INTRODUCTIONMedia coverage of a local residential care home leaving its elderly residents “naked on rooftop before taking a shower” (SCMP, 26 May 2015) has aroused much public concern about the quality of care delivery for the elderly and management of long-term care (LTC) service enterprises. In view of the mistreatment of elderly, a review on relevant legislations has been conducted to remedy the situation. Besides, this also makes room for examining the role of corporate social responsibility (CSR) in LTC enterprises in Hong Kong, particularly how CSR might help enhance overall care delivery through reinforcing various aspects of responsibility that a company should assume in business operation.

Besides, Hong Kong has been facing serious problem of aging population in the recent decades. The proportion of the population aged 65 and over (the elderly) would rise remarkably. This would be coupled with long life expectancies, low fertility rate, as well as worsening of elderly dependency ratio. This alarms the service quality of the public health care sector but may open opportunities to the private health care sector, in particular long-term service providers.

Care provision relies on resources, quality, and responsibility of the service providers. Long-term care (LTC) services are complex and may vary with characteristics of clients, content of services, and the physical environments. LTC services face challenges such as health status of citizens, demographic trends, availability of resources, and priority of their use. In recent years, there is increasing discussion on the quality of LTC, ethics, and social responsibility.

Corporate social responsibility (CSR) is now a popular concept but its meaning is still evolving. Based on the socioeconomic view, corporations should also serve public or social purposes; their managers need to go beyond profits and improve society’s welfare. Although there are mixed results for the relation of CSR and firm performance, LTC service providers can learn from principles of CSR, drivers for CSR, its implementation issues, as well as best practices for improvement. While sustainability has now become a common strategic goal for many private enterprises, LTC service providers need to understand CSR frameworks and their application in the industry.

To explore CSR in Hong Kong’s LTC industry, this chapter aims at (1) evaluating the current profile of the LTC industry in Hong Kong and the difficulties faced by LTC service providers; (2) understanding on CSR among LTC service providers in Hong

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Kong; and (3) evaluating the current CSR practices among LTC service providers in Hong Kong against internationally recognised CSR standards, and (4) providing managerial and policy recommendations which could serve as sustainable solutions in the midst of aging population, while fostering better business practices among LTC enterprises in the CSR context.

AGING POPULATION AND RISING NEEDS FOR LONG-TERM CARE IN HONG KONGHong Kong has been facing serious problem of aging population in recent decades. The Hong Kong resident population was 7.32 million at end-2015 (Census and Statistics Department, 2016a) and it was projected to increase to 7.81 million in mid-2064. The proportion of the population aged 65 and over is projected to rise markedly from 15% in 2014 to 33% in 2064. Correspondingly, the median age would rise from 42.8 in 2014 to 51.0 in 2064. Since the elderly have the heaviest demands on health and social services (Chi & Chui, 1999), the public and private healthcare service providers need to plan ahead. The elderly are more prone to chronic diseases and in need of services that can cater for their need on amore regular basis, such as LTC for the elderly. While Field et al. (2013, p. 17) sees the needs for worldwide collaboration to effectively deal with an aging global population, the Hong Kong government has to tackle local problems by itself.

Hong Kong becomes famous for the long life span of its citizens. Life expectancies for male and female Hong Kong citizens were 81.2 and 87.3 respectively in end-2015 (Census and Statistics Department, 2016c) while the corresponding projected figures would be raised to 87.0 and 92.5 in 2064 (Census and Statistics Department, 2016b, p. 54).

Hong Kong also has low fertility rate (number of life births per 1,000 female population). Hong Kong’s total fertility rate was 1,195 in end-2015 (Census and Statistics Department, 2016c) but its projected figure in 2064 would be decreased to 1,182 which would be lower than Japan, Sweden, Australia, United Kingdom, and the United States (Census and Statistics Department, 2016b, p. 48). This 2064 projected figure is only slightly more than half of the replacement level of 2,100 estimated by the Hong Kong government (Chief Secretary for Administration’s Office, 2016, p. 36). Caldwell (2004) sees the great impact of low fertility on the age structure of societies in various countries.

