Family caring for the elderly during the pandemic in Hong Kong: perspective from Confucian familism

Abstract

Purpose

The aim of this paper is to argue for the values of familial caring and relationships in addition to the provision of social media technology during the COVID-19 pandemic in Hong Kong.

Design/methodology/approach

The discussion of this paper has adopted an inter-disciplinary approach by integrating health care system and psychological analysis, based on cultural philosophical argument through the hermeneutic approach of classical texts and critical analysis.

Findings

The COVID-19 pandemic has exposed the dilemma between the public health measures for COVID-19 and sustaining elderly social psychological health through familial connection. From a Confucian perspective, the practice of filial piety (xiao, 孝), which demands taking care of parents, is essential for one’s moral formation, and for one’s becoming a virtuous (ren, 仁) person. The necessity of taking care of elderly parents by adult children is not something that can be explained in terms of consequentialism. Indeed, the rising trend of instrumental rationality seems to weaken rather than strengthen the sense of filial obligation. In the face of the COVID-19 pandemic which tends to separate connections between family members, the author argues that we should emphasize the values of familial caring and relationship because it enhances the elderly’s characteristic of resilience.

Originality/value

This paper shows that while social media technology has mitigated the negative effect of social distancing, such online relationships should never replace the bodily connections between the elderly and their family members from a Confucian perspective.

Citation

Hung, A.T.W. (2022), "Family caring for the elderly during the pandemic in Hong Kong: perspective from Confucian familism", Public Administration and Policy: An Asia-Pacific Journal, Vol. 25 No. 1, pp. 13-24. https://doi.org/10.1108/PAP-01-2022-0007

Introduction

Family support is important to elderly persons. However, the COVID-19 pandemic has exposed the dilemma between the public health measures for COVID-19 (including social distancing, quarantine and isolation) and sustaining elderly social-psychological health through familial connection.

Because of the lessons learned from fighting the severe acute respiratory syndrome (SARS) epidemic in 2003, the Hong Kong SAR Government has published the first “Guidelines on Prevention of Communicable Diseases in Residential Care Homes for the Elderly” in 2004; and these infection control measures have effectively helped residential care homes in Hong Kong in dealing with COVID-19. As a result, the COVID-19 infection rate and mortality rate are very low compared to other countries (Chow, 2021; Lum et al., 2020; Law, 2020).

However, the measures of social distancing and isolation have aggravated the existing social isolation of the elderly, seriously affecting the connection between the elderly and their family members. According to a non-profit organization known for its 24-hour Care-on-Call Service in Hong Kong, mental health problems among the elderly have increased dramatically due to isolation and anxiety during the coronavirus pandemic. The Senior Citizens Home Safety Association reported that the number of cases in which the elderly required emotional support has increased by 52 percent year on year, and the number of cases considered to be at “suicide risk” has increased by 36 percent (Wong, 2020).

This paper attempts to explore the problem of social isolation of the elderly in Hong Kong during the COVID-19 pandemic with reference to situations of other countries. It advocates the necessity of taking care of elderly parents by adult children from the perspective of Confucian virtue ethics. The author also refutes the consequentialist approach of filial obligation and argues that taking care of elderly parents is essential for one’s moral formation, for one’s becoming ren (仁). Such filial responsibility should not be considered a matter of maximizing the utilities of the whole community. With the demise of filial piety due to modernity, values of filial piety, familial caring and relationship should be re-emphasized because it enhances the elderly’s characteristic of resilience. This paper also explores the situation of online relationships through the use of social media technology during the COVID-19 pandemic. It is agreed that online communications have mitigated the negative effect of social distancing. However, such online relationships should never replace the bodily connections between the elderly and their family members from a Confucian perspective.

Social isolation of the elderly in Hong Kong

In 2016, Hong Kong’s elderly (aged 65 and above) made up 16 percent of the total population of 7.4 million. While 91.9 percent were living in domestic households, the remaining 8.1 percent were living in non-domestic households, such as residential care homes, hospitals and penal institutions, etc. As population aging continues, there has been a dramatic increase (67.4 percent higher than 2006) in the number of elderly-only domestic households (such as elderly living alone and households consisting of elderly couples only) (Census and Statistics Department, 2016). Because of having a higher risk of severe illness from the coronavirus, the elderly are advised to stay at home as much as possible; and thus, the elderly and the elderly couples living alone are most vulnerable to social isolation and loneliness.

