed, leading to the formation of the European Union (Gabel 2021). The treaty consists of the provision of freedom of movement central to the idea of EU citizenship. This encourages migration within European countries (Ackers and Dwyer 2002). In East Asia, the Japanese government rolled out its Silver Columbia Plan in 1992. Under the plan, Japanese government led a project to build overseas “ikigai” or “Japanese villages” for retirees providing lower costs of living, pleasant climate, and better living environments (MITI 1986). However, the project was criticised severely and it was therefore proposed as a long-stay international tourism plan instead of a “migration” plan (Ono 2008). In Southeast Asia, a 5-Year Thailand retirement visa programme and a 10-Year Malaysia My Second Home Programme (MM2H) were introduced to allow foreigners who meet stipulated criteria to stay in the two countries for a long period (Wong and Musa 2017). The MM2H program originated from a long-term residence plan implemented by the Ministry of Tourism of Malaysia for foreign retirees in 1996, namely the “Silver Hair Programme”. This residence plan encouraged foreign retirees to take their pensions to Malaysia for travel and long-term residence. Due to the project’s positive results, in 2002, the government decided to change its name officially from “Silver Hair Programme” to “Malaysia My Second Home”. The applicants were no longer limited to retirees but expanded to all foreigners over the age of 21. As of 2019, the Malaysian government approved 48,471 eligible foreign individuals or families to settle in Malaysia (Kang 2021). In 2017, following the success of the MM2H program, a Malaysian state government and a Japanese city government agreed to experiment with a larger-scale project, which involved replicating the Japanese elderly care infrastructure and service ecosystem in, and relocating long-stay retirees to a new township in Malaysia.

3.3 Conceptual Model This section reviews the conceptual model developed by the author during a threeyear (2017–2019) consultancy for the previously mentioned experimental project to relocate elderly Japanese to Malaysia for retirement. The conceptual model analyse three key factors that drive Japanese retirees toward overseas migration, specifically, ageing population, caregiver shortage, and high housing costs in Japan, and compared with those of Hong Kong in order to assess whether these factors identified in the Japanese project are applicable to the ageing society faced by Hong Kong. The model is then adopted to compare the three key factors between Hong Kong and Malaysia,

30

E. L. M. Foo

with the result findings concluded that Malaysia is a plausible host destination for Hong Kong retirees to relocate to foreign location for retirement.

3.3.1 Conceptual Model for Overseas Relocation of Japanese Retirees During the project’s stakeholder consultation process, the author identified three main factors influencing the Japanese’s pursuit of overseas relocations. These included the ageing population, the supply of caregivers, and the cost of housing. Figure 3.1 illustrates the conceptual model. The conceptual model shows that in the build up to pursuing retiree relocations, 1. the policymakers acknowledged the various problems of a super-aged population, 2. the care operators faced serious caregiver shortages in the market, and 3. the retirees found the cost of housing in Japan financially unbearable. Based on findings from the stakeholder consultation, the Japanese city government accepted a proposal from the Malaysian state government to run an experiment replicating the Japanese elderly care infrastructure and service ecosystem in, and moving its retirees to Malaysia. Several locations were proposed and analysed before settling on the final one. Both governments decided that the experiment should be a government-driven project, with actively involved representatives in subsequent processes. The author was appointed as the lead consultant throughout the planning, approval, and negotiation stages, which ended in December 2019 when the two governments appointed working committees to execute the project.

Fig. 3.1 Conceptual Model for Overseas Relocation of Japanese Retirees: The Main Factors, Government Role, Choice of Locations, and Processes

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31

3.3.2 Proposed Conceptual Model for Overseas Relocation of Hong Kong Retirees Throughout this study, the author will analyse whether the three main factors identified in the Japanese project are applicable in Hong Kong to assess the readiness for and suitability of a similar project to relocate Hong Kong retirees overseas, as depicted in Fig. 3.2. If the preliminary findings show that these three main factors are applicable to Hong Kong, then the proposed model can be used to suggest a strategic collaboration between a Malaysian state government and the Hong Kong government, and/ or private stakeholders, to run an experiment to relocate Hong Kong’s retirees to Malaysia. This will also require replicating its elderly care infrastructure and service ecosystem in Malaysia.

3.4 Ageing Population According to The United Nations, for developed countries, a country is defined as “ageing” when the share of people aged 65+ is above 7 percent, “aged” when it is 14 percent or more, and “super-aged” when it exceeds 20 percent (World Bank Group 2019). A summary of Japan’s and Hong Kong’s ageing populations from 2020 to 2050 is presented in Table 3.1.

Fig. 3.2 Proposed Conceptual Model for Overseas Relocation of Hong Kong Retirees: The Main Factors, Government Role, Choice of Locations, and Processes

12.4%

*84.35

48.00

Population ages 0–14 (% of total population)

Life expectancy at birth, total (years)

1 Age

8,336,683

23.3%

16,103,417

45.1%

11,293,897

31.6%

- % of total population

- Ages 65–69 (no.)

- Ages 65–69 (%)

- Ages 70–79 (no.)

- Ages 70–79 (%)

- Ages 80 and above (no.)

- Ages 80 and above (%)

41.5%

15,279,000

38.4%

14,141,000

20.1%

7,397,000

30.8%

36,817,000

53.22

85.84

11.1%

30.8%

40.0%

15,730,000

36.5%

14,349,000

23.5%

9,243,000

35.1%

39,322,000

65.52

87.03

11.1%

35.1%

2050

41.3%

16,319,000

40.7%

16,068,000

18.1%

7,138,000

37.7%

39,523,000

74.32

88.18

11.6%

37.7%

104,854,000

27.8%

378,570

38.5%

524,020

33.7%

458,860

18.2%

1,361,446

26.32

*85.07

12.7%

18.2%

7,481,800

2030

24.8%

513,000

45.8%

945,000

29.4%

607,000

25.8%

2,065,000

43.23

86.12

14.4%

25.8%

7,989,000

2040

36.2%

895,000

42.4%

1,047,000

21.4%

529,000

30.8%

2,471,000

54.83

87.33

13.0%

30.8%

8,020,000

2050

42.9%

1,167,000

36.5%

992,000

20.6%

560,000

34.7%

2,719,000

64.65

88.51

11.7%

34.7%

7,841,000

Note: * As at year 2019 Explanation Note: 1 Age Dependency Ratio, Old (% of Working-Age Population): The ratio of older dependents (people older than 64) to the working-age population (those aged 15–64). Data are shown as the proportion of dependents per 100 working-age individuals.

35,733,999

28.4%

- Population

Aged 65 and over

dependency ratio, old (per 100 working-age population)

28.4%

Aged 65 and over (% of total population)

2040 111,794,000

2020

2030 119,263,000

2020

125,836,021

Total population

Hong Kong SAR, China

Japan

Table 3.1 Ageing Population in Japan and Hong Kong, 2020–2050 (Source: The World Bank DataBank)

32 E. L. M. Foo

3 Overseas Housing for Elderly Hongkongers? Comparing the Key …

33

3.4.1 Ageing Society – Japan vs. Hong Kong In this sub-section, the data set published by the World Bank DataBank was adopted to compare the ageing populations in Japan and Hong Kong (World Bank Group 2021). Based on the definition of ageing population as mentioned in Sect. 3.4, it is observed that in year 2020, Japan was already categorised as a “super-aged” country, with 28.4% of its total population (or 35.73 million people) aged 65 and above. Hong Kong also became an “aged” city-state, with a record of 18.2% of its total population (or 1.36 million people) aged 65 and above. By year 2040, Hong Kong is forecast to become a “super-aged” city-state with 30.8% of its total population (or 2.47 million people) aged 65 and above. By comparing Hong Kong’s and Japan’s elderly populations, life expectancy at birth, and age dependency ratio for people older than 64 years, there is a clear indication that both governments are facing mounting pressure due to their ageing societies. The demand for and supply of aged care services are expected to increase significantly in the near future.

3.4.2 Population Structure of Adults Aged 65 and Above – Japan vs. Hong Kong As elderly persons age, demand for aged care services is expected to increase. Thus, an analysis of Japan’s and Hong Kong’s population structures of those aged 65 years and above may provide some indications of their future demand for aged care services. As shown in Fig. 3.3, the 70–79 age population formed the largest share of the total population of those aged 65 and above in both Japan (45.1%) and Hong Kong (38.5%) in 2020.

of total population 65 and above – 35.73 million

of total population 65 and above – 1.36 million

Fig. 3.3 Population Structure of Adults Aged 65 and above—Japan vs. Hong Kong, 2020 (Source: World Bank)

34

of total population 65 and above – 39.32 million

E. L. M. Foo

of total population 65 and above – 2.47 million

Fig. 3.4 Population Structure of Adults Aged 65 and above—Japan vs. Hong Kong, 2040 (Source: World Bank DataBank)

Figure 3.4 shows that the 70–79 age population in Japan is estimated to have declined to 36.5% (2020: 45.1%) of the total population of adults aged 65 and above by 2040, but that the 80-and-above population will have risen to 40% (2020: 31.6%). In Hong Kong, the 70–79 age population is estimated to have increased to 42.4% (2020, 38.5%) by 2040.

3.4.3 Future Population Trend – Japan vs. Hong Kong Finally, a rapidly rising life expectancy at birth and a diminishing share of the 0–14 age population indicate that a country will face increasing pressure from a superaged population in the future. Although Japan and Hong Kong are both facing such pressure, it is noteworthy that Hongkongers have even higher life expectancy and a lower share of the 0–14 age population than Japan. This is depicted in Fig. 3.5 and 3.6 below.

3.5 Caregiver Shortages 3.5.1 Caregivers in Japan The rapid increase in Japan’s aging population has put mounting pressure on senior care service providers in the country. According to a survey conducted by the Ministry of Health, Labour and Welfare (MHLW) of the Japanese government, the number of elderly people who require some type of long-term care continues to grow from 2009 to 2017. In year 2017, the number of elderly people requiring long-term care services stood at 6.3 million (or 18%) of the country’s 35.8 million adults aged 65 and above (Yasuhiro 2020).

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35

Fig. 3.5 Hong Kong vs. Japan—Life Expectancy at Birth (years old), 1960–2019

Fig. 3.6 Hong Kong vs. Japan—Population ages 0–14 (% of total population), 1960–2019 (Source: World Bank)

With the rapid growth of the aging population, the MHLW estimated that from 2016 to 2025, approximately 550,000 additional care workers will be needed to serve the elderly population in the country, which is a huge challenge to the senior care industry owing to the country’s low birth rate (Yasuhiro 2020). The survey also found that the jobs-to-applicants ratio for long-term care positions is 3.95, higher than 1.46 for all industries in 2018 (Yasuhiro 2020).

3.5.2 Caregivers in Hong Kong Table 3.2 shows the types and numbers of residential places offering elderly care services to elderly people in Hong Kong.

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Table 3.2 Number of Residential Places Offering Elderly Care Services in Hong Kong, as at 30 June 2021 (Source: Hong Kong Social Welfare Department) Subsidized places

Non-subsidized places

Total

Care and attention homes for the elderly

25,151

3,018

28,169

Nursing homes

4,315

1,729

6,044

Homes for the aged

67

462

529

Total

29,155

5,237

34,742

To initiate the policy of “ageing in place” and “continuum of care” and simplify the application procedures, in November 2003, the Hong Kong Social Welfare Department implemented a central waiting list for subsidised long-term care services to facilitate registered elders’ applications for the subsidised services at a single point of entry. According to statistics released by the department, as of 30 June 2021, a total of 36,531 applicants were on the central waiting list to stay in various subsidised residential care service (RCS) places, as shown in Table 3.3 (Social Welfare Department 2021a, b). Table 3.4 shows that the average waiting time of the elderly who applied for accommodation at subsidized residences offering aged care services is more than 6 months, with a range of 7 to 41 months. This indicates a high demand for RCS in Hong Kong. Further, the Hong Kong government is facing a shortage of caregivers for the elderly. A survey of 69 subsidised non-government aged care providers found that Table 3.3 Number of Applicants Listed in the Central Waiting List for Subsidized Long Term Care Services as at 30 June 2021 (Source: Hong Kong Social Welfare Department) Subsidized RCS for the Elderly

No. of Applicants

Care and attention places

30,438

Nursing home places

6,093

Total

36,351

Table 3.4 Average Waiting Time for Subsidized RCS for the Elderly in Hong Kong as at June 2021 (Source: Hong Kong Social Welfare Department) Subsidized RCS for the Elderly

*Waiting Time (in months) Average from the past 3 months

Subvented homes and contract homes

41 months

Private homes participating in the Enhanced Bought Place Scheme

7 months

Overall

18

Nursing homes

22 months

* Note: The average number of months between the waitlist date and the admission date of normal cases admitted to service in the past three months.

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Table 3.5 Caregivers Shortage in Hong Kong, 31 July 2017 (Source: Social Welfare Department, Government of the Hong Kong Special Administrative Region, 2017) Staff Establishment

Staff Strength

Vacancy Rate

Personal Care Workers

7,403

6,073

18.0%

Home Helpers

1,318

1,070

18.8%

Ward Attendants

1,643

1,384

15.8%

Table 3.6 Quarterly Survey of Employment and Vacancies for RCS in Hong Kong, December 2016 to March 2021 (Source: Quarterly Survey of Employment and Vacancies, Hong Kong Census and Statistics Department) As at Year

No. of Establishment

No. of Person Engaged

No. of Vacancies

Dec 2016

746

21,230

2,198

Dec 2017

750

21,511

2,114

Dec 2018

729

21,362

2,375

Dec 2019

723

21,855

2,300

Dec 2020

720

21,821

2,211

Mar 2021

720

21,936

2,196

the overall vacancy rate for workers providing aged care in these homes stood at 18% in 2017 (Social Welfare Department 2017) (Table 3.5). Table 3.6 shows that the number of vacancies for caregivers has remained at more than 2,000 over the past five years. The number of job vacancies has decreased slightly from 2,211 in December 2020 to 2,196 in March 2021. A survey on the problems faced by service providers for the elderly shows that the main reason for the vacancy rate is the difficulty in hiring caregivers, especially frontline workers. Government policy and funding have a direct influence on recruitment, and the majority of service providers believe that low pay is the key factor behind hiring difficulties, followed by poor career prospects and the nature of the job, as other factors affect caregivers’ perceptions of the jobs offered by the service providers (Wong and Musa 2014). According to the survey, many participants pointed out that, although professional care services such as nursing, dietetics, and physiotherapy can be outsourced, it is difficult to rely solely on outsourcing healthcare assistance and personal care workers.

3.5.3 Caregivers vs. Foreign Domestic Helpers in Hong Kong In the author’s opinion, Hongkongers are less affected by the caregiver shortage issue than the Japanese because Hong Kong is temporarily delaying the problem by importing foreign domestic workers.

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E. L. M. Foo

The shortage of caregivers in Hong Kong has led the Hong Kong government to predict that an additional 240,000 foreign domestic helpers will need to be recruited in the next three decades to cope with the growing demand for its rapidly aging population (China Daily 2018). According to the Hong Kong Thematic Household Survey Report, it was estimated that among the 2,657,000 households surveyed during the period from October 2019 to January 2020, approximately 355,900 households (13.4%) employed domestic helpers. Among them, foreign domestic helpers accounted for 92.1% of the total number of employed domestic helpers (Table 3.7). The survey further revealed that, of the 355,900 households that have employed domestic helpers, 164,800 included elderly persons aged 60 and above, of which 91.1% (or 150,200 households) employed foreign domestic employees, as shown in Table 3.8. However, some experts are concerned about foreign domestic helpers’ ability to care for the elderly. In light of this, the Social Welfare Department launched a free-ofcharge 18-month pilot program in 2018 to train 300 foreign domestic helpers. These foreign domestic helpers were trained by medical professionals, such as nurses, dieticians, and physiotherapists, to become caregivers for the elderly (China Daily 2018). While foreign domestic helpers have received training to take care of the elderly, their living space is not well managed. According to a survey conducted by the Table 3.7 Number of Households that Have Employed Domestic Helpers and Foreign Domestic Helpers, October 2019 to January 2020 (Source: Thematic Household Survey Report No. 72, Hong Kong Census and Statistics Department) Total

%

Total No. of Households

2,657,000

-

No. of Households that Have Employed Domestic Helpers

355,900

13.4%

Employing Local Domestic Helper

28,200

7.9%

Employing Foreign Domestic Helper

327,700

92.1%

Table 3.8 Type of Domestic Helpers Employed by Household Type (Source: Thematic Household Survey Report 2019/20, Hong Kong Census and Statistics Department) Type of Domestic Helpers Employed Local

Foreign

Total

Whether households had elderly persons aged 60 and above

No. of Households

%

No. of Households

%

Total No. of Households

%

Yes

14,600

8.9%

150,200

91.1%

164,800

100.0%

No

13,600

7.1%

177,500

92.9%

191,100

100.0%

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39

migrant workers group, most foreign domestic helpers occupy only 50 square feet of space in their employers’ residential units, and most of them sleep in shared rooms or living rooms instead of in a private room (Mission for Migrant Workers 2017).

