Lingnan research highlights heavy pressure on Hong Kong’s compound carers Nearly half of employed carers fear disclosing identity, dread being labelled ‘troublesome employees’

The Hong Kong Council of Social Service estimates that the number of carers across the territory reaches as high as 1.12 million. Some employed people are forced to juggle the demands of work alongside caring for parents, spouses, or children, taking on the arduous role of “compound carers”.  The Asia-Pacific Institute of Ageing Studies (APIAS) at Lingnan University conducted in-depth interviews with over 40 multiple carers who care for at least two family members, one of whom has a disability or a chronic illness. The study found that these working compound carers face heavy pressure in balancing professional and family duties. Nearly half of those interviewed keep their caregiving responsibilities hidden at work for fear of being branded “troublesome employees”. Consequently, several had to give up promotions or switch to part-time work due to caregiving demands. Researchers note that current support networks remain fragmented, leaving compound carers to search for, evaluate, and arrange various services entirely on their own — adding substantial friction to an already overwhelming load. The research team recommends introducing dedicated Case Managers who will integrate healthcare, rehabilitation, and social welfare services.

Led by Lingnan and funded by the Research Grants Council of Hong Kong, the one-year study conducted in-depth interviews between April 2025 and January 2026 with 45 compound carers in the Hong Kong SAR, aged from 25 to over 75. Recruited through social welfare agencies and carer social media platforms, they were full- and part-time workers, full-time homemakers, and retirees, 35 of whom were female. In terms of their caregiving loads, 34 were looking after two family members, nine were caring for three, and two were single-handedly looking after four to five relatives.

The study revealed that many of these 104 care recipients suffered from complex comorbidities, which included chronic health conditions (30), diagnosed dementia (20), and severe mobility impairments or bedridden states resulting from conditions such as stroke (20). Respondents emphasised that their daily responsibilities encompassed coordinating frequent multi-speciality medical consultations, giving medication at fixed times, managing physical transfers, and responding to unpredictable medical emergencies, all of which represent an intensive, sustained care burden. Consequently, many carers reported feeling trapped in a relentless 24-hour on-call cycle, continually forced to make trade-offs between different responsibilities.

The study also showed that approximately 45 per cent of respondents had to balance paid employment with their caregiving duties. Most reported relying on annual leave, time off in lieu, or shift swaps to attend to family medical consultations and sudden emergencies. As leave requests accumulated, carers expressed growing concern that supervisors or colleagues might perceive them as having persistent family issues or lacking commitment to their role, thereby threatening their prospects for promotion and contract renewal. Consequently, nearly half of the employed respondents chose to conceal their carer status at work, with some preferring “to absorb the burden privately rather than risk being viewed as troublesome employees”.

For example, one respondent declined a promotion offer due to concerns over managing both workplace and caregiving responsibilities, explaining, “Because new roles typically offer no annual leave during the initial months, I needed to ensure my family members would have no medical appointments or sudden emergencies during that period.” Another respondent who very much wished to change jobs feared a new post might demand longer hours and limit the ability to respond immediately to family emergencies, forcing this individual to remain in the same position. The research team pointed out that these accounts illustrate how care responsibilities directly impact the career options of certain respondents.

Notably, caregiving responsibilities also take a severe toll on personal psychological well-being, with some carers undergoing psychiatric treatment due to the heavy pressure. One respondent highlighted having to care simultaneously for an 88-year-old amputee father with limited mobility and an 87-year-old mother living with dementia. This unceasing pressure resulted in chronic sleep disruption, physical exhaustion, and deteriorating mental health, ultimately leading to suicidal ideation during moments of profound helplessness and the need for ongoing psychiatric care.

Furthermore, the study underscored that respondents find the existing social support infrastructure highly fragmented. Carers are forced to navigate a complex maze of services across public hospitals, the Social Welfare Department, non-governmental organisations, residential care facilities, and online portals by themselves, investigating application procedures, waiting lists, means-testing requirements, and eligibility criteria in each case. Beyond these structural challenges, respite care capacity remains severely constrained on weekends, public holidays or times of emergency, daycare transport schedules frequently conflict with standard working hours, and rehabilitation transit routes and operational hours are restrictive, creating substantial hurdles for carers seeking support. The research team says that the bureaucratic complexity of the existing support apparatus and scattered information have become part of the overall chronic stress burden for compound carers.

Prof Dickson Chan Chak-kwan, Research Professor and Director of APIAS, said, “The public currently pays relatively little attention to the problems and needs faced by ‘compound carers’ who care for several dependents. These people encounter immense strain regarding time management and role execution, alongside psychological and financial pressure; they often face a heavier burden than carers looking after a single family member, yet existing policies offer meagre targeted assistance. We advocate formally recognising compound carers as core stakeholders within the Hong Kong SAR’s long-term care architecture. Strategic inter-agency coordination alongside dedicated funding streams would tangibly elevate quality of life for these households, while fortifying systemic sustainability against an accelerating demographic ageing curve to address the long-term challenges posed by an ageing population and growing demand for services.”

To operationalise this, the research team proposes establishing a dedicated Carer Case Manager framework, where designated professionals evaluate household needs, communicate with healthcare, rehabilitation, and social care networks, and design integrated post-discharge transition plans and service packages, eliminating the procedural burden on families. They also recommend short-term residential care and home support services beyond standard office hours and on weekends. Finally, they suggest carer-friendly employment standards, specifically introducing a statutory entitlement to seven days’ unpaid carer leave annually as well as corporate incentives for flexible scheduling, hybrid working arrangements, and agile shift swaps. Additionally, the monthly amount of the carer's allowance is only HK$3,300, which accounts for 15 per cent of the median monthly domestic household income and falls short of covering the various additional expenses associated with caregiving. Therefore, increasing the carer's allowance is the most direct and prompt way to assist carers facing financial hardship.

For the full research paper, please visit: 

https://commons.ln.edu.hk/apias_research/29/