Private care home fees in Hong Kong: the admission agreement

Why a private care home fee is not one number

A private residential care home for the elderly sets its own monthly fee. The government does not fix that fee, and the published fee levels for subvented homes and bought places do not apply to a private place taken at the market rate. What the law does fix is how the fee must be described to a family before admission, and that is where the leverage sits.

The framework is licensing rather than price control. The SWD Elderly Information Website states that the operation of residential care homes for the elderly in Hong Kong is governed by the Residential Care Homes (Elderly Persons) Ordinance (Cap. 459), the Residential Care Homes (Elderly Persons) Regulation (Cap. 459 sub. leg. A) and the Code of Practice for Residential Care Homes (Elderly Persons), which sets out the principles, procedures, guidelines and standards for operating, keeping, managing or otherwise controlling a home.

It helps to know what counts as a home at all. The Code of Practice for Residential Care Homes (Elderly Persons), June 2024 (Revised Edition).pdf) states that a residential care home means any premises at which more than five persons who have attained the age of 60 are habitually received for the purposes of care while resident there, and that the Ordinance does not apply to premises maintained by the Government or the Housing Authority, or to premises used solely for medical treatment. A home of that kind needs a licence, and the licence is administered by the Licensing Office of Residential Care Homes for the Elderly, which states on its own page that it carries out licensing matters under Cap. 459 and that it also takes enquiries and complaints about the service of care homes.

The licence and the fee schedule that must be on display

Two documents should be visible in a home. The Code of Practice states that operators shall display the licence in a prominent place of the premises, so that the public may be able to identify the legal status of the home concerned, and that where a home holds an electronic licence the operator may display it, or a copy, on an electronic screen or in printed form in a prominent place.

The charge list is the second. The Guidelines on Fees and Charges in Residential Care Homes for the Elderly, which form Annex 8.1 of the same Code, state that a home shall explicitly specify the amount of the home fee and of other charge items, including services and goods, with the actual amount or unit cost for each chargeable item, and shall display a clear list of charges at prominent places in the home so that residents, family members and other people can read it.

The same guidelines state that the schedule of fees and charges must be given to the resident or to the guardian, guarantor, family member or relative before admission, with the charges explained. A home cannot leave that explanation to the first invoice, and the inspection and compliance work that follows a placement is built on documents of this kind being in place already.

Advertising is covered as well. Chapter 1 of the Code states that the operator must ensure that every advertisement published by or on behalf of the operator for promoting the home contains information to the effect that a licence is in force in respect of that home.

The fee items the admission agreement has to name

The admission agreement is the document that turns a verbal quote into something the family can hold to. Chapter 8 of the Code states that the agreement must state the rules of the home, the roles and responsibilities of both parties, and the payment arrangement with the precise amounts of all chargeable items, including services and goods, and that a copy signed by both parties is given to the resident or the family for retention.

Annex 8.1 lists what has to be inside it. The agreement must state the home fee for that resident as an amount per month in Hong Kong dollars, the specific amounts, per month, per visit, per service or per item, for the payable items of different services and goods, the arrangement for charging a deposit, the deadline for payment and how late payment is handled, the fee arrangement for a resident who is in hospital for a long period, the arrangement for collecting or refunding payment when a resident leaves or dies, and the arrangement for adjusting fees.

The examples in the guidelines are worth reading as a checklist, because they are the items a family most often assumes are included: transport to a medical appointment, an escort to medical treatment, dressing charges, diaper fees, nutritional milk products and air conditioning. Each one has to carry an amount in the agreement rather than a description, and a home cannot answer the question with a formula instead of a figure.

Deposit, receipts and the way a fee changes

A deposit is allowed, but only on stated terms. Annex 8.1 requires the arrangement for charging a deposit to be set out in the admission agreement, together with the arrangement on discharge for the home fee, the deposit and any other fees already paid, which fees are not refundable, and the procedure for a refund.

An increase cannot arrive with the invoice. Paragraph 8.4.2 of the Code, repeated in the guidelines, states that a home should inform the affected resident or family in writing of any proposed increase in fees or charges for any service or goods, including an adjustment for inflation or for a change in the resident's health condition, at least 30 days before the effective date, and that any revision takes effect only after it is signed and confirmed by both the home and the resident or family.

Payments need a trail. The guidelines state that on receipt of payment a home shall immediately issue an official receipt bearing the name or business stamp of the home and showing the payer, the date of payment, the payee, the items of payment, the payment period and the amount paid, and that homes may encourage residents to pay by autopay so that transactions and records stay clear. Where a family disagrees with a proposed adjustment, the guidelines state that the follow up arrangement in that case should itself be written into the admission agreement.