3.6 Cost of Housing During the project’s consultation process involving a Japanese local government and the Malaysian state government, many Japanese stakeholders complained about the cost of housing in Japan, stating, “I cannot afford an apartment in my country after retirement”. This complaint can be expected from the people of Hong Kong because housing there is even more expensive than in Japan, including Tokyo. Table 3.9 illustrates this scenario.

3.6.1 Rents and Prices of Apartments in Hong Kong and Japan Table 3.9 shows that as of June 2021, monthly rent for one- and three-bedroom apartments in Hong Kong was between 152.9% and 199.8% more expensive than similar apartments in Japan. Similarly, compared to Tokyo, monthly rent in Hong Kong was between 53.8% and 124.4% higher. In terms of house prices, Hong Kong apartments were 277.8% to 334.0% more expensive than similar apartments in Japan, and 170.4% to 197.2% higher than those in Tokyo.

3.6.2 House Price Affordability in Hong Kong and Tokyo According to the UBS Global Real Estate Bubble Index 2020, it takes 20 years for skilled service staff to purchase a 60 square meter (650 square foot) apartment in Hong Kong—the longest period among the 25 cities studied in the report. The report also pointed out that even skilled service workers in Hong Kong, whose income is twice the city’s median income, find it difficult to pay for such expensive housing. In Tokyo, the number of years it takes for a skilled service worker to purchase an apartment of the same size is estimated at 12, ranking fifth among the 25 cities (Holzhey and Skoczek 2020).

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E. L. M. Foo

Table 3.9 Cost of Housing—Hong Kong vs. Japan (Source: Numbeo, as at June 2021) Rent Per Month

HONG KONG

JAPAN

HONG TOKYO KONG vs. JAPAN

HONG KONG vs. TOKYO

Apartment (1 bedroom) in City Centre

17,230.77 HK$

5,877.80 HK$

193.1%

60.3%

(243,500.71 ¥)

(83,063.53 ¥)

Apartment (1 bedroom) Outside of City Centre

12,294.12 HK$

4,100.79 HK$

(173,737.24 ¥)

(57,951.34 ¥)

(77,436.25 ¥)

Apartment (3 bedrooms) in City Centre

35,718.31 HK$

14,125.60 HK$ 152.9%

23,225.82 HK$

(504,761.78 ¥)

(199,619.20 ¥)

(328,221.16 ¥)

Apartment (3 bedrooms) Outside of Centre

23,394.37 HK$

8,431.04 HK$

(330,603.04 ¥)

(119,145.30 ¥)

(171,444.44 ¥)

Apartment Purchase Price

HONG KONG

JAPAN

TOKYO

10,748.09 HK$ (151,889.20 ¥)

199.8%

177.5%

5,479.60 HK$

12,131.87 HK$

Price per 250,281.77 HK$ 66,244.71 HK$ 277.8% Square Meter (3,536,916.25 ¥) (936,152.92 ¥) to Buy Apartment in City Centre

92,549.23 HK$

Price per 162,412.21 HK$ 37,424.57 HK$ 334.0% Square Meter (2,295,166.67 ¥) (528,874.23 ¥) to Buy Apartment Outside of Centre

54,639.27 HK$

124.4%

53.8%

92.8%

170.4%

(1,307,881.40 ¥)

197.2%

(772,147.90 ¥)

3.7 Compare Hong Kong with Malaysia One way for Japanese and Hong Kong retirees to overcome the housing problems they face back home is to relocate to developing countries that can offer affordable care services at a lower cost. We will take Malaysia as an example to compare the ageing population, caregiver shortages, and housing costs issues that confront them.

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3.7.1 Malaysia as a Destination for Retirement According to the 2021 Annual Global Retirement Index published by International Living, a magazine on living abroad, Malaysia is rated among the 10 most suitable countries for comfortable retirement. Malaysia ranks 7th , with high scores in many aspects such as great facilities at low cost, good weather, ease of integration as English is the first unofficial language, direct flights from Kuala Lumpur and Penang International Airport to more than 30 different countries, and attractive natural and social environments. Furthermore, Malaysia’s multi-ethnic people (i.e. Malays, Chinese, and Indians), cultural integration, and history of being colonised by Portugal and the United Kingdom have created great architectural and gastronomic wealth (International Living 2021) for foreign retirees to enjoy their lives in the country. In addition, Malaysia’s islands are regularly ranked in the top 10 in various global surveys, and its rainforests and parks are among the best and largest islands in Southeast Asia. In the Asia–Pacific Personalised Health Index, measured by the multinational healthcare company, Roche, Malaysia ranks 8th among 11 countries regarding the readiness and resilience of the local health system (Malay Mail 2021). The Personalized Health Index covers multiple parameters that measure aspects of the country’s readiness, infrastructure, policy, and strategy of its medical reforms to conduct individual assessments of patients’ medical needs. Singapore was ranked 1st , followed by Taiwan, Japan, Australia, South Korea, New Zealand, and Thailand. In addition to the above common indicators, Malaysia has a special characteristic that is uniquely attractive to Hong Kong, specifically, Malaysian Chinese’s proficiency in Cantonese and Mandarin, as well as the Chinese culture being familiar to Hong Kong people. This characteristic means that there will be less or no communication barriers between retirees, their caregivers, and local citizens.

3.7.2 Contrasting Hong Kong and Malaysia – Ageing Population Overall, the pressure of an aging population is far more prevalent in Hong Kong than in Malaysia. This is reflected in the percentage of the population aged 65 and over, life expectancy at birth, and age dependency ratio, as shown in Table 3.10 below.

3.7.3 Contrasting Hong Kong and Malaysia – Availability of Caregivers Malaysia’s population is relatively young compared to that of Hong Kong and Japan. As shown in Table 3.11, Malaysia’s 15-to 39-year-old population accounts for 43.5%

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E. L. M. Foo

Table 3.10 Socioeconomic and Demographic Profiles of Hong Kong and Malaysia (Source: World Bank) Hong Kong

Malaysia

GDP per capita (current USD) - 2020

46,323

10,401

Fertility rate, total (births per woman) - 2019

1.05

1.98

Life expectancy at birth, male (years) - 2019

82.2

74.2

Life expectancy at birth, female (years) - 2019

88.1

78.3

Population ages 65 and above (% of total population) - 2020

18.2%

7.2%

Age dependency ratio, old - 2020

26.3

10.4

of the total population, whereas that of Hong Kong and Japan account for 30.1% and 25.5%, respectively. Malaysia’s young population is a potential source of caregivers. However, until recently, there has been a lack of caregiving courses to train young people in Malaysia to become qualified caregivers. This situation was recognised by Deputy Prime Minister Dr. Wan Azizah in 2018, who stated that “…the shortage was not due to any lack of manpower, but an insufficiency in training providers to produce qualified caregivers” (Malay mail 2018). In 2020, the first university-based caregiver training program in Malaysia was established to train young people in caregiving and to recruit them into the senior care industry (New Era University College). The main source of these young caregiving trainees is expected to be recruited from the unemployed youth. Malaysia’s unemployment rate has reached a 20-year high, standing at 4.5% in December 2020. Owing to the Covid-19 pandemic, the unemployment rate rose sharply to 5.3% in May 2020, but by May 2021, it had declined to 4.5% or 728,100 unemployed persons (Fig. 3.7). A more detailed analysis shows that among the 711,000 unemployed population in 2020, those aged 15–39 years accounted for 84.7% (602,400 persons), while those aged 40–59 years represented 13% (92,100 persons) (FIg. 3.8). From 2010 to 2020, the number of unemployed workers remained high in the 15–39-year-old group, providing the aged care industry with opportunities to hire these labourers and fill the gap in the shortage of caregivers for the elderly in Malaysia.

3.7.4 Contrasting Hong Kong and Malaysia – Costs of Housing Compared with Hong Kong, the monthly apartment rent in Malaysia in June 2021 was 86% cheaper than that in Malaysia as a whole (Table 3.12). Similarly, apartment prices in Malaysia are 94% lower than in Hong Kong (Table 3.13).

Total Population (mil)

32.4

36.1

38.8

40.6

Year

2020

2030

2040

2050

Malaysia

13.3

13.3

13.6

14.1

Population ages 15–39 (mil)

32.7%

34.4%

37.8%

43.5%

% of Total Population

7.8

8.0

8.0

7.5

Total Population (mil)

Hong Kong

2.0

1.8

1.9

2.3

Population ages 15–39 (mil)

25.4%

23.0%

24.3%

30.1%

% of Total Population

Table 3.11 Population Ages 15–39 in Malaysia, Hong Kong and Japan, 2030–2050 (Source: World Bank)

104.9

111.8

119.3

125.8

Total Population (mil)

Japan

23.3

25.9

28.7

32.1

Population ages 15–39 (mil)

22.2%

23.2%

24.0%

25.5%

% of Total Population

3 Overseas Housing for Elderly Hongkongers? Comparing the Key … 43

44

E. L. M. Foo

Fig. 3.7 Unemployed Persons in Malaysia (Source: Department of Statistics Malaysia (Reproduced from Department of Statistics Malaysia, 8 July 2021))

Fig. 3.8 Unemployed Persons by Age Group in Malaysia, 2010–2020 (Source: Department of Statistics Malaysia)

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45

Table 3.12 Rent Per Month of Apartments in Hong Kong and Malaysia (Source: Numbeo, as at June 2021) Rent Per Month

Hong Kong

Malaysia

Rent Difference by %

Apartment (1 bedroom) in City Centre

17,230.77 HK$

2,580.66 HK$

-85.02%

(9,120.13 RM)

(1,365.93 RM)

Apartment (1 bedroom) Outside of City Centre

12,294.12 HK$

1,627.35 HK$

(6,507.20 RM)

(861.35 RM)

Apartment (3 bedrooms) in City Centre

35,718.31 HK$

4,793.46 HK$

-86.76% -86.58%

(18,905.47 RM) (2,537.15 RM)

Apartment (3 bedrooms) Outside of 23,394.37 HK$ 3,115.02 HK$ -86.68% City Centre (12,382.48 RM) (1,648.76 RM)

Table 3.13 Prices of Apartments in Hong Kong and Malaysia (Source: Numbeo, as at June 2021) Buy Apartment Price

Hong Kong

Malaysia

Price Difference by %

Price per Square Meter to Buy Apartment in City Centre

250,281.77 HK$

16,040.53 HK$

-93.59%

(132,472.50 RM)

(8,490.15 RM)

Price per Square Meter to Buy Apartment Outside of Centre

162,412.21 HK$

9,572.68 HK$

(85,963.72 RM)

(5,066.76 RM)

-94.11%

Malaysia’s cheaper rent and apartment prices make the country an attractive place for Hongkongers to migrate for a more affordable retirement life. Malaysia’s low housing costs will remain low even in the long term due to the abundance of land and low population density. Compared to Hong Kong and Japan, Malaysia’s population density is much lower, at 99 persons/km2, compared to 334 persons/km2 in Japan and 6,841 persons/km2 in Hong Kong. This indicates that Malaysia has more rural land for stakeholders and developers to build large-scale retirement facilities (Table 3.14). Table 3.14 Population Density by Country (Source: Countries By Density 2021, World Population Review by World Bank (https://worldpopulationreview.com/country-rankings/countries-bydensity)) Country Malaysia

Land Area 330,803

km2

km2

Hong Kong

1,104

Japan

377,930 km2

2021 Population

Population Density (no. of persons)

32,776,194

99/km2

7,552,810

6,841/km2

126,050,804

334/km2

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E. L. M. Foo

3.8 Government Role Should an experiment to replicate Hong Kong’s elderly care infrastructure and service ecosystem in, and move Hong Kong retirees to Malaysia be carried out? If so, what would be the role of the Hong Kong government? In the case of the experimental project between the Japanese city government and Malaysian state government, both governments decided that they should play active roles because of the several functions that must be played. Here, we examined whether the same functions apply to Hong Kong.

3.8.1 Immigration Policy One of the functions of the Malaysian government is to facilitate the application of visas for foreign retirees. Immigration policy plays a vital role in resolving international mobility because retirees who wish to stay in the host country longer do not have to face visa requirement issues to return to their home countries, which affects their decision to choose a country as their retirement destination. From its inception in 2002 to 2019, the MM2H program has approved 48,471 applications in total, of which 15,883 were approved for Chinese migrants, followed by those for Japanese migrants with 5,150 approvals. Hongkongers were approved and ranked 6th , with 1,691 applicants. Figure 3.9 shows the country of origin of the MM2H participants (Kang 2021).

Fig. 3.9 Top 10 countries of origin of MM2H participants (2002–2019) (Source: The Edge Malaysia, Malaysia My Second Home)

3 Overseas Housing for Elderly Hongkongers? Comparing the Key …

47

It can be said that, like for the Japanese, Hong Kong retirees’ relocation to Malaysia requires the active role of the Malaysian government to support immigration policy.

3.8.2 Property Purchase Policy Under the MM2H Programme, applicants have the privilege of purchasing property in Malaysia at a lower minimum price in selected states than those without MM2H visas. However, as land is a state affair in Malaysian law, state governments play an important role in setting specific minimum purchase prices in the states. Therefore, the minimum purchase prices in the states are not standardised, as shown in Table 3.15. It can be said that, like for the Japanese, Hong Kong retirees’ relocation to Malaysia requires the active role of the Malaysian state government to support property purchase policy. Table 3.15 Minimum Purchase Price for Property Purchased by MM2H Applicants (Source: Malaysia My Second Home; Invest Selangor (Reproduced from Propsocial.my 2018)) State

Without MM2

With MM2H

Selangor

RM2 million

*RM2 million for Zone 1 & 2 *RM1 million for Zone 3

Terengganu

RM1 million

RM1 million

Johor

RM1 million

RM1 million

Pahang

RM1 million

RM1 million

*Kuala Lumpur, Putrajaya, Labuan

RM1 million

RM1 million

Negeri Sembilan

RM1 million

RM1 million

Perlis

RM1 million

RM500,000

Sabah

RM1 million

RM500,000

Kelantan

RM1 million

RM500,000

Malacca

RM1 million

RM500,000

Penang

RM2 million on the island and RM1 million on the mainland for all types of property

RM500,000 (minimum 2 units)

Perak

RM1 million

RM350,000

Sarawak

RM1 million

RM300,000

Notes: * Federal Territory: Kuala Lumpur, Putrajaya, Labuan ** RM2 million in Zon 1 and 2 (most of Selangor) areas. In Zon 3, Selangor and Bernam

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E. L. M. Foo

3.8.3 Award of Government Land In Malaysia, the state government is the largest landowner and holds the power to award government land to projects that benefit the local economy and society. In the case of the experimental project between the Japanese city government and Malaysian state government, the latter has awarded a piece of government land, over 700-acre in size, located in a hot spring area for the project, in return for some controlling stake in a newly established company or special purpose vehicle (SPV) that spearheads the project. The awarding of land significantly reduces project costs. It can be said that, like for the Japanese, Hong Kong retirees’ relocation to Malaysia requires an active role of the Malaysian state government to support the award of land.

