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Carer resources · Deciding on a residential home

Choosing a Residential Care Home

The first obstacle with residential homes is not which one to choose. It is the names. The everyday term “old people's home” is not a category in the system, and a “convalescent home” belongs to the Hospital Authority's system and not the Social Welfare Department's. This page first explains how homes are actually graded and how the subsidised and private routes work, and then turns to the decision of whether or not to send the older person to a home, which many families find hard to talk about.

Home levels by level of care

Every residential care home for the elderly in Hong Kong must hold a licence from the Social Welfare Department, and homes are graded by the level of care their residents need. Understanding this grading is practical, because the level into which the older person's care needs fall decides directly what type of home the family should look for and which type of subsidised place to wait for.

Elderly home (安老院)This type of home suits older people with lower care needs who can mostly look after themselves. Homes of this type are becoming fewer on the market, and many have been converted into care-and-attention homes.
Care-and-attention home (護理安老院)This type of home suits older people with medium to high care needs, for example those who need help with daily living, have difficulty moving around, or have a chronic illness that needs daily nursing care. Most homes on the market are at this level, and the “care-and-attention places” on the waiting list for government-subsidised services also refer to this type.
Nursing home (護養院)This type of home has the highest care density. Its residents are mainly older people with heavier medical and nursing needs, for example those who are bedbound for long periods or need regular nursing procedures. This type has the fewest places and the longest waiting times.
Convalescent home (療養院)This service is not part of the Social Welfare Department's classification of residential care homes. It is provided by the Hospital Authority, which runs general convalescent services and a central waiting list for convalescent services, and applications must be submitted through a referral office designated by the Social Welfare Department. Carers easily confuse this service with a nursing home, but the application routes and assessment systems of the two are different.

Subsidised places and private homes compared

Once the family decides to look for a residential home, the next fork is the choice between a subsidised place and a private home. This is more than a question of cheap against expensive. It involves two entirely different sets of admission rules.

Subsidised places
  • Subsidised by the government, so the cost is much lower
  • The standardised care need assessment for elderly services must be done first, to confirm the level of care need
  • After assessment the older person is placed on the waiting list, and the wait is counted in months or even years
  • Includes subsidised home places and the Enhanced Bought Place Scheme (the government buys places from private homes)
  • Suits: families whose need can wait and for whom cost matters
Private homes
  • Approach the home directly, and admission can be within a few days
  • No standardised assessment is needed
  • Paid in full by the family, and fees and quality vary enormously
  • Charges beyond the monthly fee (nappies, escort to appointments, medication management) are billed item by item, and this is where the real difference lies
  • Suits: families who cannot wait, or who want to choose the environment themselves

In practice many families take a mixed approach. They arrange for the older person to move into a private home first to cope with the urgent need, and at the same time join the queue for a government-subsidised place through the standardised assessment, moving to the subsidised home once a place is allocated. This only works if the assessment process is started early. To find out how the assessment and waiting list work, see the standardised assessment and waiting list for elderly care services.

Factors to weigh when choosing between a home and care at home

Many families hesitate for a long time at this point, because it looks on the surface like a moral question (worry that sending the older person to a home will be seen as lacking filial duty). In fact it is a supply and demand calculation. On one side are the older person's care needs: whether someone needs to be on watch at night, how many people are needed to lift, transfer and bathe the older person, and whether the cognitive state allows being left at home alone. On the other side is the help and energy the family can actually give. The key is whether the two can be matched.

There are two common blind spots in this judgement. The first is to equate “the carer is close to being unable to carry on” directly with “the older person must move into a residential care home”. If the gap in care appears only in the daytime, or is purely short-term, day care centres and respitemay already be able to fill it, and moving into a home may not be needed. The second is to see moving into a home as all or nothing. After the older person moves in, the family's role does not disappear. It changes from worn-out day and night carer to relatives who visit and keep company, and in many families the relationship mends only after the heavy burden of physical care has been put down.

If the final decision is for the older person to stay at home, the system supports for care at home, including allowances, hiring a domestic helper or care worker, and community support services, can be found as entry points to detailed information in the overview of carer resources.

“Old people's home”, “elderly home”, “care-and-attention home”, “nursing home” and “convalescent home”: which is which?
“Old people's home” (老人院) is just an everyday catch-all term and is not a formal category. Residential care homes for the elderly in Hong Kong are graded by the level of care residents need. They include the elderly home (安老院, low care need), the care-and-attention home (護理安老院, medium to high care need, and the majority on the market), and the nursing home (護養院, the highest care density, where residents usually have heavier medical and nursing needs). A “convalescent home” (療養院) is not part of this classification by the Social Welfare Department. Hong Kong does have convalescent services, though. The Hospital Authority runs general convalescent services and a central waiting list for convalescent services, for people with chronic illness and severe disability who cannot get suitable care at home or in an ordinary elderly home, or who have a terminal illness and need continuing medical care. Applications must be submitted through a referral office designated by the Social Welfare Department. In other words this is the Hospital Authority's system, with a different entrance from Social Welfare Department places, and searching for the term in the register of residential care homes will naturally find nothing.
What is the difference between subsidised places and private homes?
They are two very different routes. Subsidised places are subsidised by the government and cost much less, but the older person must first have the standardised care need assessment to confirm the level of care needed, and then be placed on the waiting list until a place is allocated, and the wait is often counted in months or even years. A private home can be approached directly, and admission can be as quick as a few days, but the whole fee is paid by the family, and quality and fees vary enormously between homes. Many families in fact take a third approach: moving into a private home first to cope with the urgent need while waiting for a subsidised place (some private homes also have places under the “Enhanced Bought Place Scheme”, in which the government buys places from private homes).
How can I tell whether an older person has reached the point of “needing a residential home”?
The key is not the older person's age or diagnosis. It is the gap between the care needed and the help available at home. Does someone need to be on watch at night (night care is often the hardest part for a family to sustain)? How many people are needed to lift, transfer and bathe the older person? Does the older person's cognitive state allow being left at home alone without danger? And how much longer can the present carer keep going? If the main reason for considering a home is that the carer is close to being unable to carry on, it is worth finding out first whether respite and day services can fill the gap, because moving into a residential care home may not be needed straight away.
Does deciding on a residential home mean the family has given up on the older person?
No, although almost every family member feels this guilt. In fact moving into a residential care home is just a new division of work between the home and the family. The home takes over the physically demanding daily and night care, and the family changes from an exhausted worker back into a relative who visits and keeps company. Some family relationships actually mend after the older person has moved into a home, because when they meet, neither side is caught in the strain and friction of bathing and lifting. Before deciding, the question worth thinking about is not the yes-or-no one of “send or not send”. It is which parts of care the family truly cannot manage at home.
What should I look at on a visit to a private home, at the very least?
A licence and the staffing are the basic floor. First check whether the home holds a licence from the Social Welfare Department, the staff ratio on day and night shifts, and whether the home has registered or enrolled nurses, or only health workers. Next, observe the daily environment and atmosphere: the smell in the home (often one of the most honest indicators), whether residents spend the day just sitting around the television or take part in activities, the tone staff use when speaking to residents, and how far the actual meals differ from the menu. Finally, be sure to ask about charges beyond the fee schedule. Items charged one by one, such as nappies, escort to appointments and medication management, are often where the real gap in monthly cost between homes lies.

Related gateways

Gateways before the residential route

Alternatives to a home: care at home

Disclaimer: This article is general health information and is not professional medical advice. If you have any health concerns, please consult a qualified healthcare professional.