In 2020, the HKU research team and NGO partners (JC JoyAge, n.d.) conducted a telesurvey of 8,382 senior citizens aged 60 or above. The survey found that 92.5 percent of the elderly would avoid gatherings with family and friends during the pandemic, and around one-tenth of the elderly reported symptoms of depression or anxiety. Although the rate of such symptoms remained stable as compared to previous years, the elderly’s psychological problems are generally caused by stress, health problems, and a lack of social familial engagement. The sense of isolation caused by social-distancing measures has harshly impacted those living alone; they can no longer go out freely to see their family members and friends. On the other hand, the pandemic for some elderly means that the family members stay at home longer, thus causing more conflicts.

Furthermore, in March 2021, the City University of Hong Kong (2021) conducted telephone interviews with 341 elderly people in Ho Man Tin District and found that according to the Lubben Social Network Scale (LSNS-6), the average score of local elderly people was only 9.6 out of 30 points, which was lower than the 13.6 points in 2018, that is, before the epidemic. It was also lower than 12 points of vigilance line and much lower than that of the same age group in overseas countries. This means that their risk of social isolation is extremely high which “makes them more likely to become sick, as their physical and mental health are affected”, and may finally lead to “a higher healthcare services usage rate and risk of hospitalization.”

For those living in residential care homes, while lockdown is very effective to prevent virus transmission, it causes psychological hardship for the elderly and family members. The elderly living in residential care homes experience loneliness and the feeling of being abandoned by their relatives, and at the same time, family members also have a sense of guilt (Chow, 2021). Social isolation, loneliness and depression may lead to long-term health crises at any age, and the negative effect has been shown to be magnified in the elderly (Shankar et al., 2015). These may even cause a relapse in symptoms of post-traumatic stress disorder (Wong, 2020).

Indeed, the impact of the pandemic on the elderly is not limited to Hong Kong, but also extends to the global world. Up to date, the pandemic has affected over 222 million patients in 188 countries around the world, with almost 4.6 million deaths (The Johns Hopkins Coronavirus Resource Center, 2021). This highly contagious and deadly disease has forced governments to take extraordinary measures in different countries, including declaring a state of emergency, encouraging social distancing, isolating patients and their close contacts, as well as implementing restricted access policies in social and healthcare facilities. As Delgado (2022, p. 41) states, while these policies are effective in containing the outbreak, they have also “caused patients and their relatives to suffer through the disease in isolation and family separation, even in challenging and unique moments such as end-of-life events.”

Confucian familism and elderly caring

Confucianism emphasizes the value of family relationships, and considers them as based on human natural affection. Loving one’s family and respecting the elderly are considered constitutive to one’s moral character. As Mencius (7A15) said, “What people are able to do without having learned it is an expression of original, good ability. What they know without having to think about it is an expression of original, good knowledge. There are no young children who do not know enough to love their parents, and there are none who, as they grow older, do not know enough to respect their older brothers. To be affectionate toward those close to one — this is humaneness (ren, 仁). To have respect for elders — this is rightness (yi, 義). All that remains is to extend these to the entire world” (Bloom, 2009, p. 147).

And filial piety (xiao, 孝) is considered the core of Confucianism and the foundation of social ethics. In Analects (1.2), Master You said, “It is a rare thing for someone who has a sense of filial and fraternal responsibility (xiaodi, 孝悌) to have a taste for defying authority. And it is unheard of for those who have no taste for defying authority to be keen on initiating rebellion. Exemplary persons (junzi, 君子) concentrate their efforts on the root, for the root having taken hold, the way (Dao, 道) will grow therefrom. As for filial and fraternal responsibility, it is, I suspect, the root of authoritative conduct (ren)” (Ames and Rosemont, 1998, p. 89). And in The Classic of Filial Piety, Chapter 1, Confucius said, “filial piety is the root of (all) virtue, and (the stem) out of which grows (all moral) teaching.”