3.8.4 Long Term Care Insurance In the case of Japanese retirees, the involvement of the Japanese city government is crucial because of long-term care insurance (LTCI). This insurance was launched in 2000 to support the long-term care of elderly Japanese individuals. Compared to most countries, LTCI is quite generous in terms of the levels of coverage and benefits offered, and all Japanese citizens over the age of 40 are covered by this system. Along with the rapid aging of the population, the number of people requiring long-term care, as well as the length of care itself, increased, and as long-term care needs rose, the financial burden on the Japanese government at the central, prefectural, and municipal levels also increased. A unique feature of LTCI is that city governments and municipalities operate as key insurers. Municipal governments were given the final say in the selection of services, and users did not have the power to select services. Therefore, the involvement of the Japanese city government is crucial to enable care services in Malaysia or any host country to be included in LTCI coverage. Unlike the Japanese’s case, Hong Kong retirees’ relocation to Malaysia does not require the active role of the Hong Kong government, as they do not have a care insurance similar to Japan’s LTCI. The Hong Kong government’s role is optional in any project to relocate retirees to Malaysia.

3.8.5 Collective Strategy Without the active involvement of the Hong Kong government, a collective strategy by non-government organisations (NGOs) or private developers can be adopted to maximise the negotiation power of Hong Kong stakeholders when they deal with

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49

the host government; for instance, to negotiate for a favourable immigration policy, property purchase policy, and award of state land. A collective strategy will also consolidate the strength of Hong Kong stakeholders to raise funds for the project and recruit the talent needed to build the elderly care infrastructure and service ecosystem in the new location. Finally, a collective strategy is needed to ensure a crowd effect for Hong Kong retirees to relocate and rebuild a new community of Hongkongers in a foreign land. This will help retirees adjust better to the new stage of life they are entering without the accompany of family members and friends.

3.9 Conclusion and Recommendation This analysis revealed that the main factors that drove Japanese retirees to consider international migration were also applicable to Hong Kong retirees. First, while Hong Kong is facing less pressure regarding the super-aged population phenomenon compared to Japan, it is catching up at a rapid pace. Second, Hong Kong is confronted with a serious shortage of eligible caregivers. While this shortage is not as dire as in Japan due to Hong Kong engaging foreign domestic helpers for the job, such a solution is not sustainable in the long term and not ideal for the quality of care provided. Third, retirees face an even higher housing cost in Hong Kong than their counterparts in Japan. These three factors are expected to continue to exert pressure on Hong Kong retirees to consider alternative locations for retirement outside Hong Kong (Fig. 3.10). In conclusion, Malaysia is a plausible host destination that contrasts sharply with Hong Kong in terms of the three factors described above. Its population is far less

Fig. 3.10 Conceptual Model for Overseas Relocation of Hong Kong Retirees: The Main Factors, Government Role, Choice of Locations, and Processes

50

E. L. M. Foo

aged, with a relatively young labour force that can be trained to become certified caregivers, and has affordable housing for retirees. Therefore, an experimental project to replicate care facilities and services in, and relocate Hong Kong retirees to Malaysia is recommended. Project stakeholders, which may or may not include the Hong Kong government, can form a collective strategy to spearhead the processes of planning, approving, and negotiating with the Malaysian government for favourable immigration policy, property purchase policy, and award of state land.

3.10 Limitations This study has some limitations. First, the caregiver shortage factor in Japan and Hong Kong was analyzed in the absent of in-depth analysis on the elderly care infrastructure and service ecosystem in the country and the city-state. It is important to analyze these elderly care infrastructure and service ecosystem in order to assess the possibility of replicating it, and modified it if necessary to comply with the unique conditions, in Malaysia. Second, the lack of availability of statistics on the supply of caregivers prompted author to use proxy measures to depict the caregiver shortage phenomenon in the country and the city-state, such as the jobs-to-applicants ratio for long-term care positions in Japan, and the central waiting list for subsidized long-term care services to facilitate registered elders’ applications for the subsidized services in Hong Kong.

3.11 Direction for Future Study Future direction for the study is to analyze elderly care infrastructure and service ecosystem in Japan and Hong Kong, so that a framework can be developed to provide the assessments on the elderly care infrastructure and service ecosystem in Malaysia.

References Ackers L, Dwyer P (2002) Senior citizenship? Retirement, migration and welfare in the European Union. The Policy Press. Balkir C, Kirkulak B (2007) Turkey as a new destination for retirement migration. Paper presented at the meeting of international migration, multi-local livelihoods and human security: Perspectives from Europe. Asia, Africa and Latin America: The Hague. China Daily. (2018) Elder-care shortage needs early remedy. http://www.chinadaily.com.cn/hkedit ion/2018-10/02/content_37015233.htm. Accessed 24 Mar 2022.

3 Overseas Housing for Elderly Hongkongers? Comparing the Key …

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Department of Statistics Malaysia (2021, July 8) Key statistics of labour force in Malaysia, May 2021. Department of Statistics Malaysia. https://www.dosm.gov.my/v1/index.php?r=column/ cthemeByCat&cat=124&bul_id=a09WTHNBQVpVcHFiZkNTaEZnTHF3UT09&menu_id= Tm8zcnRjdVRNWWlpWjRlbmtlaDk1UT09. Accessed 24 Mar 2022. Department of Statistics Malaysia (2020) Labour force by age group, Malaysia/states, 1982– 2020. Department of Statistics Malaysia. https://www.dosm.gov.my/v1/uploads/files/3_Time% 20Series/LFS_1982-2020/04.TABLE-4.pdf. Accessed 24 Mar 2022. Fournier GM, Rasmussen DW, Serow WJ (1988) Elderly migration: For sun and money. Popul Res Policy Rev 7(2):189–199. Gabel MJ (2021) The Maastricht Treaty. Encyclopaedia Britannica. https://www.britannica.com/ topic/European-Union/The-euro-zone-debt-crisis. Accessed 24 Mar 2022. Green P (2015) Mobility, subjectivity and interpersonal relationships: Older, Western migrants and retirees in Malaysia and Indonesia. Asian Anthropol 14(2):150–165. Hall K, Ono M, Kohno A (2021) British and Japanese international retirement migration and creative responses to health and care challenges: A bricolage perspective. Comp Migr Stud. https://doi. org/10.1186/s40878-020-00217-x. Holzhey M, Skoczek M (2020) UBS Global Real Estate Bubble Index 2020. UBS Switzerland AG. Hong Kong Census and Statistics Department. (2020) Thematic Household Survey Report No. 72. Hong Kong SAR Government. Hong Kong Census and Statistics Department. Quarterly Survey of Employment and Vacancies. Hong Kong SAR Government. International Living (2021) The exotic, modern paradise. https://internationalliving.com/countries/ malaysia/. Accessed 24 Mar 2022. Kang SL (2021) Special report: Second home dream crushed as pandemic puts MM2H in limbo. The Edge Malaysia. https://www.theedgemarkets.com/article/special-report-second-home-dreamcrushed-pandemic-puts-mm2h-limbo. Accessed 24 Mar 2022. King R, Warnes AM, Williams AM (1998) International retirement migration in Europe. Int J Popul Geogr 4:91–111. Mission for Migrant Workers (2017) Pictures from the inside: Investigating living accommodation of women migrant domestic workers towards advocacy and action. MFMW Limited. Ministry of International Trade and Industry (1986) Sirub¯a-KoronbiaKeikaku ’92: Yutaka na Daini no JinseiwoKaigai de Sugosu Tameno Kaigai Kyôjyû Shien Jigyô (Silver Colombia Plan ’92: A Support Project for Affluent Second Life Abroad). Tokyo, MITI. Numbeo (2021) Property prices (https://www.numbeo.com/property-investment/). Accessed 26 Aug 2021. Ono M (2008) Long-stay Tourism and International Retirement Migration: Japanese Retirees in Malaysia. Senri Ethnological Reports 77:151–162. Propsocial Editor (2018) Buying property in Malaysia as a foreigner. Propsocial.my. https://www. propsocial.my/topic/1132/buying-property-in-malaysia-as-a-foreigner-posted-by-propsocialeditor. Accessed 24 Mar 2022. Razak R (2021) Malaysia ranked 8th in Asia Pacific for healthcare personalised to each patient. Malay Mail. https://www.malaymail.com/news/malaysia/2021/02/19/malaysia-ranked-8th-inasia-pacific-for-healthcare-personalised-to-each-pat/1951081. Accessed 24 Mar 2022. Robertson M (2018). More caregiver training needed to boost supply, says Dr Wan Azizah. Malay Mail. https://www.malaymail.com/news/malaysia/2018/05/29/more-caregiver-trainingneeded-to-boost-supply-says-dr-wan-azizah/1636005. Accessed 24 Mar 2022. Serow WJ, Charity DA, Fournier GM, Rasmussen DW (1986) Cost of living differentials and elderly interstate migration. Res Aging 8(2):317–327. Social Welfare Department (2021a) Overview of residential care services for the elderly. The Government of the Hong Kong Special Administrative Region. https://www.swd.gov.hk/en/ index/site_pubsvc/page_elderly/sub_residentia/id_overviewon/. Accessed 24 Mar 2022.

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Social Welfare Department. (2021b) Statistics on waiting list for subsidized residential care services for the elderly. The Government of the Hong Kong Special Administrative Region. https:// www.swd.gov.hk/storage/asset/section/632/en/LTC_statistics_HP-Eng(202106).pdf. Accessed 24 Mar 2022. Social Welfare Department. (2017) LCQ7: Manpower shortage in elderly service sector. The Government of the Hong Kong Special Administrative Region. https://www.info.gov.hk/gia/ general/201711/29/P2017112900367.htm. Accessed 24 Mar 2022. Toyota M, B Xiang (2012). The Emerging Transnational ‘Retirement Industry’ in Southeast Asia. Int J Sociol Soc Policy 32(11):708–719. Williams AM, King R, Warnes A, Patterson G (2000). Tourism and international retirement migration: new forms of an old relationship in southern Europe. Tour Geogr 2(1):28–49. Wong KM, Musa G (2014). Retirement motivation among “Malaysia My Second Home” participants. Tour Manag 40, 141–154. Wong BKM, Musa G (2017). Malaysia My Second Home (MM2H): Retirees’ demographic profile and spending dynamics. Tour Manag 60:42–46. World Bank Group (2019). Approach paper - World Bank support to aging countries. IEG approach paper Washington D.C. https://documents1.worldbank.org/curated/en/870611561130594816/ pdf/World-Bank-Support-to-Aging-Countries-Approach-Paper.pdf. Accessed 24 Mar 2022. World Bank DataBank (2021) Population-Estimates. The World Bank. World Population Review (2021) Countries by density 2021. The World Bank. https://worldpopu lationreview.com/country-rankings/countries-by-density. Accessed 27 Aug 2021. Yasuhiro Y (2020). The challenges facing Japan’s long-term care services. Nippon.com. https:// www.nippon.com/en/in-depth/d00530/the-challenges-facing-japan%E2%80%99s-long-termcare-services.html. Accessed 24 Mar 2022.

Edward Loke Min Foo is the Director of Institute of Ageing and Professional Care at New Era University College, a private not-for-profit university in Malaysia. He graduated from University of Oxford and specialized in Private-finance-Initiatives (PFI) and Public-Private-Partnerships (PPP) in social infrastructure and services, ageing society, ageing economics, long-term care and elderly housing. He has been lead consultant in several aged care projects undertaken by the governments of Malaysia and Japan. He also advises property developers from Malaysia to form partnership with Japanese elderly care operators and technology producers in designing and marketing their retirement properties to affluent foreigners. [email protected]

Chapter 4

Successful Ageing: The Novel Perspectives and Experiences of Vietnamese Migrants in Australia Hien Thi Nguyen, Loretta Baldassar, and Raelene Wilding

Abstract Existing studies on successful ageing have been criticised for their western-centric approach. To address this criticism, this study presents Vietnamese migrants’ perspectives and experiences of successful ageing in a transnational context. Using a grounded theory approach and featuring emic perspectives, data collected on 42 Vietnamese migrants in Australia through ethnographic interviews and participant observation were analysed to develop a model of successful ageing based on the socio-cultural values and economic and institutional contexts of the home and host countries. The findings indicate that, contrary to the western notions associated with individual successes, self-control, and independence, Vietnamese migrants’ successful ageing perceptions comprise three key dimensions: family fulfilments, individual achievements, and social engagement and protection, of which family fulfilments is the most crucial; the others, individual achievements and social engagement and protection, are relevant but rendered meaningless without the former. Accordingly, Vietnamese migrants’ conceptualisation of successful ageing is culturally driven and socially constructed, and must be understood subjectively by incorporating multiple self-defined and self-categorised dimensions. This is especially evident in transnational and migrant contexts, in which the Vietnamese people’s perceptions of successful ageing are influenced by cultural exchanges and transformation, but retain their dominant cultural meanings.

H. T. Nguyen (B) · L. Baldassar School of Arts and Humanities, Edith Cowan University, Perth, Australia e-mail: [email protected] H. T. Nguyen School of Allied Health, The University of Western Australia, Perth, Australia R. Wilding School of Humanities and Social Sciences, La Trobe University, Melbourne (Bundoora), Australia © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 T. Chun Tat Shum and C. C. L. Kwong (eds.), Housing and Ageing Policies in Chinese and Global Contexts, Quality of Life in Asia 15, https://doi.org/10.1007/978-981-99-5382-0_4

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4.1 Introduction The concept of successful ageing (SA) has been central to gerontology studies for around 70 years (Cosco et al. 2013, 2014). However, it has been examined in relation to Asian cultures only in the last two decades (Cheng et al. 2015). The concept is completely new for Vietnamese public policy, and the Vietnamese people in general, although some equivalent notions such as active ageing, productive ageing, and healthy ageing have been communicated through the Government’s health campaign slogan ‘living happily, healthily, and productively’ (sống vui, sống khỏe, sống có ích) (VAE 2021; VNA 2009). This campaign aims to promote seniors’ wellbeing through continuous contributions to their families, communities, and the society. Several studies have examined the effects of medical care, poverty, social security, aged care policies and services, gender, and social determinants on Vietnamese people’s ageing experiences (e.g., Bich et al. 2019; Dao-Tran et al. 2017; Friedman et al. 2003; Hoi et al. 2011). Nonetheless, no study has hitherto analysed the SA concept from the perspective of the Vietnamese people in either local or transnational contexts.