What a home may not do when it sets or collects a fee

Two prohibitions matter more than any price comparison. Annex 8.1 states that a home is strictly prohibited from adopting a pricing method that does not specify actual amounts, and names the practices the department is concerned about: charging the whole Comprehensive Social Security Assistance payment, including the residential care supplement, as the home fee, charging a fee equivalent to the amount of assistance received, or charging a fee equivalent to the price under the Enhanced Bought Place Scheme or under the Residential Care Service Voucher Scheme. A fee has to be a figure in Hong Kong dollars.

The second prohibition protects the assistance itself. The guidelines state that a home is forbidden to draw on the long term supplement or on additional standard rate payments released to residents receiving Comprehensive Social Security Assistance in order to subsidise the home fee or service charges.

Money in a resident's bank account is restricted as well. Chapter 8 of the Code states that operators and staff should not take the initiative to handle a resident's personal financial matters such as paying home fees, and that withdrawing money from a resident's bank account to pay fees is prohibited unless the home has set up and follows a monitoring mechanism that includes a written authorisation signed jointly by the resident, the staff member concerned and a witness, records kept by a designated member of the management or supervisory staff, and accounts and receipts available for inspection at any time by the resident, family members, inspectors of the Licensing Office and the department's staff. Where a registered medical practitioner certifies that a resident is incapable of managing personal financial matters, the Code states that the operator and staff are strictly prohibited from withdrawing savings on that resident's behalf.

Bought places, assistance and a private fee

A subsidised place and a private place are different purchases. The Bought Place Scheme page of the SWD Elderly Information Website describes two routes in which the department buys places from private homes: the Enhanced Bought Place Scheme, which provides care and attention places, and the Nursing Home Place Purchase Scheme. The department's page on the Enhanced Bought Place Scheme states that the department has purchased places from private homes under that scheme since 1998 in order to upgrade service standards through staffing and space requirements, that the eligibility criteria are the same as for subvented care and attention homes, and that a place has a published monthly fee.

The practical distinction is who the place belongs to. A bought place is one the department has taken in a private home, with the fee for it published by the department. A private place at the market rate is bought directly from the home, and its fee is the home's own. The residential care home voucher scheme is a third route again, available only to a person who has been assessed for it and is on the Central Waiting List, and the types of residential care home and what each subsidy covers sets out which category of place goes with which subsidy.

Where a resident receives Comprehensive Social Security Assistance, the guidelines state that the resident or an appointed person is obliged to manage the assistance payment properly so that home fees and other charges are met, and that where the fees are not paid a home may contact the staff of the relevant social security field unit, which may then recover an overpayment or make other appropriate arrangements. Nothing here is legal or financial advice: a personal position belongs with the department and with a professional adviser, not with an article.

What to ask, and write down, before signing

A short question list prevents most of the disputes that surface months into a placement.

• Which items on the charge list are inside the monthly home fee, and which are charged on top?
• What is the amount in Hong Kong dollars for diapers, dressings, nutritional milk products, air conditioning, and transport and escort to medical appointments?
• Is a deposit required, how much is it, what part is refundable, and what is the refund procedure on discharge or death?
• What is the charging arrangement if the resident spends a long period in hospital?
• How much notice is given before a fee increase, and who signs the revised agreement?
• Is the licence displayed, and does the charge list on the wall match the amounts in the agreement?
• Does the agreement state what the home will do if the family does not agree to a proposed increase?

The admission process around the contract, and where a problem goes

Three procedural points are worth knowing before the first visit. The Code of Practice states that every resident must have a medical examination conducted by a registered medical practitioner before admission, using the prescribed form or another form approved by the Director of Social Welfare, and that where an urgent or special case makes an examination before admission impossible it must still be conducted within three calendar days after admission. It states that the rules of admission to and discharge from a home should be posted in the home's office and stated on the admission form. It also states that, under section 35 of the Regulation, an operator may discharge a resident by giving written notice to the resident and to a relative or contact person, with a notice period of not less than 30 days.

If the problem is with the paperwork rather than the care, the body that regulates the licence is the Licensing Office of Residential Care Homes for the Elderly, whose remit is licensing under Cap. 459 and whose address, telephone numbers and email address are published on that page. If a home closes, the Code requires the operator to inform the Licensing Office in writing, with a relocation plan for the residents, at least three months before closure, and to give residents and their guardians, guarantors, family members or relatives written notice at least three months before the closure.

Keep the paper. The signed admission agreement, every receipt, every notice of a fee increase and the current charge list together are the whole of the fee record, and they are what a family, the home and the Licensing Office will all work from if an amount is later questioned. The record discipline that makes an aged care file usable at all is the same discipline described in care home documentation.