According to Chinese characters, the Chinese word 孝 (xiao, filial piety) is the combination of two words: 老 (lau, old) and 子 (zi, son). The word 老 (lau, old) is on top of 子 (zi, son); it means that the son should take on the responsibility of caring for his elderly parents. Traditionally, the majority of the elderly were cared for by their family members, especially when they developed severe diseases or lost the ability to work. It was quite natural for family members to take up such responsibility because every generation of them lived under the same roof. Offspring, particularly adult sons, were responsible for taking care of their elderly parents until the end of their lives. Furthermore, the combination of the words 老 (lau, old) and 子 (zi, son) also implies that there exists a kind of unity and continuity between generations.

According to Fei Xiaotong (1998, pp. 201-202), a prominent Chinese sociologist, children are always considered by their parents to be part of themselves, i.e., the second life of themselves. Generally, the elderly are very much concerned about their family relationships; they cherish moments of getting along with their children and grandchildren. In traditional Chinese family culture, the lives between parents and children are closely connected; their dignities are very much inseparable; and both share glory and disgrace together. In short, for traditional Chinese, both parents and children are highly interdependent; they share a common identity. Thus, there are many teachings about caring for children and parents in Confucian texts. Such care is not only for the survival of family members, but also for the goal of being ren, that is, providing comprehensive care for the physical, mental and spiritual well-being of family members. Unlike Western culture, because of the value of filial piety, traditional Chinese will pursue a bi-directional caring model. Parents take care of the young, and when they have grown up and get married, they must take care of the young and their elderly parents. And when they are old, they rely on their adult children to take care of them. Based on the emphasis on traditional family values, Chinese people have a higher sense of family ties and norms of reciprocity in intergenerational relationships (Xu et al., 2007).

Criticism of the rule-consequentialist approach of filial obligations

According to William Sin (2016), we may understand the demand of filial obligations from the perspective of rule consequentialism. Sin distinguishes two kinds of filial obligations: a moderate view and an extreme view, or also called a strong view. While the moderate view morally permits adult children to stop supporting their parents after offering a substantial amount of sacrifice, the extreme view demands adult children to take care of their elderly parents and bear the sacrifice indefinitely. Sin argues that from the perspective of rule consequentialism, in the current situation of an aging population, it is more justifiable to demand adult children to take up an extreme view of filial obligations for two reasons. First, it is easier to inculcate or to internalize the moral demands to assist one’s own parents’ lives than to save strangers’ lives. As children are born with strong instincts to protect their parents, the “costs of internalizing strong filial obligations among children will be lower than what we might initially expect” (Sin, 2016, pp. 6-9). Second, as there is a much higher percentage of elderly population than that of the young in an aging population, society has a great demand for adult children to take care of their parents for a long time. This has increased the demand for strong filial piety. In this case, the benefits of promoting strong filial piety, instead of the moderate view, may exceed the costs. Parents would likely be taken care of by their children and thus may feel a stronger sense of security because they know that they will be protected from some of the worst possibilities in life. The mutual trust between two generations will also be strengthened.

Basically, leaving aside the controversies of how we should count the benefits or utilities of different approaches, we may agree with Sin’s consequentialist analysis from the perspective of policymaking. However, from the perspective of moral motivation, the underlying motivation to take care of one’s parents due to consequentialism is for the sake of social utility rather than for the well-being of one’s parents per se. Such motivation to care for one’s parents seems to be problematic and hypocritical. Consequentialists may reply that the benefits for parents and for society under a strong view of filial obligations can go together, so we do not need to separate these two in our analysis. And indeed, one of the important features of consequentialism is that it only considers the effect and utility, not moral motivation, in moral judgement. Consequentialist arguments can be compatible with Confucianism in promoting strong filial piety.