4.1.1 Multidimensional Approach to SA Looking back on the historical development of SA, Pressey and Simcoe’s (1950) seminal work introduced the notion. However, the concept came into greater focus only in the 1980s when Rowe and Kahn (1987) included it in their ‘human ageing’ study. To challenge ‘ageism’, casual or systematic age-based stereotypes and/or discrimination against older individuals or groups (Butler 1969), various theories supporting the positive dimensions of late-life experiences have been introduced in the last fifty years, including Butler’s (1969) pioneering ‘productive ageing’ notion. Later, other interchangeable approaches, including healthy ageing, active ageing, effective ageing, positive ageing, resilient ageing, ageing well, and age-friendly communities and cities (Brown and Bond 2016), were introduced. These approaches have been studied mainly in the Global North, with relatively fewer interrogations in the Global South and in transnational contexts (Cosco et al. 2013; Iwamasa and Iwasaki 2011; Lamb 2014). Despite significant research across a range of disciplines, SA continues to be a controversial concept (Cosco et al. 2013). Its early definitions emphasised western notions of individual agency and self-control. Pioneering this model, Rowe and Kahn (1987) introduced three SA components: low probability of disease and diseaserelated disability, high cognitive and physical functioning, and engagement with life. These components are hierarchical, such that the absence of diseases and disabilities provides the conditions for high physical and cognitive functioning, which in turn facilitate engagement with life. Although this tri-partite model has been applied to measure the level of SA across various societies (Cosco et al. 2013), it has been

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criticised for ignoring larger structural barriers and health gaps generated by socioeconomic disparities (Cheng et al. 2015; Ferraro and Shippee 2009; Iwamasa and Iwasaki 2011); different cultural and political contexts (Lamb 2014); and dissimilar individual experiences that have shaped attitudes towards SA (Montross et al. 2006; Strawbridge et al. 2002). To address these critiques, recent empirical studies have applied a single physical, functional, psychological, or social dimension of health and well-being or a combination of such dimensions to identify the multi-dimensionality of SA (Cosco et al. 2013). For instance, Hodge et al. (2013) analysed a sample of seniors born in Australia, New Zealand, and the United Kingdom and found that health-related factors (diseases, disabilities, and psychological distress) are the key determinants of SA. Meanwhile, Young et al. (2009) and Tesch-Römer and Wahl (2017) contradicted Rowe and Kahn’s (1987) model by arguing that SA is achievable among those living with diseases and disabilities if they receive appropriate and adequate care and psychological and/or social compensatory mechanisms. Although limited in its scope, the social and cultural aspects of SA have been studied for seniors living in or originating from Asia. For instance, Hsu (2007) and Lee (2009) revealed that Chinese people perceive SA in terms of family and social support, economic security, the social environment, and social policies that support their ‘engaged citizenship’ (Mihailidis and Thevenin 2013). Meanwhile, Miah and King (2023), in their research on the British-Bangladeshi ageing and mobilities experience in transnational spaces, argue that SA is about social activity, respect, and ‘being cared for’ by family members, rather than about physical activity and independence. The literature indicates that cultural, political, and economic conditions and personal opinions significantly constitute and influence the perceptions and understandings of SA. Notably, due to the impact of cultural values driven by familism and collectivism, Asian people tend to interpret SA primarily in terms of their active social engagement, family intergenerational care, and respect (Cheng et al. 2015; Chou and Chi 2002; Miah and King 2023) and view factors related to biomedical, psychological, and physical health as secondary determinants. Therefore, we agree with Baltes and Baltes (1990, p.4) that ‘defining the nature of success is elusive,…[and] consensus about the definition of success is difficult to achieve’.

4.1.2 Conceptualisation of SA Through Self-Definition There has been considerable debate on the definition of SA for a single population or society because of its multifaceted nature. Many studies have used the etic approach (the perspective of the outsiders/researchers), assuming that pre-determined concepts (biomedical, activities of daily living, physical, social, and psychological dimensions) can assess SA most effectively (Annele et al. 2019; Gopinath et al. 2018; Hodge et al. 2013). However, a recent growing literature has criticised these universal approaches and argued for a shift in focus towards culturally-based SA concepts featured in the emic approach (the perspective of the insiders/participants) (Lamb

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2014; Samanta 2018). For instance, Iwamasa and Iwasaki (2011) examined the influence of Japanese culture on older Japanese American people’s self-definitions of SA. Their model comprised six elements: physical health, psychological health, cognitive functioning, socialisation, spirituality, and financial security, thus incorporating cultural variations ignored by previous studies on western populations. Notably, the literature based on an emic approach indicates that self-ratings generate a higher percentage of successful agers compared with the pre-determined frameworks. Research conducted by Strawbridge et al. (2002) revealed that 50.3% of seniors aged 65–99 years participating in the Alameda County Study recognised themselves as successful agers, whereas this rate was only 18.8% based on Rowe and Kahn’s (1987) criteria. In another project that examined the correlates of self-rated SA among community-dwelling adults in California, Montross et al. (2006) reported that a high proportion of older adults (92%) rated themselves as ageing successfully despite living with chronic physical illnesses (and disability, in some cases), whereas only 5% of them met researcher-defined criteria. These empirical findings suggest that a comprehensive approach to define and measure SA should incorporate the subjective experiences (self-definitions) of seniors living in diverse cultural, social, political, and institutional contexts. To address the existing research gap, a qualitative analysis was conducted for a sample of Vietnamese migrants in Australia to explore their perceptions of SA. Diverging from the widely applied etic approach and the existing operational alternative concepts,1 this study used a grounded theory approach featuring emic perspectives (Headland et al. 1990), enabling participants to self-define their SA model. Taking socio-cultural variations into careful consideration, the findings supported Estes and Mahakian (2001)’s critique that ‘social and environmental factors remain under-explicated, under-theorised, and under-researched in the work on successful ageing’. This study provides important insights on transnational circumstances, revealing that Vietnamese migrants’ diverse individual understandings of SA are influenced by the institutional contexts of both the home and host countries. Finally, it highlights a cross-cultural dimension of the Vietnamese migrants’ SA model, influenced by the tensions and intersections between familism and collectivism in the home country and individualism in the host country.

4.2 Research Methods This study applied empirical data from a PhD project, ‘Growing older overseas: how older Vietnamese people are experiencing ageing and aged care in Australia’. Ethnographic interviews and participant observation were conducted in Perth, Melbourne, and Sydney throughout 2020–2021. The sample comprised 42 participants, namely

1

Ageing well, active ageing, productive ageing, healthy ageing, effective ageing, active ageing, and resilient ageing.

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22 Vietnamese migrant parents, aged 54–91 years, and 20 adult migrant children, aged 27–60 years as presented in Table 4.1 below. The parental sample included two cohorts: 10 parent visitors who made (repeated) short-term (3–12 months) visits to stay with and care for their migrant descendants, and 12 parent migrants settled with their adult children in Australia. 8 migrant parents were graduates and post-graduates, whereas the other 14 had completed primary and secondary education; there were 10 men and 12 women; of 22, 16 were married, 5 were widowed and 2 were either divorced or separated. The sample of 20 adult children comprised 12 permanent residents/citizens and 8 international students; of the 20, 15 had completed either tertiary or higher education, had received technical education and 1 had completed primary education. In terms of marital status, 14 adult children were married with 1 to 3 children; 4 were single; and 1 was separated. Participants self-identified as belonging to the lower-middle or middling class that is ‘…often, but not always, well educated…’ and ‘…may come from wealthy families, but more often than not …appear to be simply middle class’ (Conradson and Latham 2005). Table 4.1 Selected demographics of the research sample Categories

Grandparent Visitors

Adult children Permanent residents/citizens

Temporary international students/skilled immigrants

Permanent residents/citizens

Female

Male

Female

Male

6

2

10

2

Female

Male

Female

Male

7

3

5

7

Age group: 54–91 27–60 Educational attainment: Primary & secondary education

5

1

3

5

2

Technical & further education (TAFE) Graduates

2

1

Postgraduates

2

2

1

1

1

2

2

5

2

4

1

7

6

2

5

1

3

1

Marital status: Married

3

3

2

Single Widowed

3

2

Divorced/ separated

1

1

1

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H. T. Nguyen et al.

The participants were recruited using snowball and purposive sampling through the personal networks of Nguyen, the first author, who is a Vietnamese international student in Australia. The ethnographic interviews were conducted in Vietnamese (as per all participants’ preferences) either in-person or online with the assistance of information and communications technologies (ICTs) using the digital kinning research method (Nguyen et al. 2021); each interview lasted from 1.5 to 4 h. Online participant observation was carried out on the Facebook pages of migrant parents and their adult children to see how the participants engaged in virtual social interactions with their distant kin and contacts back in their home country. The study covered a number of research themes on the Vietnamese migrants’ ageing and aged care experiences. Apart from examining their real experiences with living environments, motivations for migration, perceptions of social and aged care services, use of ICTs and new media for transnational care practices, kin networks, social engagement, and well-being, a salient research component involved the exploration of participants’ perceptions of SA, active ageing, healthy ageing, and ageingfriendly attributes of the current global discourse on positive ageing. Given the critiques of western-centric SA models, (Iwamasa and Iwasaki 2011; Lamb 2014), a pre-determined concept was not used in our study. Instead, a subjective or emic approach was applied to allow the Vietnamese migrants to self-define their SA model. Three questions were posed to participants: 1. Are you aware of the terms ‘SA’, ‘active ageing’, ‘healthy ageing’, or ‘ageingfriendly’? 2. How do you define these concepts? 3. Do you think that you/your migrant parent is ageing successfully? The verbatim transcripts were conducted in Vietnamese. The data analysis followed the grounded theory approach (Martin and Turner 1986) involving inductive reasoning (Kemp and Tenenbaum 2009) to construct the SA notion from participants’ unique ideas/concepts. Using the NVivo 12 qualitative data analysis application, the ideas/concepts were tagged with codes to summarise them. The codes were then grouped into higher-level concepts, and subsequently into categories, which became the basis for formulating the multiple facets of the Vietnamese migrants’ SA concept that reflected its complicated nature. In the process of summarising and analysing specific categories, all the authors carefully processed and verified the data (English translations) to retain the originality and uniqueness of participants’ views. To protect the participants’ anonymity and confidentiality, pseudonyms were used in coding the data and writing this paper. The data collection, transcription, processing and analysis followed the ethical standards guided and approved by the UWA Human Ethics Committee (Ref: RA/4/20/5807). Informed consent was obtained from all participants to be included in this paper. The data used in this paper is stored in the UWA Institutional Research Data Store (IRDS) ‘SS-EFDAOVBPIA-001’.

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4.3 Results and Discussion The results showed that migrant parents and adult children shared homogeneous views towards SA in terms of three key categories: family fulfilments, individual achievements, and social engagement and protection, of which the family fulfilments category was the most important. Comparisons across variables such as gender, educational attainment, professional histories, and cultural and socio-economic backgrounds of participants revealed inconsistent perceptions. Figure 4.1 summarises SA ideas in a hierarchical format, showing micro level (individual achievements), meso level ( family fulfilments), and macro level (social engagement and protection) dimensions.

4.3.1 Family Fulfilments Family fulfilments was recognised as the most prominent component in the Vietnamese migrants’ perceptions of SA. The category comprised four sub-categories: successful descendants, family harmony and happiness, intergenerational care, and respect from descendants; of these, successful descendants was the sub-category that was most valued by the participants.

Fig. 4.1 Vietnamese Perceptions of Successful Ageing

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4.3.1.1

Successful Descendants

Successful descendants refers to the factor representing the descendants’ achievements across various dimensions, such as higher education, professional attainments, health, independence, wealth, and morality. The following narrative shows how the Vietnamese migrant respondents perceived the idea of successful descendants: MP8: I find that I am the most successful parent because my eight children all grew up with dignity and morality. They all pursued higher education and have good jobs and happy families with well-educated and docile children.

The notion of successful descendants is new in SA scholarship. The current literature may identify the role of family members in terms of respecting and caring for seniors’ psychological and social well-being (Miah and King 2023) or maintaining family relationships with descendants and partners (The et al. 2020). However, no study has hitherto identified successful descendants as a relevant determinant. In Vietnamese culture, parents tend to invest their wealth, love, and efforts to nurture their descendants and help them gain recognition in society. They also consider their children as sources of financial support and care in their old age; hence, they aspire for their children to be more successful and have a better life than they did. There is a popular proverb in Vietnam, ‘if the child surpasses his father, the home is blessed’. This proverb has become the norm and goal for Vietnamese parents. The success of their descendants is, thus, considered the ‘sweet fruit’ that individuals should enjoy in older age after a long process of planting and nurturing the ‘young trees’. The following disclosure from a parent clearly indicated this point of view: MP7: I feel totally satisfied and happy now. I have excellently fulfilled my duties of raising my children. They have all finished tertiary education, have stable jobs, are getting married and having children, and own their own houses…They are my ‘savings books’ for my old age…

Successful descendants is thus a unique feature in the Vietnamese migrants’ SA perceptions. Combined with professional success, identified within individual achievements, and the entire family fulfilments category, it shows that the Vietnamese people emphasise the continuity and advancement of family lineage, which is only viable when the successive generations develop and expand, both qualitatively and quantitatively. In this sense, promoting the success of descendants is considered a crucial obligation to be fulfilled in one’s lifetime. Successful descendants not only bring honour and respect to their predecessors but also to their family clan, a matter of pride for seniors in their advanced years.

4.3.1.2

Family Harmony and Happiness

The participants affirmed the relevance of ‘family’, specifically, family harmony and happiness, as one of the central factors determining SA. Family harmony and happiness implies maintaining cordial relations with family members through mutual

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support, love, and care, with no significant intra-family conflicts. For this, each family member should appreciate and fulfil their role: adult children and grandchildren should respect their elders, and parents and grandparents should reciprocate by showing love and care for their descendants. Family members should be patient and tolerant to preserve a warm and comfortable family atmosphere. In particular, the parents emphasised the role of family ethics and values in maintaining family harmony and happiness. The grandparents and parents should be the teachers who instruct and guide descendants regarding these principles. In turn, the descendants should follow the rules to cultivate their moral and filial responsibilities. MP12: A harmonious family must first have family ethics and values based on which descendants treat predecessors…I have cultivated my children’s morality since they were young. They have been following my family rules, have grown up, and become good people.

Notwithstanding this, migrant parents disclosed the inevitability of intra-family conflicts. When conflicts occur, both parents and children must find ways to address them. If the migrant parents chose to reduce their authority over their descendants and followed the principles of ‘covering ears’ and ‘non-interference’, adult children chose to confront or ‘stay silent’. The following revelations describe how participants used their own ways to address their family conflicts: MAC9: …Whenever I have any disagreements with my mother, I often choose to stay silent or go somewhere to relieve my temper. I am afraid that if I continue my argument with her, I will hurt her feelings. On the following day, I find some way to please her. My mother often sulks, but she has to bear it anyway because I am her daughter (smile)…

The key role of family in ensuring the older parents’ well-being shows the influence of cultural values in constructing the concept of SA. Embedded in familism, family continues to be central to the Vietnamese people’s life (Horton and Rydstrom 2019). This ideology persisted in the sampled Vietnamese migrants’ beliefs despite their migration to the Global North, where individualism and liberalism tend to guide people to respect privacy, self-reliance, and independence (Thomas 1999, 2003; Thomas and Hallebone 1995; Tran 2018). Although they experienced cross-cultural practices, such as respecting individual decisions and wishes in maintaining family harmony and happiness, they were unwilling to jeopardise intra-family relations under any circumstances.

4.3.1.3

Intergenerational Care

Intergenerational care is the manifestation of descendants’ filial piety towards their (grand)parents and of the latter’s reciprocal obligations, known in the gerontological literature as the ‘intergenerational contract’ (Croll 2010; Svallfors 2008; Walker 1996). Baldassar and Merla (2014) defined this as the circulation of care that operates throughout the course of family life, characterised by the norms of reciprocity, multidimensionality, and asymmetry. In the Vietnamese migrants’ SA model, intergenerational care is a key criterion.

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H. T. Nguyen et al. MP17: …SA means that you are cared for emotionally and physically by your descendants. You know…(burst into tears)… my children and grandchildren often come and hug me; It feels so pleasant when they care for me…

Although none of the migrant parents sampled had experienced neglect, several of them expressed apprehensions about the restricted opportunities for intergenerational care. In particular, they worried about their ability to provide proximate care, due to what has been termed by migration scholars as the ‘immobility regime’ (Brandhorst et al. 2020; Merla et al. 2020), characterised by restrictions on mobility through expensive visas, long waiting times, and increasingly limited access to permanent migration pathways (Merla et al. 2020; Nguyen et al. 2023), evident from the following quote: MP6: Though I have three daughters, I am worried about my old age. I cannot move to Australia to stay permanently with my second daughter while the two others in Vietnam live far from me. I do not know how I will be able to care for myself when my physical/mental health deteriorates.

This ‘immobility regime’ specifically concerned the parental group that had not obtained permanent residency in the host country. Although current scholarship has highlighted the important role of distant and virtual care through digital communication technologies in facilitating the psychological well-being of left-behind and migrant parents (Baldassar and Merla 2014; Baldassar et al. 2016; Reynolds and Zontini 2014), proximate care is crucial when parents are affected by chronic diseases (Baldassar 2014) or become more care-dependent (Kilkey 2018). This implies that migrant parents may experience unsuccessful dimensions of ageing when intergenerational care is subject to the stringent migration policies of the host countries.