Apparently, the consequentialist argument may be compatible with the concern of Confucian filial piety when both social and parents’ benefits are aligned. However, when social utility and parents’ benefits are in conflict, consequentialism may demand adult children to forgo the duty of taking care of their parents or to take up a less demanding view of filial obligations. Indeed, Sin (2016, pp. 7-9) admits that according to rule consequentialism, we may promote weak filial obligations in society in which the percentage of young people is much higher than that of the old and thus the demand for being cared for is lower and thus adult children can have greater freedom. Sin anticipates such criticism and gives two responses. First, he defends that demographic development is not the only factor, as other factors, such as the established way of treatment of the elderly and the mode of interaction between generations, etc., will also affect the demand burden of filial obligations. Second, the aim of rule-consequentialist analysis is not to identify the deliberative factors of taking care of parents, but rather its goal is to identify the set of appropriate codes for society to adopt in the long run. The question of how to cultivate people’s moral motivation to comply with the code is left to moral education. And thus, Sin argues that his rule-consequentialist filial obligations are compatible with other non-consequentialist theories regarding filial obligations. According to Sin (2016, p. 8), these non-consequentialist theories include debt theory, gratitude theory, friendship theory and special goods theory. Sin did not mention Confucianism. However, as Confucian filial piety, to a certain extent, includes elements of the above non-consequentialist theories, it is obvious that Sin will consider his rule-consequentialist argument to be compatible with Confucianism.

Sin’s second response seems to assume that the justification of policymaking and reasons given in moral education can be separated. However, in an open society, people usually deliberate policy publicly. The idea endorsed in the justification of policy, when it becomes the dominant political ideology, will inevitably gradually permeate through the people, and thus will shape people’s attitude and moral motivation regarding filial obligations, including the way of interaction between adult children and elderly parents, which is the “other factor” mentioned in the first response above. It is unconvincing for the government to demand citizens to take care of their elderly parents simply for the sake of parents’ well-being without considering the social utility while the justification of policy is simply based on the maximization of social utility. It is hypocritical to have two different sets of justifying reasons between the social moral code and that given in moral education, and in particular social utility and parents’ benefits may be in conflict in certain circumstances as discussed.

Moreover, Sin’s defenses of the strong view of filial obligations cannot really respond to worries caused by rule consequentialism. In principle, it is still possible that in certain circumstances, a weaker version of the filial obligation is justified rather than a strong version. It is also possible to imagine that, in certain circumstances, giving up the duty of caring for one’s parents in order to pay more attention to taking care of younger children would better benefit the long-term development of the whole society. Indeed, if we simply consider the criteria of the maximization of social wealth and productivity, it seems to be justifiable that the benefits of using resources to nurture young children outweigh that of caring for elderly parents because there are still many different possibilities for young children to contribute to society in the future, while the elderly will inevitably become weaker, and their productivity will gradually decline. This also exposes the dilemma of the theory of consequentialism. While consequentialism requires us to count the interests of every individual equally, in reality, the potential contribution of young children will generally be much higher than that of the elderly. This means that when resources are limited, in most circumstances, it is justifiable to offer young children more resources and caring at the expense of elderly parents’ well-being. In the face of the problem of an aging population, to offer and promote to the elderly varieties of easy access to euthanasia, to let the elderly die earlier, “voluntarily” and “peacefully,” seems to be a more effective way to deal with the problem and more beneficial to the development of the whole of society rather than providing long-term care by their children from the consequentialist perspective.

Indeed, there is a relevant debate between Dave Archard and Arthur Caplan (2020) about “Is it wrong to prioritise younger patients with Covid-19?”. While Archard argues that it is discriminatory to use age to decide who should receive potentially life-saving treatment, Caplan argues that when rationing is inevitable, age is a morally relevant factor in deciding who gets care because there is a diminishing chance of survival with increased age. It seems that based on consequentialist rationality, to prioritize younger patients instead of the elderly in the healthcare system is inevitable. And that is why Kevin Connolly, when seeing the elderly die without sufficient medication during the COVID-19 pandemic in a U.S. nursing home and his father-in-law who lived in the facility also die, would say, “We have limited resources to battle this disease, and I think somebody somewhere decided that this population of people wasn’t worth wasting resources on” (Abrams, 2021).

Obviously, Confucianism would not agree with consequentialist analysis of filial obligations. Confucianism is a kind of virtue ethics. For Confucians, to respect and take care of elderly parents is what one should do. It is expressing one’s moral character as being ren. While Confucians may not reject the consideration of utility in determining how one can better take care of one’s parents and other family members, they would reject the consideration of the necessity of filial obligations (yes or no, or to what degree) simply based on its social utility.