4.3.1.4

Respect from Descendants

In Vietnamese culture, the descendants’ respect for seniors is essential, captured by the well-known concept of filial piety, wherein seniors deserve respect, even veneration, from their descendants in their role as the bearers of wisdom and authority (Cheng et al. 2015; Friedman et al. 2003; Hsu 2007; Miah and King 2023). However, the influence of cross-cultural practices and tensions between individualism and collectivism have resulted in the transformation of practices and manifestations of filial piety. For instance, the findings showed that there has been a shift from authoritarian filial piety to reciprocal filial piety, in which descendants need not suppress their wishes and decisions because of their (grand)parents’ seniority. Instead, they may selectively adhere to the advice and wishes of their (grand)parents if they find them reasonable and achievable (Chou 2011; Eklund 2018; Li et al. 2021; Nguyen et al. 2023). An adult child revealed the following: MAC9: I still respect my mother, but I cannot follow all her advice, especially in raising my daughter. She prefers to care for my daughter based on her experiences, but those experiences are irrelevant now.

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The transformed dynamic of respecting seniors hurt migrant parents’ emotions to an extent by undermining their authority over their descendants. To address this, most migrant parent respondents chose to accept the fact that their descendants now lived in a culture that was different from the culture of their homeland. Most migrant parents adapted to a more liberal view of the notion of ‘respect for elders’, in which they tried to limit their role to moral advisors rather than authoritarian gatekeepers, as stated below: PV19: In Vietnam, children must follow the adults’ advice and guidance. If they do not, it is ‘disrespectful’ to adults. However, they receive western education here; they have the right to argue with their grand(parents). I perceive that change and have to accept it.

Nonetheless, several parents were reluctant to accept these changes and persisted in their view that they held prime authority over their descendants. The following statement by a parent illustrates this: MP12: I am the master of my family’s ethics and values. My descendants have to follow my advice though we have settled here. Our values cannot be degraded.

Parents such as MP12 did not perceive themselves as fully successful agers because of cultural clashes. These parents indicated a preference to return to their homeland and spend their late years there. MP12 stated that after all their descendants attained good jobs and happy families, they, along with their spouse, would return to Vietnam. The respect from descendants sub-category reiterates how cultural values govern the SA model and affect ageing parents’ wellbeing.

4.3.2 Individual Achievements Although not the dominant category, individual achievements included a number of variables commonly identified by participants, including good physical and mental health, self-care and independence, financial security, personal expression (e.g. hobbies), professional success, and longevity. Of the six variables, the first three elements were the most common with the highest weights.

4.3.2.1

Good Physical and Mental Health

Participants indicated good health or healthy ageing as a crucial factor that facilitates SA. Physical functioning is associated with the individual capability to run one’s everyday life smoothly and independently. The indicators of physical functioning, as mentioned by the migrant parents, included ‘freedom from illnesses’, ‘eating and sleeping well’, ‘fulfilling everyday routines independently’, ‘doing regular physical exercises’, and ‘feeling comfortable with physical body’:

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H. T. Nguyen et al. MP32 : …one’s capability to do everyday activities…be active and resourceful, and do the work suitable to health conditions… MP6: …freedom from illnesses, feeling well and comfortable about their physical body…

Regarding mental health, participants highlighted ideas such as ‘blithe, calm and optimistic mind’, ‘positive thoughts’, ‘healthy spirit’, and ‘desires for living independently’. They believed that accepting the reality of old age with deteriorating physical and cognitive health and finding solutions to cope with the challenges posed by ageing signals good mental health, which is defined as follows: MP9: …viewing everything positively, having nothing to be concerned about, and being comfortable… MAC15: …positive mind-set, accepting that we are no longer as young and healthy as we were. We need to find ways and sources of happiness to lessen the painful feelings caused by diseases…

Participants strongly believed that physical functioning and mental health are closely interrelated and together support healthy ageing. They considered mental health a prerequisite for a healthy body and believed that seniors living with sicknesses could achieve better physical functioning and a meaningful life through positive thoughts. Their emphasis on mental health as the primary condition for good physical health directly contradicts Rowe and Kahn’s (1987) statement that freedom from diseases and disabilities provides conditions for high physical and cognitive functioning, which in turn promotes seniors’ engagement with life. The Vietnamese migrants in this study stated that seniors could continue to live a successful life given good mental health, despite their deteriorating physical health. This indicates the important role of social and family support in ageing and well-being, depicting a subjective understanding of SA as inherently social and relational.

4.3.2.2

Self-Care and Independence

Although Vietnamese people expect to rely on intergenerational care in old age (Bang et al. 2017; Hoi et al. 2011), our findings indicated a shift in the Vietnamese migrants’ ideology regarding self-care and self-reliance in terms of maintaining an independent life with self-control. A migrant parent made the following claim: MP9: …The most successful ager is a person who can care for himself/herself. He/she should not become a burden to his/her descendants…

The participants acknowledged that they may need intensive hands-on personal care in their late years, but did not expect to become a burden to their family. In their culture, living in residential care facilities continues to be socially stigmatised (Dung et al. 2020), despite migrating to and living in another culture. A migrant parent revealed the following: 2

Migrant parents are coded as ‘MP’, and ‘Migrant adult children’ are coded as ‘MAC’, followed by an ordinal number (1,2,3,4….). For instance, migrant parent 1 is coded as MP1; migrant adult child 2 is coded as MAC2.

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MP21: …I do not want to stay in a nursing home. I have several adult children here, and I believe they can care for me. I felt so cold when I visited some seniors there…

Nonetheless, several migrant parents appeared to have changed their minds about nursing home care in Australia, accepting that they would need to spend their late years in these facilities if they were not healthy enough to live independently at home. They claimed that their adult children were burdened with multiple family care tasks and paid work and did not have the time or patience to care for them, especially if their care was not covered by the home care package.3 A male parent confided: MP22: …my adult children are too busy; they cannot give up their families and jobs to come and care for me. I cannot expect them to care for me as other descendants often do for their (grand)parents in Vietnam…

The respondents were more influenced by individualist frameworks emphasising the features of independence and self-reliance (Lukes 1973) that characterise western societies, including Australia (Biddle 2012). This ideology contrasts with familism and collectivism, which are characteristic of traditional Vietnamese cultural frames (Nguyen and Chen 2017). Although this shift in ideology can be perceived as involuntary, in the sense that it was not the ideal aged care scenario envisioned by older Vietnamese parents, they considered it an inevitable repercussion of the cultural lifestyle in Australia. This is largely because their own adult children had clear concepts of self-care and independence in old age, including a more positive evaluation of the idea of living in a nursing home, whereas only around one-third of migrant parents fully accepted this. The migrant parents’ reluctance to enter nursing homes is mostly attributable to the lack of quality and affordable aged care services in Vietnam (Van Hoi et al. 2012) and/or a shortage of culturally appropriate aged care services in Australia. One migrant parent (MP21) revealed, ‘I have no intention of going to a nursing home; however, if there is one for Vietnamese people in Perth, I am willing to come and stay there’, highlighting the importance of culturally appropriate aged care services that can support the older migrants’ access to SA in their transnational life.

4.3.2.3

Financial Security

Financial security featured in the participants’ understanding of SA, defined as the ‘financial independence or autonomy’ that would secure basic needs such as food, clothing, and shelter when they aged. They believed that seniors should have substantial savings or pensions to safeguard their quality of life and access to payable medical services:

3

The home care package is an intensive and complex support program funded by the Australian Federal Government since 2013. The package offers four levels of home-based care, including home help, personal care, social support, allied health, transport, equipment and other relevant services on a regular basis.

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H. T. Nguyen et al. MAC9: SA means having some savings to be financially independent. Many older Vietnamese people rely on their adult children financially, so they do not think they can be successful.

Financial security for seniors in developed nations is not as critical as in developing nations because life after retirement is partly secured by the respective governments through a functioning social safety net, pensions paid by public/private social insurance schemes, and/or individual savings. Even for those with no individual savings or retirement pensions, the social safety net provides a minimum standard of living (Valente 2019). In contrast, in developing countries such as Vietnam, financial security for seniors is a fundamental concern because of the limited capacity of the government to provide financial security. Recent research indicates that Asian countries, such as China, Vietnam, Japan, and South Korea, continue to promote the notion of ‘socialisation’ in their state care regimes (Feng et al. 2015; Nakagawa et al. 2020; Nguyen and Chen 2017). This implies that individuals and families are accountable for their own welfare and wellbeing (Hui Chian Teh et al. 2020; Iwamasa and Iwasaki 2011; Nguyen and Chen 2017). Accordingly, descendants must have the moral obligations and filial piety to care for their grandparents and parents. Given this institutional context, the Vietnamese migrants continued to perceive financial security as a key criterion to support their ageing well-being, especially because most parents relied on their adult children’s financial support for transnational migration, including visa fees, air tickets, food, accommodation, and other essential needs (Nguyen et al. 2023). The findings further revealed that well-educated migrant parents with better socioeconomic backgrounds valued financial security more than those with lower educational attainment and poorer socio-economic conditions. The former cohort pursued a higher level of independence and self-control, having experienced the changing global attitudes towards ageing and elder care (Nguyen and Chen 2017) and transnational mobility. Meanwhile, the latter cohort, whose knowledge and awareness of institutional care and care policies in the home and host countries were limited, strongly believed that their descendants were obligated to provide them with financial support. The Vietnamese migrants’ unique financial concerns indicate the role of institutional and socio-economic contexts in constructing the SA notion.

4.3.2.4

Personal Expression

Personal expression was perceived by the participants as a type of ‘motive’ for seniors to pursue a meaningful and active life. They strongly believed that one could not live without any passions or interests. They listed a number of personal expressions, ‘reading books and news’, ‘watching films and videos’, ‘cooking delicious food’, ‘playing favourite sports or exercising’, ‘travelling to desired destinations’, ‘chatting to loved ones’, ‘gardening’, or ‘caring for beloved family members, especially grandchildren’ in their subjective understandings of SA. These expressions may not

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have been fulfilled when they were young but could be pursued at present, given the availability of more free time, as one male parent explained: MP19: My friend is enjoying a ‘pink’ life here. He has no burdens now, so he has more time to read. He is a voracious reader; he reads about Buddhism and other topics and then composes poems to summarise his thoughts on what he has read. For me, he is a successful ager.

However, the Vietnamese migrant parents tended to pursue the forms of personal expression that were most closely linked to their everyday routines and activities and could be performed at home or nearby. They expected their personal expressions to benefit not only themselves but also their family members, especially when the primary purpose of migration was ‘caring for’ and supporting their migrant descendants (Nguyen et al. 2023). The findings also indicated differences in personal expression between migrant parents according to their educational attainment. The welleducated cohort tended to read more and play sports (tennis, swimming, badminton) in sports centres near their homes. Meanwhile, the less-educated cohort preferred jogging or regularly exercising at home. Both parent groups enjoyed gardening, watching films and videos, cooking, and helping their adult children with childcare and homecare.

4.3.2.5

Professional Success

Professional success was not identified as a criterion by parent respondents, but several adult children participants deemed it necessary for the evaluation of a senior’s success. These participants believed that SA was a lifetime journey, in which a successful career was a benchmark for the level of achievement. Past professional success could emerge as a source of honour and respect in one’s late life, as revealed by a participant: MAC3: SA means obtaining professional achievements in one’s life. Mrs Doan, a famous Vietnamese chef, is a good example. When she was young, she had a successful career and was a representative for Knorr’s Seasoning Powder Trademark in Vietnam. She adopted an orphan and then mentored him to become a chef in a five-star hotel. She is now retired, has become a nun, and lives in a pagoda, but her past professional successes continue to bring her honour and social respect.

The idea of professional success suggests that SA is impacted by people’s individual developmental processes in early life. Informed by the life course approach (Hanson et al. 2016), similar to bio-medical conditions, professional success can involve a social dimension. For populations that attach great value to family and community life, such as the Vietnamese people, professional success is central to ageing and wellbeing because it is perceived as a prime goal that brings honour, respect, and prosperity to their family lineage.

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4.3.2.6

Longevity

On the whole, longevity was not significantly identified as a determinant in the Vietnamese migrants’ SA model. Of the 42 participants, only two adult children believed that SA was associated with longevity: MAC12: SA … I do not know … does it mean to ‘live a long life’? MAC20: SA means having the physical health to live as long as other people.

They valued quality of life with good health, successful descendants, and social respect, rather than longevity, and held the view that SA did not entail living for 90 years whilst becoming bedridden and a burden for their family or not being cared for and loved by their descendants. On the contrary, SA represented living life in a way, irrespective of its length, that fulfilled all family obligations. This finding challenges the studies that emphasise the salience of longevity as an indicator of SA (Cosco et al. 2014; Depp and Jeste 2006) and reiterates the importance of a subjective and cultural understanding of SA.

4.3.3 Social Engagement and Protection The research participants also valued the role of social engagement and protection in accelerating SA. This category comprised four sub-categories: active social participation, social respect and care, accessible aged care services, and social security. Owing to their experiences of social engagement and protection in both cultures, participants discussed the differences in social participation and social security in the two contrasting cultural, social, and institutional contexts.

4.3.3.1

Active Social Participation

All the Vietnamese migrants recognised the central role of social participation in SA. An adult child stated, ‘seniors need to have their own communities to entertain, relax, find empathy, and seek advice to address their own challenges’. The environment for active social participation predominantly involves kin and social ties in the homeland and additionally comprises the ‘communities’ and ‘groups’ formed by Vietnamese diaspora, friends, peers, and former colleagues in the host country. However, many parents stated that they did not have as much social participation in the host country as expected. Language barriers and the inability to drive or use public transport independently limited their social interactions. They had to rely on their adult children for moving around and participating in social events. Most parents confided that their everyday activities were limited to their homes and nearby areas; thus, they felt isolated, lonely, and bored (Nguyen et al. 2023). A male parent disclosed the following:

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MP3: I can drive, but my children do not let me because they are concerned about my safety. I want to go to the supermarket, park, or CBD because I know they organise some events. However, I cannot ask them to give up their jobs and drop me there.

Because of restricted movement, migrant parents reminisced about their community life in the homeland where they could move freely and socialise through various networks: MP6: Everything here is good. However, I cannot go anywhere and am locked at home for 24 hours. In Vietnam, I could go here and there; I could go to the church, local market, and visit my neighbours and close friends nearby.

To address these limitations, migrant parents chose to maintain and develop their social interactions in the virtual world through digital communication technologies (Nguyen et al. 2022). These online practices were particularly meaningful for newly migrating parents who had no pre-established social relations in the host country. A parent revealed: MP12: I have a group of 10 close high school friends in Vietnam. I call them once or twice per day via Facebook or Zalo, and we actively engage in online chats. I feel less bored and distant through this form of communication.

The findings revealed that ICTs and new media greatly contributed to the Vietnamese migrants’ SA, especially for those who preferred to live a mobile life and had scattered kin and social ties. Technology helped the migrant parents navigate spaces and manage an independent life in the host country, boosting their confidence and fostering a sense of belonging.

4.3.3.2

Social Respect and Care

In Vietnamese culture, age is a key factor that determines the level of respect that a person is accorded within their family and society. Vietnamese seniors expect to be treated with respect, especially in public, given their seniority, experience, and wisdom accumulated throughout their lifetime (Thomas 1999, 2003; Tran 2018). Social respect and care is thus relevant to the quality of social relations obtained through social interaction and participation. It is also associated with the cultural and social environment that creates a respectful atmosphere for seniors. A parent defined the relationship between social respect and care and SA as follows: MP19: SA comprises the quality of one’s social relations. The Vietnamese people have high self-esteem. They expect to be cared for and not belittled in their community. They do not want to be looked down upon and easily get their pride injured.

Most migrant parents stated that they felt socially respected and cared for in the host country. They held the opinion that Australia is an ideal society for seniors to live in. The age-friendly surroundings, living environments, and the ways in which the public services prioritise and care for seniors indicate how the Australian society shows and practises respect and care for seniors. A parent visitor revealed the following:

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The Vietnamese migrants stated that social respect and care systems in Australia are better than in Vietnam because human behaviours are ‘standardised’ and follow a well-structured system. Hence, the age-friendly environments and facilities evoke a sense of being care for and respected, which contributes to SA.