Blind obedience and the demise of filial piety

However, the upholding of filial piety by Confucianism in the past was harshly criticized by scholars during the May Fourth Movement (1919) as promoting foolish filial piety (YuXiao, 愚孝) and blind obedience to parents. Lu Xun has drawn several examples from the Twenty Four Acts of Filial Piety to show that certain filial acts that had been praised were actually absurd and superstitious (Huang, 2019). In the face of criticism of foolish filial piety, the author has two responses. First, such an extreme view of foolish filial piety does not conform with the teaching of Classical Confucianism. Indeed, Confucius, in the Xiaojing, Chapter 15, asks his students to remonstrate with their parents’ wrongdoings, as he says, “if a father has a son who will remonstrate with him, he will not behave reprehensively (buyi). Thus, if confronted by reprehensible behavior on his father’s part, a son has no choice but to remonstrate with his father… remonstrance is the only response to immorality. How could simply obeying the commands of one’s father be deemed filial?” (Rosemont and Ames, 2009, pp. 113-114).

Second, the rise of blind obedience to parents in the past was partially caused by sons’ and daughters’ ignorance and their high reliance on their parents, regarding their economic, social life or education. Nowadays, in modern society, children usually acquire their education from schools and work outside the family when they have grown up, so the elderly have lost much of their traditional authority, leading to what Yunxiang Yan (2003, pp. 173-189), an anthropologist, calls, “the demystification of parenthood and filial piety.” Thus, there is no reason to believe that those who are brought up in modern society would likely fall into the kind of blind obedient, foolish filial piety again. On the contrary, Yan observes that with the development of the market economy, society is becoming more and more individualized. Traditional filial piety has gradually declined even in Chinese villages. Many elderly people complain that their sons no longer respect them; some would even ignore them. Their grandsons also dislike them for having an old person smell and refuse to eat together with them. Although adult children still think that they should support their parents, they no longer think that their parents’ nurturing of them was out of a great kindness and thus children must repay them throughout their lives. Rather they believe that a child is born without a choice, and once children are born, it is parents’ responsibility to nurture their children. They also need to raise their own children. Some even complain that their parents do not help them to get married gracefully and glamorously, or that their parents are partial to other children and are not fair towards them, so they reduce their support for their parents. Therefore, it seems that instead of worrying about the potential problem of blind obedience caused by filial piety, we should rather worry about the decline of the value of filial piety, thereby reducing the care of elderly parents by adult children in modern society. And it seems that the increasing trend of instrumental rationality – the mindset of calculating utilities, driven by modernity and market economy – has actually weakened, rather than enhanced, people’s sense of their filial obligation. Thus, what is needed in modern society is to enhance people’s attention to the value of filial piety, and thus the elderly can receive appropriate care from their family members.

Resilience and the COVID-19 pandemic

Apart from the above argument of moral motivation, this paper also argues that such values of parent-children mutual support, familial caring and relationship should be emphasized in the face of the COVID-19 pandemic which tends to separate connections between family members, because familial caring and relationships are highly related to one’s character of resilience. Resilience is defined as the capacity to recover from difficulties. It refers to one’s ability to withstand adversity and bounce back and grow in the face of adversity. However, COVID-19 presents unique challenges because people are physically distancing themselves from each other, and social connections, as a key factor in enhancing resilience, have become difficult (Richards and Dixon, 2020).

A survey conducted by Zhuang et al. (2021) in Hong Kong shows that although about one-third (30.6 percent) and one-tenth (11.5 percent) of the respondents reported that a moderate or severe level of psychological distress due to financial problems, family members’ mental-emotional problems and addiction problems under the influence of COVID-19, as well as family support and community resources can be an important protective factor that fights against risks and adversities with positive outcomes. Moreover, family support and family leisure activities can positively contribute to family members’ mental health. Family leisure activities in which pats and children can spend time together in recreational activities can create a sense of rhythm within the family and cultivate the inner confidence to cope with unpredictable changes (McCubbin and McCubbin, 1988). This finding is consistent with previous studies, showing that family cohesion, integration, intimacy, and relationships are important protective resources for individual mental health in the face of stressful situations, such as earthquakes (Cao et al., 2013) and health-related epidemics, such as SARS (Main et al., 2011).