4.3.3.3

Accessible Aged Care Services

Aged care services refer to both public and private care resources that are either chargeable or free of charge. In Vietnam, the aged care system is underdeveloped because the state government follows the politics of ‘family-based’ elderly care (Nguyen and Chen 2017); thus, Vietnamese seniors mainly rely on family care. In contrast, its Australian counterpart involves governmental, for-profit private, and notfor-profit organisations in providing support at home or in aged care facilities. The services involve substantial assistance with accommodation, everyday living, health care, and equipment supporting seniors’ independence and safety (DOH 2021). Despite parental respondents’ expectations of being cared for by their descendants, they highly appreciated the available and accessible aged care services in the host country. A parent complimented the way the system of medical, social, and aged care services jointly collaborated to care for his sick spouse, MP19: When my spouse was sick, a doctor referred her to the relevant services, which included medical, psychological, and physical care. Had we been in Vietnam, we could not have accessed those services within our financial capacity.

Having observed the functional aged care service system in the host country, several participants appeared to consider more out-of-family support for their ageing needs. They realised that SA could be better achieved with appropriate and accessible aged care services. This reaffirms the significant role of the available aged care service system in ensuring SA.

4.3.3.4

Social Security

Social security refers to ‘the protection that a society provides to individuals and households to ensure access to health care and to guarantee income security, particularly in cases of old age…’ (ILO 2003). In general, Vietnamese seniors fundamentally rely on their own savings or on financial support from their descendants. Without a secure financial source, it is difficult for them to age well. On being questioned about the role of social security in supporting SA, all participants stated its importance and highly appreciated the current Australian system of social welfare payments that

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ensure a minimum standard of living for every citizen, including seniors (Whiteford and Angenent 2002). A parent drew the following comparison regarding social security in the home and host countries: MP21: In Vietnam, I can only get medical treatment if I have money. If I do not, I will die. Here, it is different; even I have no money, the state cares for me. I do not think I could have lived such a long and healthy life had I been in Vietnam.

MP21’s revelations may not accurately reflect Vietnam’s current socio-economic context, as the government has made efforts to develop a social safety net to support disadvantaged and vulnerable groups, including seniors, by providing a free Medicare card and monthly cash transfers (The-Government-of-Vietnam 2021; VNA 2009). Accordingly, seniors are eligible for a base cash transfer of 270,000 VND (about USD 12) if they are over the age of 80 years. Notwithstanding, 26% of Vietnamese seniors reported that they did not have Medicare, and nearly half of them (49%) could not afford health care costs (Hoang and Duong 2018). In addition, the benefit amount of USD 12 is too low to ensure a minimum standard of living for seniors (Long and Pfau 2009). Hence, Vietnamese migrant parents, especially those ineligible for a retirement pension, highly appreciated the Australian social security system’s role in successful ageing. They confided that ageing would be easier if they were provided a liveable social pension. This would make them less dependent on their descendants’ financial support and ensure a more independent and self-reliant life.

4.4 Conclusions This study examined the Vietnamese migrants’ perceptions and experiences of SA using an emic approach with inductive reasoning. This culturally responsive approach enabled participants to share their ideas about multiple dimensions of SA, both universal and culture specific. Compared with the western notion that emphasises individual successes, the SA model self-defined by the Vietnamese participants was multifaceted, with three main dimensions: family fulfilments, individual achievements, and social interaction and protection. Reflecting the strong influence of cultural values driven by familism and collectivism, the Vietnamese migrants recognised family fulfilments as the most salient component in their SA model, of which the successful descendants factor was the most valued. Vietnamese culture emphasises the continuity of family lineage, and individuals often invest their lifetime, finances, love, and efforts to nurture a more successful generation that can augment the family’s honour, in addition to providing them intergenerational care and financial security when they age. Hence, the Vietnamese migrants tried to preserve family harmony and happiness despite transnational displacement. However, influenced by the more individualistic culture of the host country, Vietnamese migrants have gradually shifted their expectations of intergenerational care and respect from descendants towards a more liberal view, whereby the descendants can act based on their individual rights

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and interests rather than suppressing their wishes to fulfil their traditional obligations and roles. In other words, the Vietnamese migrants’ traditional authoritarian filial piety has transformed into a more permissive and reciprocal filial piety to adapt to the host country’s norms. Although the other categories—individual achievements and social engagement and protection—were less valued than family fulfilments, they were key to the Vietnamese migrants’ SA. Four sub-categories within Individual achievements—physical and mental functioning, self-care and independence, personal expression, and longevity—overlapped with the western SA notion, unlike the sub-categories of financial security and professional success. Furthermore, the social engagement and protection dimension mirrored the contradictory institutional contexts of the home and host countries. Despite low social interaction because of language barriers and dependence on adult children for movement, migrant parents highly appreciated the aged care services and social welfare system of the host country, in which socio-economic advancements have created favourable conditions for seniors to age successfully. In particular, the age-friendly environment and facilities evoke a sense of being respected and cared for. Conversely, the underdeveloped aged care services and incomplete social safety net, in addition to the politics of ‘family-based’ aged care in their home country, have hindered the Vietnamese people’s SA. The findings demonstrate how socio-cultural and institutional factors shape and impact older migrants’ wellbeing. For the Vietnamese migrants in Australia, individual life experiences and family play a vital role in supporting SA. This study reaffirms that subjective understandings, including self-definitions, are critically important to facilitate the conceptualisation of SA for various populations based on their specific cultural and institutional contexts. Despite its strengths in presenting detailed and in-depth emic perspectives, this study has several limitations. The small sample size restricts the generalisability of the research findings, which may not represent the greater population of Vietnamese migrants in general, nor the Vietnamese population more broadly. Moreover, the participants mainly come from the ‘middling class’ (Conradson and Latham 2005, pp 229), and may not represent the perceptions of SA from the other lower or upper classes. Hence, the SA model introduced in this study should be further examined for other Vietnamese migrants and cultural groups for comparison and contrast. Acknowledgements This paper was developed under the scholarship sponsored by Australian Government International Research Training Program (RTP) Scholarship, UWA Postgraduate Award, and linked to ‘Ageing and New Media ARC Project’ led by Prof Loretta Baldassar and A/Prof Raelene Wilding. We are grateful to Vietnamese migrant parents and adult children who provided valuable information.

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References Annele, U., Satu, K. J., & Timo, E. S. (2019). Definitions of successful ageing: A brief review of a multidimensional concept. Acta Bio Medica: Atenei Parmensis, 90(2), 359–363. https://doi. org/10.23750/abm.v90i2.8376. Baldassar, L. (2014). Too sick to move: Distant ‘crisis’ care in transnational families. International Review of Sociology, 24(3), 391–405. https://doi.org/10.1080/03906701.2014.954328. Baldassar, L., & Merla, L. (2014). Introduction: Transnational family caregiving through the lens of circulation. In L. Baldassar, & L. Merla (Eds.), Transnational families, migration and the circulation of care: Understanding mobility and absence in family life (pp. 3–24). Routledge. Baldassar, L., Nedelcu, M., Merla, L., & Wilding, R. (2016). ICT-based co-presence in transnational families and communities: Challenging the premise of face-to-face proximity in sustaining relationships. Global Networks, 16(2), 133–144. https://doi.org/10.1111/glob.12108. Baltes, P. B., & Baltes, M. M. (1990). Psychological perspectives on successful aging: The model of selective optimization with compensation. In P. B. Baltes, & M. M. Baltes (Eds.), Successful aging: Perspectives from the behavioral sciences. NY: Cambridge University Press. Bang, K. S., Tak, S. H., Oh, J., Yi, J., Yu, S. Y., & Trung, T. Q. (2017). Health status and the demand for healthcare among the elderly in the rural Quoc-Oai District of Hanoi in Vietnam. BioMed Research International, 2017, Article 4830968-13. https://doi.org/10.1155/2017/4830968. Bich, N. N., Dung, N. T. T., Vu, T., Quy, L. T., Tuan, N. A., Binh, N. T. T., Hung, N. T., & Anh, L. V. (2019). Dementia and associated factors among the elderly in Vietnam. Mental Health Systems, 13, 57–57. https://doi.org/10.1186/s13033-019-0314-7. Biddle, C. (2012). Individualism vs. collectivism: Our future, our choice. The Objective Standard, 7(1), 19–28. Brandhorst, R., Baldassar, L., & Wilding, R. (2020). Introduction to the Special Issue: “Transnational Family Care ‘On Hold’? Intergenerational Relationships and Obligations in the Context of Immobility Regimes”. Intergenerational Relationships, 18(3), 261–280. https://doi.org/10.1080/ 15350770.2020.1787035. Brown, L. J., & Bond, M. J. (2016). Comparisons of the utility of researcher-defined and participantdefined successful ageing. Australasian Journal on Ageing, 35(1), E7–E12. https://doi.org/10. 1111/ajag.12250. Butler, R. N. (1969). Age-ism: Another form of bigotry. The Gerontologist, 9(4), 243–246. https:// doi.org/10.1093/geront/9.4_part_1.243. Cheng, S.-T., Chi, I., Fung, H. H., Li, L. W., & Woo, J. (2015). Successful Aging: Asian Perspectives. Dordrecht: Springer. Chou, K. L., & Chi, I. (2002). Successful aging among the young-old, old-old, and oldest-old Chinese. The International Journal of Aging and Human Development, 54(1), 1–14. https://doi. org/10.2190/9K7T-6KXM-C0C6-3D64. Chou, R. J. A. (2011). Filial piety by contract? The emergence, implementation, and implications of the “family support agreement” in China. The Gerontologist, 51(1), 3–16. https://doi.org/10. 1093/geront/gnq059. Conradson, D. & Latham, A. (2005). Transnational urbanism. Ethnic and Migration Studies, 31(2), 227–233. https://doi.org/10.1080/1369183042000339891. Cosco, T. D., Prina, A. M., Perales, J., Stephan, B. C., & Brayne, C. (2013). Lay perspectives of successful ageing: a systematic review and meta-ethnography. BMJ Open, 3(6), Article e002710. https://doi.org/10.1136/bmjopen-2013-002710. Cosco, T. D., Prina, A. M., Perales, J., Stephan, B. C., & Brayne, C. (2014). Operational definitions of successful aging: a systematic review. International psychogeriatrics, 26(3), 373–381. https:// doi.org/10.1017/S1041610213002287. Croll, E. J. (2010). The Intergenerational Contract in the Changing Asian Family. Oxford development studies, 34(4), 473–491. https://doi.org/10.1080/13600810601045833.

74

H. T. Nguyen et al.

Dao-Tran, T. H., Anderson, D., & Seib, C. (2017). How life stressors influence modifiable lifestyle factors, depressive symptoms, and physical and mental health among Vietnamese older women?. BMC psychiatry, 17(1), 1–9. https://doi.org/10.1186/s12888-017-1395-y. Depp, C. A., & Jeste, D. V. (2006). Definitions and predictors of successful aging: a comprehensive review of larger quantitative studies. The American Journal of Geriatric Psychiatry, 14(1), 6–20. https://doi.org/10.1097/01.JGP.0000192501.03069.bc. Department of Health (DOH). (2021). What is Aged Care? Canberra: DoH, Australian Government. Retrieved June 2, 2021, from https://www.health.gov.au/health-topics/aged-care/about-agedcare/what-is-aged-care. Dung, V., Thi Mai Lan, N., Thu Trang, V., Xuan Cu, T., Minh Thien, L., Sy Thu, N., Dinh Man, P., Minh Long, D., Trong Ngo, P., & Minh Nguyet, L. (2020). Quality of life of older adults in nursing homes in Vietnam. Health Psychology Open, 7(2), Article 2055102920954710. https:// doi.org/10.1177/2055102920954710. Eklund, L. (2018). Filial daughter? Filial son? How China’s young urban elite negotiate intergenerational obligations. NORA-Nordic Journal of Feminist and Gender Research, 26(4), 295–312. https://doi.org/10.1080/08038740.2018.1534887. Estes, C., & Mahakian, J. (2001). The political economy of productive aging. In N. Morrow-Howell, J. Hinterlong, & M. Sherrande (Eds.), Productive aging: Concepts and challenges. Baltimore: Johns Hopkins University Press. Feng, Q., Feng, Q., Son, J., Son, J., Zeng, Y., & Zeng, Y. (2015). Prevalence and correlates of successful ageing: a comparative study between China and South Korea. European journal of ageing, 12(2), 83–94. https://doi.org/10.1007/s10433-014-0329-5 Ferraro, K. F., & Shippee, T. P. (2009). Aging and cumulative inequality: How does inequality get under the skin? The Gerontologist, 49(3), 333–343. https://doi.org/10.1093/geront/gnp034. Friedman, J., Knodel, J., Cuong, B. T., & Anh, T. S. (2003). Gender dimensions of support for elderly in Vietnam. Research on Aging, 25(6), 587–630. https://doi.org/10.1177/016402750325 6693. Gopinath, B., Kifley, A., Flood, V. M., & Mitchell, P. (2018). Physical activity as a determinant of successful aging over ten years. Scientific reports, 8(1), Article 10522. https://doi.org/10.1038/ s41598-018-28526-3. Hanson, M. A., Cooper, C., Aihie Sayer, A., Eendebak, R. J., Clough, G. F., & Beard, J. R. (2016). Developmental aspects of a life course approach to healthy ageing. The Journal of Physiology, 594(8), 2147–2160. https://doi.org/10.1113/JP270579. Headland, T. N., Pike, K. L., & Harris, M. E. (1990). Emics and etics: The insider/outsider debate. Beverly Hills: Sage Publications, Inc. Hoang, V. M., & Duong, H. Y. (2018). Health and health care for older people in Vietnam. Healthy Ageing Research, 7(15), 1. https://doi.org/10.12715/har.2018.7.15. Hodge, A. M., English, D. R., Giles, G. G., & Flicker, L. (2013). Social connectedness and predictors of successful ageing. Maturitas, 75(4), 361–366. https://doi.org/10.1016/j.maturitas.2013. 05.002. Hoi, L. V., Thang, P., & Lindholm, L. (2011). Elderly care in daily living in rural Vietnam: need and its socioeconomic determinants. BMC geriatrics, 11(1), Article 81. https://doi.org/10.1186/ 1471-2318-11-81. Horton, P., & Rydstrom, H. (2019). Reshaping boundaries: Family politics and GLBTQ resistance in urban Vietnam. Journal of GLBT Family Studies, 15(3), 290–305. https://doi.org/10.1080/ 1550428X.2018.1518739. Hsu, H. C. (2007). Exploring elderly people’s perspectives on successful ageing in Taiwan. Ageing & Society, 27(1), 87–102. https://doi.org/10.1017/S0144686X06005137. Hui Chian Teh, J., Brown, L. J., & Bryant, C. (2020). Perspectives on successful ageing: The views of Chinese older adults living in Australia on what it means to age well. Australasian Journal on Ageing, 39(1), e24–e31. https://doi.org/10.1111/ajag.12677.

4 Successful Ageing: The Novel Perspectives and Experiences …

75

International Labour Organization (ILO). (2003). Facts on Social Security. Geneva: ILO. Retrieved June 2, 2021 from https://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/docume nts/publication/wcms_067588.pdf. Iwamasa, G. Y., & Iwasaki, M. (2011). A new multidimensional model of successful aging: Perceptions of Japanese American older adults. Journal of Cross-cultural Gerontology, 26(3), 261–278. https://doi.org/10.1007/s10823-011-9147-9. Kemp, C., & Tenenbaum, J. B. (2009). Structured statistical models of inductive reasoning. Psychological Review, 116(1), 20–58. https://psycnet.apa.org/doi/10.1037/a0014282. Kilkey, M. (2018). Transnational families: Opportunities and constraints for caring across borders. In O. Kapella, N. Schneider, & H. Rost (Eds.), Familie - Bildung - Migration (pp. 335–345). Berlin: Verlag Barbara Budrich. Lamb, S. (2014). Permanent personhood or meaningful decline? Toward a critical anthropology of successful aging. Journal of Aging Studies, 29, 41–52. https://doi.org/10.1016/j.jaging.2013. 12.006. Lee, J. J. (2009). A pilot study on the living-alone, socio-economically deprived older Chinese people’s self-reported successful aging: a case of Hongkong. Applied Research in Quality of Life, 4(4), 347–363. https://doi.org/10.1007/s11482-009-9085-7. Li, J., Liu, H., van der Heijden, B., & Guo, Z. (2021). The role of filial piety in the relationships between work stress, job satisfaction, and turnover intention: a moderated mediation model. International Journal of Environmental Research and Public Health, 18(2), 714. https://doi.org/ 10.3390/ijerph18020714. Long, G. T., & Pfau, W. D. (2009). Ageing, poverty and the role of a social pension in Vietnam. Development and Change, 40(2), 333–360. https://doi.org/10.1111/j.1467-7660.2009.01517.x. Lukes, S. (1973). Individualism. Oxford, England: Blackwell. Martin, P. Y., & Turner, B. A. (1986). Grounded theory and organizational research. The Journal of Applied Behavioral Science, 22(2), 141–157. https://doi.org/10.1177/002188638602200207. Merla, L., Kilkey, M., & Baldassar, L. (2020). Examining transnational care circulation trajectories within immobilizing regimes of migration: Implications for proximate care. JFR-Journal of Family Research, 32(3), 514–536. https://doi.org/10.20377/jfr-351. Miah, M. F., & King, R. (2023). Ageing and mobilities in transnational space: The BritishBangladeshi experience. Journal of Ethnic and Migration Studies, 49(4), 945–961. https://doi. org/10.1080/1369183X.2022.2115625. Mihailidis, P., & Thevenin, B. (2013). Media literacy as a core competency for engaged citizenship in participatory democracy. American Behavioral Scientist, 57(11), 1611–1622. https://doi.org/ 10.1177/0002764213489015. Montross, L. P., Depp, C., Daly, J., Reichstadt, J., Golshan, S., Moore, D., Sitzer, D., & Jeste, D. V. (2006). Correlates of self-rated successful aging among community-dwelling older adults. The American Journal of Geriatric Psychiatry, 14(1), 43–51. https://doi.org/10.1097/01.JGP.000019 2489.43179.31. National-Assembly-of-Vietnam (NA). (2009). Law on the Elderly. Ha Noi: ILO. Retrieved June 2, 2021 from http://ilo.org/dyn/natlex/natlex4.detail?p_lang=en&p_isn=84194&p_coun try=VNM&p_count=532. Nguyen, H. T., Baldassar, L., & Wilding, R. (2022). Lifecourse transitions: How ICTS support older migrants’ adaptation to transnational lives. Social Inclusion, 10(4), 1–13. https://doi.org/ 10.17645/si.v10i4.5735. Nguyen, H. T., Baldassar, L., & Wilding, R. (2023). Care visits: Obligations, opportunities and constraints for older Vietnamese parent visitors in Australia. Journal of Ethnic and Migration Studies, 49(4), 996–1013. https://doi.org/10.1080/1369183X.2022.2115628 Nguyen, H. T., Baldassar, L., Wilding, R., & Krzyzowski, L. (2021). Researching older Vietnamborn migrants at a distance: The role of digital kinning. In H. Kara, & S.-M. Khoo (Eds.), Research Methods in Times of Crisis. Bristol: Bristol University Press.

76

H. T. Nguyen et al.

Nguyen, M. T. N., & Chen, M. (2017). The Caring State? On Rural Welfare Governance in Postreform Vietnam and China. Ethics and Social Welfare, 11(3), 230–247. https://doi.org/10.1080/ 17496535.2017.1300307. Pressey, S. L., & Simcoe, E. (1950). Case study comparisons of successful and problem old people. Journal of Gerontology, 5(2), 168–175. https://doi.org/10.1093/geronj/5.2.168. Reynolds, T. & Zontini, E. (2014). Care Circulation in Transnational Families. In L. Baldassar, & L. Merla (Eds.), Transnational Families, Migration and Circulation of Care. London: Routledge. Rowe, J. & Kahn, R. (1987). Human aging: usual and successful. Science, 237, 143–149. https:// doi.org/10.1126/science.3299702. Samanta, T. (2018). Successful Aging: Asian Perspectives. Journal of Women & Aging, 30(3), 275–277. https://doi.org/10.1080/08952841.2018.1458393. Strawbridge, W. J., Wallhagen, M. I., & Cohen, R. D. (2002). Successful aging and well-being: Self-rated compared with Rowe and Kahn. The Gerontologist, 42(6), 727–733. https://doi.org/ 10.1093/geront/42.6.727. Svallfors, S. (2008). The generational contract in Sweden: age-specific attitudes to age-related policies. Policy and politics, 36(3), 381-396. hhttps://doi.org/10.1332/030557308X307720. Tesch-Römer, C., & Wahl, H. W. (2017). Toward a more comprehensive concept of successful aging: disability and care needs. The Journals of Gerontology: Series B, 72(2), 310–318. https:// doi.org/10.1093/geronb/gbw162. The Government of Vietnam. (2021). Decree on social assistance policy for social protection beneficiaries. 20/2021/NĐ-CP. Ha Noi: Retrieved July 2, 2021 from https://thuvienphapluat. vn/van-ban/Van-hoa-Xa-hoi/Nghi-dinh-20-2021-ND-CP-chinh-sach-tro-giup-xa-hoi-doi-voidoi-tuong-bao-tro-xa-hoi-467723.aspx. Thomas, T. (1999). Stress, coping, and the mental health of older Vietnamese migrants. Australian Psychologist, 34(2), 82–86. https://doi.org/10.1080/00050069908257433. Thomas, T. (2003). Older migrants and their families in Australia. Family Matters, (66), 40–45. Canberra. Retrieved May 4, 2021 from https://search.informit.org/doi/10.3316/ielapa.808638 779601002. Thomas, T., & Hallebone, E. (1995). Adolescents’ attitudes towards the elderly and their relationship with grandparents. In Lincoln Gerontology Series. Melbourne: Lincoln Gerontology Centre. Tran, G. T. T. (2018). Sharing cultural values across generations in Vietnamese Australian families (Doctoral dissertation, Swinburne University of Technology). http://hdl.handle.net/1959.3/ 443479. Vietnam Association of the Elderly (VAE). (2021). Để người cao tuổi được sống vui, sống khỏe, sống có ích là mục đích cao nhất của Hội người cao tuổi Việt Nam. Hanoi, Vietnam: VAE. Retrieved May 4, 2021 from http://hoinguoicaotuoi.vn/c/de-nguoi-cao-tuoi-duoc-songvui-song-khoe-song-co-ich-la-muc-dich-cao-nhat-cua-hoi-nguoi-cao-tuoi-viet-nam-5461.htm. Valente, S. (2019). Safety Nets: An international comparison. New Labor Forum, 28(2), 44–50. https://doi.org/10.1177/1095796019838824. Van Hoi, L., Thi Kim Tien, N., Van Tien, N., Van Dung, D., Thi Kim Chuc, N., Goran Sahlen, K., & Lindholm, L. (2012). Willingness to use and pay for options of care for community-dwelling older people in rural Vietnam. BMC health services research, 12(1), Article 36. https://doi.org/ 10.1186/1472-6963-12-36. Walker, A. (1996). The New Generational Contract: Intergenerational Relations, Old Age and Welfare. London: UCL Press. Whiteford, P. & Angenent, G. (2002, June 1). The Australian System of Social Protection - An Overview (Second Edition). FaHCSIA Occasional Paper No. 6. Retrieved June 3, 2021 from SSRN: https://ssrn.com/abstract=1729044. Young, Y., Frick, K. D., & Phelan, E. A. (2009). Can successful aging and chronic illness coexist in the same individual? A multidimensional concept of successful aging. Journal of the American Medical Directors Association, 10(2), 87–92. https://doi.org/10.1016/j.jamda.2008.11.003.

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Hien Thi Nguyen is currently a Postdoctoral Research Fellow of Anthropology and Sociology at the Social Ageing (SAGE) Futures Lab, School of Arts and Humanities, Edith Cowan University. She has over 16 years of experience working as social researcher and development practitioner in Vietnam and Australia. Her current research questions focus on examining late life-course transitions and older-age wellbeing of diverse communities in Australia (with a particular focus on Vietnamese migrants) in relation to mobility, ICTs and new media, gender, social inclusion, and social solutions for social care across the life course. [email protected] Loretta Baldassar is Professor of Anthropology and Sociology, Vice Chancellor’s Professorial Research Fellow, and Director of the Social Ageing (SAGE) Futures Lab in the School of Arts and Humanities at Edith Cowan University. Loretta has published extensively in the field of migration and transnational families. In 2020, 2021, and 2022, she was named Australian Research Field Leader in Migration Studies (Social Sciences) and in Ethic and Cultural Studies (Humanities, Arts, and Literature). [email protected] Raelene Wilding is Associate Professor, Sociology at La Trobe University. Her qualitative research explores the intersections of families, care, technology, and migration, including the impact of new technologies on the wellbeing and care of older adults from diverse cultural backgrounds, the role of new media in the lives of migrants and older adults, and the role of technology in supporting health outcomes for linguistically diverse communities. [email protected]

Chapter 5

Population Ageing and Community-Based Old Age Care Supply in China Bingqin Li

Abstract The Chinese society is becoming old before becoming rich. It is also experiencing major social transitions such as smaller household sizes, intergenerational separation resulting from urbanisation, and the lack of community-level support networks for older people in need. These features pose hurdles to the development of an old age care system. In this chapter, the author argues that an old age care system is gradually taking shape with community-based care taking the lead. However, the current system continues to face the challenges of a lack of sustainable business models for private and social providers and the insufficient quality of labour supply. This study highlights not only the new policy changes that are being implemented to effectively address the weaknesses in the system but also the future directions related to policy reform and research.

5.1 Introduction China’s total population is expected to peak in 2030 or even as early as 2027, according to the more pessimistic estimation (Ning 2021). By 2020, the total population has reached 1.402 billion, with the proportion of older people over 65 accounting for 13.5% compared to just 7% in 2000 (Zhang and Zhao 2021). If the population growth continues at this speed, by 2025, 25% of China’s population will be over 65. The existing supply of old age care stems from informal care provided by families at home, private care provided by healthcare or aged care institutions, and socialised care at home or in communities by either private providers or nongovernmental organisations (NGOs). The direct challenge of the population growth pattern is that because the capacity of the informal care sector to supply old age care does not leave much room for growth (Cheung 2019), there will be mounting pressure on informal care in the future (Hu 2019). In recent years, private services have been growing fast, B. Li (B) Social Policy Research Centre, University of New South Wales, Kensington, Australia e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 T. Chun Tat Shum and C. C. L. Kwong (eds.), Housing and Ageing Policies in Chinese and Global Contexts, Quality of Life in Asia 15, https://doi.org/10.1007/978-981-99-5382-0_5

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conquering about half of the market share for old age care services in China. The growing proportion of older people in need of care means that there will unavoidably be structural changes to care provision, with more people relying on care provided by those who are not their children. The existing literature on aging society and old age care in China has several streams. The first is the aging trend, unmet needs of care, and its projection (Zhu 2015; Silverstein et al. 2020; Yang et al. 2021; Zhou et al. 2021). Without exception, research on aging trends highlights the unmet needs and a dire future for old age care. The second relates to how families facing greater care burdens cope with the pressure (Chen and Silverstein 2000; Xu 2001; Sun 2002; Zhan and Montgomery 2003; Cong and Silverstein 2008; Li and Shin 2013; Yi, George et al. 2016; Zhong and Li; 2017). These studies reveal the impact of the changes in demographics, family size, coping strategies of family care arrangement, motivation of family support, and gender perspectives of care. The findings suggest that families indeed face greater caring burdens and have already explored various avenues to meet the needs. However, as the aging and socioeconomic trends continue, family capacity will be stretched further. Rural areas already suffer from care deficits because of out-migration (Cong and Silverstein 2014; Liu 2014). The third stream relates to financing old age care. These studies include the colossal body of research on social insurance reform including pension, healthcare, and long-term care insurance (Zhu and Österle 2019; Chen and Xu 2020; Feng et al. 2020) as well as social assistance for older people who cannot afford care (Yuebin and Zhang 2012). The fourth stream relates to the labour market of old age care, comprising studies on domestic workers, including migrant workers from China and abroad, working as care workers (Hall et al. 2019) and care workers working for care institutions (Feng et al. 2011). The demands of these care workers relate to equal treatment and pay (Dong et al. 2017; Chen et al. 2018; Wang and Zhang 2018). There is scarce research on the capacity of the care labour force, with few studies on the private market supply of old age care in China. These studies focus on care quality (Feng et al. 2011; Liu et al. 2014), provision models, and sources of inspiration (Feng et al. 2011). Although private providers are keen to provide highend services, they are not affordable to older people in the middle-income brackets; thus, there has been a serious gap in the social care of older people in China (Zhu and Walker 2018). This chapter reviews the policy changes in social care service delivery and show how a more structured system has emerged. In the following section, the author outlines some of the key features of the aging society (Feng and Mason 2007; Han et al. 2020; Zhang et al. 2020a, b), arguing that it is important for service providers to develop a sustainable business model, which involves reaching a level of operation that can cover the costs. The labour supply issue is also discussed.

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5.1.1 Key Features of the Chinese Ageing Society Each aging society has its own unique feature that determines the relationship between the demand and supply of old age care (Gagliardi et al. 2012; Kazawa et al. 2018; Malhotra et al. 2019). The Chinese aging society has several distinctive features. Policy advisers and policy makers have long raised the concern of ‘growing old before becoming rich’ in China. The first article in China that discussed ‘growing old before becoming rich’ (未富先老, weifu xianlao) was by the Advisory Group in ‘Issues and Response Strategies for Population Aging in China’ (2002). This article argued that in 2001, the number of people over 65 years exceeded 90 million, accounting for 7.1 percent of the total population, marking the beginning of the era of population aging in China. In 20 years, the number of people over 65 has more than doubled in absolute terms and is close to a double-digit percentage. However, many scholars dismissed this discourse, arguing that many other countries also become older before they become rich. Figure 5.1 compares China’s median age trend with other countries’ trends and income level. The purple data line labelled ‘China’ shows the changing median age over time. The vertical line on the left reflects data from 1997 when China was upgraded to a ‘lower middle-income country’ from a ‘low-income country’. Even before it was upgraded, China’s median age was on a faster upward track than the average of the lower middle-income countries (orange line). 2010 was the year when China was further upgraded from a ‘lower middle-income country’ to an ‘upper middle-income country’. Its median age in 2010 was also above the average age of upper middle-income countries. Moreover, between 1997 and 2010, the steeper slope of the China line (purple) reveals that the upward moving speed of median age was faster than the average of upper middle-income countries. China’s aging trend is now on track to equal that of high-income countries even though its gross national income per capita is still US$ 2000, well below the average of high-income countries. A further issue is the geographic distribution of older people within China. Figure 5.2 shows the older population with gross domestic product per capita by provinces. Some lower income provinces such as Liaoning, Chongqing, Sichuan, Jilin, and Heilongjiang have the largest proportion of older people above 65. They face very similar challenges as do some of the richest regions such as Shanghai and Jiangsu. This means that even within China, some provinces suffer more serious consequences of getting old before becoming rich. Regional inequality also exists between rural and urban areas. As of 2020, there were about 285 million rural to urban migrants living and working in cities, among whom 170 million people work outside their home counties and 116 million work in their home counties but not in the towns or villages they grew up in. Even though China’s urbanisation rate is not the highest among the upper middle-income countries, the rate of change has been fast since it became a middle-income country. China had undergone many years of birth control, which has resulted in the demographic structure being artificially tweaked to have a 4:2:1 generational structure

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Fig. 5.1 Income group and aging trend (Sources: UN Population Division (Median Age) (2017), chart drawn by the author using OurWorldinData.org/age-structure) Note: 1950 to 2015 show historical estimates. From 2016 the UN projections (medium variant) are shown

Fig. 5.2 Regional inequality of growing old before being rich (Source: Census, 2020.)

which means in an extended family, each child will have two parents and four grandparents. As the child grows up. At the same time, the household size has been shrinking as shown in Fig. 5.3. Lastly, in the past four decades, China has experienced a major transition from a central planning economy to a market economy. This means that the older people spent at least a significant proportion of their working life in the central planning era during which employee income was artificially lowered to keep the production costs

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Fig. 5.3 Household size in China (2009–2019)

low. The economic transition came with a sustained economic and income growth era. Thus, older people often find it hard to afford old age care services without support. These features pose some key challenges for old age care in China. Lower affordability means that it is difficult for the majority of older people to afford private services without any special financial arrangements or support. Some regions such as the poorer provinces and rural areas face particularly acute challenges. It is difficult to expect the market to provide solutions automatically. The state needs to step in to avoid old age care crises. In the past, when families were large, several children took turns to look after older parents. The filial piety culture guarantees that most children would assume the responsibilities of looking after their elderly parents. However, the shrinking household size and the 4:2:1 generational structure mean that even if younger people are willing to look after their parents, they do not have the capacity to do so. Each young couple would need to look after multiple older couples (Zhan 2002; Zhang and Goza 2006). Evidence shows that the growing care burden of adult children has already caused adverse health outcomes (Chen et al. 2020). The highly mobile population as a result of urbanisation and migration also means that, at a given time, more people live separately from their extended families than in the past, making it impossible for adult children to shoulder the care responsibilities. Rural areas that have lost the working age population to the cities suffer the most in terms of aging before becoming rich.