As Zhuang et al. (2021, p. 2319) state, “Family support was found to be the strongest mediator of the negative influences of COVID-19-related stressors on psychological distress. The results imply that even though the families are negatively influenced by life stressors, support, such as alliance, feelings of belongingness, guidance and reassurance of personal worthiness provided by family members, is an important family factor that can facilitate family members’ positive adaptation in the face of stressful situations. It is suggested that family members with the common belief of ‘being in it together’, can collectively share difficult feelings, maintain connectedness despite heightened family stress. Regarding family leisure activities, our findings suggest that it exerted an indirect protective effect through improving family support, which then led to better family functioning. Essentially, everyday low-cost leisure activities can provide a safe and positive context in which family relationships can be enhanced and feelings of family connectedness and integration to be increased. In turn, this may contribute to better psychological health.”

Technology during the COVID-19 pandemic

In response to the problem of social distancing during the COVID-19 pandemic, information and communication technology has been heavily used to mitigate these negative effects, providing individuals with many digital alternatives to daily activities that can no longer be completed normally. Indeed, the use of technology in hospitals or residential care homes can help to achieve what Delgado (2022, p. 47) calls “synchronous communication” between the patient and his/her family or the family and the healthcare team. It helps the healthcare team to provide adequate timely information and open communication with family members of critically ill patients. In particular, when important decision-making is involved, social media technology helps family members know the patient better and communicate with the patient and the healthcare team in order to set a better therapeutic goal. The video conference provided by the healthcare team can also shorten the distance between patients and family members, and facilitate emotional connection through facial expressions and nonverbal communication. Nowadays, the use of technology, such as smartphones, tablets, personal computers with SKYPE, ZOOM, TEAMS or chat tools, to stay connected with family members and friends has become an important way to fight against these negative effects caused by prolonged isolation and loneliness. Online lectures and academic conferences have also become the new normal in many institutes.

In Hong Kong, information and communication technology is also increasingly used during the COVID-19 pandemic. For instance, some professional services, such as occupational therapy services for people with dementia, and visits by family members in the residential care homes are facilitated by information technology. Regarding the community care services, while most services provided by day care centers for the elderly have been suspended, staff still contact center members to provide social and emotional support over the phone on a regular weekly basis. Some NGOs also offer remote activities and counseling to the elderly with dementia through video links. Local telecommunications companies have sponsored and partnered with a number of NGOs to provide video calls in lieu of physical visits to nursing homes, encouraging families and friends to provide elderly residents with spiritual comfort (Wong et al., 2020).

However, while technology may have greatly mitigated the negative effects in the general population, the situation in the elderly population is more complicated. Compared with young people, the ability of old people to acquire and use technology is much lower. For those elderly people who live alone without technical assistance, they cannot benefit from the advancement of technology. Van Jaarsveld (2020, p. 7) calls such long-standing uneven technology acquisition and skill distribution “the digital divide”; and such gap will continuously increase as the rate of technological innovation speeds up. While the problem of the digital divide is not new, its seriousness has been magnified and has become obvious because of the pandemic which has already caused so many elderly to suffer the negative effects but are unable to acquire help from technological achievements. Thus, Van Jaarsveld (2020) argues that it is necessary to pay more attention to and inject more resources into improving the elderly’s digital literacy.

In Hong Kong, because of the increasing use of information technology due to the COVID-19 pandemics, the digital divide may have been narrowed down. However, the divide is still serious. According to the recent survey conducted by the City University of Hong Kong (2021), only 70 percent of elderly aged 80 or below and 28 percent of the elderly over aged 80 use smartphones. The use of smartphones is still not so popular among the elderly in Hong Kong which makes them less connected with relatives and friends and might be one of the reasons for exacerbating isolation. Regarding the use of information technology for medical consultations, only 20 percent of the elderly are confident in using video calls for medical consultations; 80 percent still prefer face-to-face consultation.

According to Van Jaarsveld (2020, p. 3), “research suggests that the main determinants of this divide are low motivational access, and a general skills deficit. A recent study showed that elderly individuals who reported disliking technology mainly attributed this to the belief that it was inconvenient, or that the costs outweighed the benefits. The task of closing the digital divide therefore becomes an issue of not only improving elderly access to technology, and offering skills training so they can develop digital skills, but also implementing programs to increase the elderly population’s motivation to use technology, and better understand the benefits it can offer.”