5.1.2 Solutions to the Old Age Care Supply Shortage—Enhancing the Role of the Communities The Chinese government has adopted various public policies to address the old age care shortage. First, it established a multi-level, integrated pension system (Wang and

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Huang 2021), which still faces challenges pertaining to equality and sustainability (Li 2014; Lin et al. 2021). In recent years, it also introduced long-term care insurance that is further integrated with medical care in some places (Shen et al. 2014; Zhu and Österle 2019). Second, it encouraged the development of the private care service market (Feng et al. 2012, 2020). Third, it strengthened intergenerational relationships through policy guidance, emphasising the responsibilities of adult children to care for older people (Cheung 2019; Zhang et al. 2020a, b), and introducing legislation requiring children to support and visit their older parents (Meng and Hunt 2013; Hu and Chen 2019). It also encouraged adapting the living environment to make it conducive to old age living, for example, by installing lifts in older residential buildings (Xie 2018; Cheng et al. 2021; Yu et al. 2021). To promote active and healthy aging, the government also encouraged investing in socialising, fitness, and learning facilities and services for older people (Cai and Kosaka 2016, 2019; Bonaccorsi et al. 2020; Wang et al. 2020; Xiao et al. 2020). Despite the improved services and facilities, the daily needs of the older population are far from being met. The following sections examine how the state gradually incentivised different stakeholders to enter the old age care sector.

5.1.3 Defining the Service System Unlike other social services such as education and childcare, old age care needs can be met by a range of providers. In people’s aging process, the development of care needs is often gradual and progressive as they become frailer or lose the capacity to perform basic activities. The process of capacity loss can vary greatly and people’s ability and means to cope also vary. Thus, even in the same age group with similar capacity losses, old age care needs can differ as a result of health inequalities and the socioeconomic status of older adults (Grundy and Holt 2001). Moreover, older people’s care preferences and care seeking may also vary (Zhang et al. 2019). Thus, it is difficult to develop a generic care service package by age group (Lum et al. 2015). China began to deal with the old age care services without following a ready-made service structure. Paradoxically, the central planning era did not provide ‘from cradle to grave’ care that people often associate with all Communist countries. However, the state provided a retirement pension for urban employees. Older people were largely dependent on their adult children for home, hospital, and palliative care. A tiny proportion of the privileged (e.g. retired civil servants) were eligible to live in publicly funded pensioners’ homes. In extreme cases where older people did not have any support, they could be collectively supported by village authorities or receive help from employers and neighbourhood authorities in cities. In this sense, the government’s role in planning and providing old age care was at most minimalistic (Li et al. 2021). When privatisation began in the 1980s, it was impossible for pensioners to rely on ex-employers, villages, or neighbourhood authorities to offer even minimal care

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support. However, as the labour market became more flexible, some rural to urban migrants and urban unemployed workers became domestic workers charging affordable rates (Wang and Wu 2017). Thus, old age care became almost completely privatised with a tiny proportion of the privileged few being able to enjoy publicly funded institutional care. However, it was not realistic for older people to receive care at home. In rural areas, most rural elders could not afford care workers; geographically, it was also not practical for care workers to travel between households to provide individualised care. As a result, in the mid-1980s, geracomiums (Jinglaoyuan, nursing care homes) emerged to offer care collectively. The funding for geracomiums came from rural villages. Because they were not meant to be profit making, they were labelled as non-profits. In the late 1980s, some urban communities also began running geracomiums (Pan 2017). Initially, these non-profit nursing care homes were only accessible to older people who could not receive care from families or relatives. Gradually, they began offering fee-based services to other older people. This is how a mixed system appeared. In 2000, with the state’s community development initiatives (shehui jianshe), aiming to re-establish a community service and support system, old age care became an important element of community development (Li et al. 2019). Simultaneously, the government realised the merit of an old age care system that includes family, community, and the society. Communities began offering nursing care and domestic support. However, as community-based services were covered by government budgets, it was necessary to set a clear structure of different types of care types and define the criteria for government subsidies. In 2007, Shanghai city developed a target to produce institutionalised care – either state provided or market provided – for 3% of the older population and community-based care for 7%, with 90% of the older population staying at home (Chen and Han 2016). This service structure assumed a continuation of the system inherited from the central planning era, where family members will be the primary care providers for older people. This old age care service provision structure was later copied by many other cities (Feng et al. 2020). After some years of local pilots and practices, people started to question the practice of differentiating home-based and community-based care. People living in communities utilise various community-based services anyway. In this sense, the community does not have to be a service delivery centre. It can be a platform for resource allocation and service matching. Thus, it can also serve older people who wish to stay at home. Therefore, these days, the service structure has changed to community and home-based care (97%) and institutionalised care (3%). Figure 5.4 depicts the faster growth of community-based old age care homes compared to institutional care homes. However, the division of home-based care and institutionalised care did not take into account the need for medical care. As a result, service providers including community and institutions cherry picked easy-to-deliver services such as social activities, physical exercises, and dining halls. Because the government subsidised infrastructure and physical facilities, such as beds in old age care homes, community service centres began offering day care services, which often included beds for older people to rest. However, when there was need for medical care, older people were

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Fig. 5.4 Different types of care facilities (Data source: Ministry of Civil Affairs, Statistical Yearbook, various issues)

referred to hospitals. This made old age care dispensable for most older residents and the day care beds were often under-used or unused. Figure 5.5 shows the trends in the number beds and people using them in the communities. The use of overnight beds and the people using them show a decreasing trend. The use of day care beds has been increasing, but the number of people using them remains low. These data show that the government subsidies have distorted the relationship between the supply and demand in community-based care. For the majority of older people who anticipated that they would need money for expensive medical care, living in community-based care facilities that do not offer healthcare support is not worthwhile. As a result, the most recent policy initiative added a new element to the home, community, and institutional care system: the integration of medical and social care (Zhou et al. 2021).

Fig. 5.5 Community- based care facilities and the number of users (Data source: Ministry of Civil Affairs)

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Defining the service system has several implications. The structural changes will determine the government funding. For example, the merging of home-based and community-based care greatly enhances the appeal of the community as a sector to attract private investment. It also greatly increases the range of services that can be subsidised. In addition, for most community-based services, having to provide services on site in the communities requires the service providers to secure land and rooms to operate. This not only incentivises investment for on-site services, which may not be useful for older people, but also ensures that a huge amount of resources is devoted to a very limited range of services. When home-based and communitybased care are merged, a lot of care services that used to be provided by domestic care workers can also be subsidised. Integrated health and long-term care also tap into one pool of funding, which may be more efficient. Of course, as the policies are still relatively new, it will take time to witness their actual effect.

5.1.4 Business Models for Care Providers ‘Becoming old before getting rich’ means that the affordability of old age care would be a serious issue even with long-term care insurance, healthcare insurance, and government subsidies. Old age care on the whole is labour intensive. While the income level of the younger generation rapidly increases, older people’s care costs could easily exceed their lifetime savings. Thus, developing a business model that can survive in such a low affordability market is a serious challenge.

5.1.5 Social Organisations as Service Providers Social organisations (SOs) include social enterprises and non-profit organisations that contract community services from the government, with some operating independently, and some adopting various forms of public–private partnerships (e.g. the government pays for the facilities and the SOs operate them). With a clearer definition of the role of the market, SOs, and governments’ subsidies, community service became very active. By the end of 2015, the total number of old age care service organisations and facilities in communities reached 26,000. There were 62,000 mutual assistance facilities and 2.98 million beds in the communities, including community nursing homes and day care centres (Ministry of Civil Affairs, 2016). In addition to nursing services, new types of services also emerged. At the end of 2015, there were 2,280 national-level old age service NGOs, 210,000 legal aid centres, 71,000 coordination agencies for the protection of rights and interests of the elderly, 53,000 third age schools, 7.33 million senior students, and 371,000 activity rooms across the country. (Ministry of Civil Affairs, 2016). However, sustaining the services remained a serious question. The challenges existed in several aspects:

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1. Interpretations of the roles between different levels of governments, and between governments and NGOs, seem to vary. As aforementioned, the purpose of the reform issued by the central government was to encourage SOs to be more involved in service provision and incorporate additional resources into the services in order to better satisfy the needs of older people. However, local governments could interpret this differently. 2. While the number of care homes kept increasing, labour supply could not catch up. The quality of services fell short of older adults’ expectations, which was worrisome to them. In most care homes, the staff had not received professional training to become care workers. Further, professionally trained care workers would not want to work in public or government-subsidised care homes, as their salaries were much lower than the market rates for private carers and childcare nurses. 3. There were different interpretations of local governments’ roles in the development of SOs. In the state–SO partnership structure, the government contributed in kind, such as venues, and/or in cash, such as the initial start-up fund and some annual cash input. Staff costs were rarely paid by the government. Even when the government purchased services directly from non-profit organisations, it paid the minimum wage to the staff members, which was much lower than the wage paid to professionals working in privately funded organisations. The government considered the partial funding model an incentive mechanism, as it did not wish SOs to be dependent on it. The purpose of the support was to help SOs launch their businesses, and SOs were expected to graduate out of this stage and become independent. Therefore, even at the early stage, the government adopted an incentive strategy by not fully funding the services. However, SOs perceived their services to be social services and expected the government to be their main source of funding. 4. Despite the overall support for the goal to improve services, not all stakeholders shared the same goals in their daily operations or for different projects. For example, superficially, the local governments could relinquish responsibility as they contracted out service delivery. However, this meant goal and role changes. In the past, local officials did not have to distribute money to SOs; they simply allocated funds to other government agencies according to the budget, which was a relatively simple task. Now, government officials, who were inexperienced in working with SOs in the past, were required to behave like venture capitalists and select projects run by people with whom they had not previously worked. In addition, government officials were held accountable to their managers to perform well, which, in this case, meant ensuring that the SOs they had supported or contracted would deliver better outcomes than in the past. Thus, they were keen to avoid being perceived as bad decision makers. 5. Paradoxically, users did not necessarily trust SOs’ services. This was partly because the old age care services provided by the public sector targeted urban elites. For ordinary people, staying at home was the only option. When residents were invited to community-based facilities – which appeared to be less formal,

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smaller, cheaper to access, and without a track record for good services – prospective users were reluctant to use the services, especially if they were older adults. As a result, initially, new SOs found it difficult to attract customers, despite the government subsidies. This was particularly problematic for door-to-door services (Huang et al. 2007).

5.1.6 Larger Private Companies For many years, despite the numerous small businesses, only private or non-profit providers entered the community old age care sector; well-established private sector companies were not keen on getting involved with community care. Successful private providers were keen to serve the high-end market, mostly comprising the wealthy, for several reasons: First, within urban communities, there is not much land to spare for property development, which was a key source of profit for estate companies. Second, in the early days, the income level of the older people was much lower than it is now. However, With the passage of time, the income and wealth of older people has grown steadily and they are now more willing to spend money on care services than they were in the past (China Gerontologist Research Centre 2018). Third, because the community sector was subsidised right from the beginning, it is difficult to determine what services people would need and how much they would be willing to pay. Because private service providers could make higher profits in the private market, the need to enter the community was low. However, in recent years, high-end elderly care institutions have marched into the more affordable segment of community services through various PPP models, such as public construction, private operation, and private non-government. In July 2019, the National Development and Reform Commission officially announced the first batch of inclusive elderly care projects, a total of 119 in the country, including well-known high-end brands in the industry. Data from the Ministry of Civil Affairs (2020) reveals that in July 2020, there were 42,300 old age care institutions nationwide, with 4.291 million beds serving 2.146 million older people, with more than 50% belonging to private care institutions. Several factors influence the private sectors’ interests in community care. First, further clarification of community care merged home-based care (90%) and community-based care (7%). This means that community care can cover not only services delivered to people’s homes by businesses based in the communities but also services delivered in the communities. The concept of community care will cover 97% of the elderly population for all care services (Zhu and Österle 2019), thereby greatly increasing the options for the types of services that can be supported by the government. Second, private old age care companies often originated from real estate development and have less room for profits. In the past, it was not difficult to secure land to sell apartments with a premium on top of retirement care services. As land prices drastically increased and care services stopped being profitable, companies could continue to make a profit through the rise of land price. This business model

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had two implications. The care services were cross subsidised by the earning from land and the properties had to be located in peri-urban areas where the potential for urban expansion would be the greatest (Aveline-Dubach 2020). However, the ability of real estate developments to continue to profit on land in this way in the future is uncertain. Since 2016, a series of land registration and taxation reforms have been introduced to make land transactions and revenue uses more transparent than before. This is expected to change the focus of businesses on the profits generated by land rather than by the activities on the land (Yang and Yang 2021). The policy changes have not yet made a difference in the urban land economy (Zhu and Österle 2019); however, private businesses have started to look for alternative solutions to diversify the risks. Third, with more government subsidies flowing into the care sector and the prospect of long-term care insurance (Du et al. 2021), the potential to earn a profit in community care is higher than before. Having said so, as the time is relatively short, it is too early to predict whether these companies can outperform their predecessors. Generally speaking, with few exceptions, old age care facilities either run by SOs or by private companies face sustainability issues. This is largely a result of the relatively low income of the majority of older people and their lack of willingness to spend money. The government subsidies have played an important part in supporting the service providers. This situation might be improved in the future as the younger generation of older people who have not worked in the Central Planning era.

5.1.7 Labour Supply Care workers have played a central role in the old age care sector. They mainly comprise rural-to-urban migrants and middle-aged women. Quite often, domestic workers who were not trained for old age care become care workers. They either work and live in older people’s homes as long-term carers or hop between households to earn hourly rates. Their income level depends on the market demand for their services. However, the market was not regulated. Abuse of either workers or older people happened in private and there was no way to address it (Laliberté, 2017). Such workers do not receive much training and may not be able to provide quality services when there are special needs (Feng et al. 2012). Moreover, they do not receive any social protection and their jobs are not secure. Table 5.1 reflects the situation of labour supply as employees who are not working for older people directly. In some cities, the local government assumes greater responsibility in managing the domestic service labour force. Workers work for local agencies and service users receive vouchers to book services. As a result, these services are regulated. However, they are limited to relatively simple tasks such as house cleaning and companionship. Others are hired by care providers (NGOs or private care institutions). Social workers play an important role in matching resources with services for the residents. However, relative to the older population, there are very few fully

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Table 5.1 Labour supply (2018) (Data source: Ministry of Civil Affairs (2019)) Registered

Cooperative

165,586

164,020

Assistant social workers

3,256

896

Social workers

1,368

514