Thus, Van Jaarsveld (2020, p. 4) suggests both short-term and long-term goals for enhancing digital literacy among the elderly. In the short term, governments and care homes should provide digital resources to the elderly and take measures to ensure that they are aware of the resources available online during this pandemic. In the long term, governments should aim at reducing the digital divide between older and younger populations, they should take the opportunity to implement digital literacy programs for the elderly, increase their motivation to use technology, and enhance their digital skills.

Confucianism and online relationships

Some critics think that Confucianism is old school and outdated, which will reject technology and online relationships. Some scholars even criticize Confucianism for emphasizing Tian/Dao, family relationships and cultural values that are unfavorable to technological advancement (Deng and Ma, 2013). It is true that Confucianism emphasizes spiritual and moral character more than the innovation of technology and instruments. As Confucius said, in Analects, 2.12, “Exemplary persons (junzi) are not mere vessels.” (Ames and Rosemont, 1998). And in the Book of Changes, it is written that Dao is metaphysical, while vessels or instruments are only physical (Legge, 1899). It is also true that Confucianism is cautious of overemphasis on technological advancement which may inhibit one’s spiritual-moral cultivation and relationship development (Tang, 2008). However, Confucianism does not reject technology per se. Sun Junhong’s (2007) exploration of Pre-Qin Confucianism shows that the emphasis on respecting Dao, learning and appropriate application by Confucianism made a profound contribution to the development of ancient Chinese science and technology. In particular, if the use of technology can enhance one’s caring for family members, there is no reason that Confucianism would reject it.

Basically, the author agrees that technology can mitigate the psychological problems caused by the COVID-19 pandemic, along with the measures to enhance the elderly digital literacy. However, such “online relationship” is not enough. From a Confucian perspective, such an online relationship is still too disengaged and disembodied. Confucian understanding of human nature is always an embodied self. For Confucianism, one’s moral cultivation (Xiushen, 修身) and experience (Tiyan, 體驗) always involve one’s body (Shenti, 身體). One can never truly acquire knowledge, know others, and establish a meaningful relationship in a detached, disembodied mode (Hung, 2013). Thus, to achieve effective communication and emotional connection, technology alone is not enough; certain creative measurements and procedures must be initiated and set up so that the elderly can keep experiencing the bodily connection with their family members.

Hong Kong long-term care services provided by the Social Welfare Department includes two streams: (1) Community Care Services (including Integrated Home Care Services, Enhanced Home and Community Care Services, and Day Care Centre / Unit for the Elderly); and (2) Residential Care Services (including Home for the Aged, Care and Attention Home, and Nursing Home). Community Care Fund also provides a monthly allowance of HK$2,400 to subsidize caregivers of low-income families. Community Care Services are basically based on the principle of “ageing in place” which is in line with Confucian familism while Residential Care Services are considered a backup only. However, as Chung (2015, p. 5) argues, the reality is that there exists a great and increasing demand for Residential Care Services. This phenomenon shows that the provision of current home care services is insufficient. Thus, even though the policy direction is to encourage “Aging in Place” and home-based elderly care, the gap between policy formulation and implementation makes home care difficult to achieve. Hence, there is still much room for improvement in promoting “Aging in Place”. Furthermore, even if the elderly are living in their domestic households, they can easily be isolated from their family members during COVID-19 pandemic if they live far away from their children. And Community Care Services can never replace the support and care from their family members. Thus, the government should advocate the values of filial piety and the responsibility of adult children to take care of their parents and encourage them to live with or near their parents; and it may be promoted with the support of certain policies.

Conclusion

Family support is important to elderly persons. The restrictions imposed by the COVID-19 pandemic should not reduce our familial caring and relationships. From the perspective of Confucian familism, caring between family members becomes even more important especially for the elderly in the situation of a pandemic. Such caring of elderly parents is not simply out of consideration of social utility, but it is a kind of Confucian moral demand and an expression of a person as being xiao and ren. With the decline of the traditional family values in modern society, there is a necessity for promoting the value of filial piety so that the elderly can receive appropriate care from their family members during the pandemic. And the healthcare system and its professionals must adapt to new situations and achieve innovation, not only by using technology, but also by finding ways or measures to maintain human bodily familial connections as a key factor in providing the best and holistic care for patients and their families.