The dependency ratio, in particular the elderly dependency ratio, of the Hong Kong

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population has been worsening. The elderly dependency ratio (i.e. the number of persons aged 65 and over per 1,000 persons aged between 15 and 64) were 198 and 567 in 2014 and 2064 respectively. That is, this ratio increased by 2.86 times in 50 years. Such increase contributes to the increase of overall dependency ratio of the population from 348 in 2014 to 716 in 2064 (Census and Statistics Department, 2016b, p. 6).

Healthcare differs from other industries because the supplier (i.e. the physicians) has the power to determine demand; this lead to asymmetric information and uncertainty regarding the quality and outcomes of products and services (Mahar, 2006, pp. 1-2).The healthcare industry was criticised for including charges that the industry markets drugs for off-label use, pushing insured patients toward unnecessary and expensive procedures, and prices healthcare services and medication unaffordable for many people (Argenti, 2016, p. 174).

The health care system in Hong Kong is dissected into the public and private sectors (Hong Kong Government, 2016). In the private health care sector, primary health care is mainly operated by medical centres, private practitioners, and private Chinese (herbal medicine) practitioners. Medical centres operate with the support of private practitioners and have been taking increasing importance in the private health care sector of Hong Kong.

Based on Hong Kong’s demographic profile and trends, the government and private health care service providers, especially long-term care service providers, need to be aware of health care policy and service planning.

LONG-TERM CARE SERVICESWhat are Long-term Care Services?Governments in both the developed and the developing world face the challenge of ensuring the quality and financial stability of care provision (Mor et al., 2014). Sharing of best practices allows nations to learn from each other in designing systems of care that support citizens’ health and well-being (Applebaum et al., 2013).

From the individual perspective, long-term care (LTC) is associated with physical and/or mental deficits that limit one’s ability to do regular daily tasks (Singh, 2016, p. 4). LTC is complex system which covers broad areas (Prince et al., 2013, p. 5). LTC provides services to the most vulnerable individuals in society and demand various regulations (Singh, 2016, p. 102). LTC involves a variety of services, including

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medical and nonmedical care, provided on an ongoing basis to people of all ages who have a chronic illness or physical, cognitive, or developmental disabilities (Touchy & Jett, 2016, p. 427). LTC can be provided in a range of environments, including an individual’s home to hospice (Applebaum et al., 2013). Long-term care facility, or nursing home, refers to a residential institutional setting for people who need assistance with several activities of daily living (Hirst et al., 2015, p. 85).

In recent years, there is increasing attention to quality of care in long-term care settings; such settings address ethical issues by establishing policies and procedures that are based on best practices (Hirst et al., 2015, pp. 149-150). The provision of quality health care to the most frequent users of LTC can be achieved when nurses acquire knowledge and skill that carefully follows prescribed educational standards (Sullivan-Marx & Gray-Miceli, 2008, p. 4). Patient care delivery in LTC requires a multiskilled team approach (Sullivan-Marx & Gray-Miceli, 2008, p. 41). The delivery of patient care under the LTC system is often accompanied by the incorporation of various competing values which share some similarities with CSR, such as autonomy, justice, beneficence (doing good), and nonmaleficence (doing no harm) are the competing values in long-term care (Gamroth et al., 1995, p. 16), that serve as some guiding principles for a socially responsible care delivery. With an increasing attention to quality of care in LTC and demographic change of LTC consumers (Pratt, 2010, p. 454), policies and procedures based on best practices are established to help address ethical issues in relation to managing LTC services (Hirst et al., 2015). Nurses also acquire knowledge and skill that carefully follows prescribed educational standards (Sullivan- Marx & Gray-Miceli, 2008).

LTC services face serious future challenges: (1) health status of citizens, including prevalence of disability in the population; (2) birth and mortality rates; and (3) availability of financial resources and priority of their use (Singh, 2016, p. 39).

Overview of Long-term Care Services in Hong KongLTC in Hong Kong aims to provide care for the elderly with disabilities and chronic health problems (Lou, 2014, p. 17). LTC in Hong Kong has been shaped by the rapid ageing population and the effect of rapid change in family structures and support (Leung, 2002, p. 156). Hong Kong needs to identify key drivers of LTC spending and develop relevant policy interventions (Chung et al., 2009).

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LTC in Hong Kong has largely been based on the principle of ‘aging in place’ or ‘aging in the community’ (Lou, 2014, p. 17; Chan & Pang, 2007, p. 402; Kwong & Kwan, 2002, p. 76). Chan & Pang (2007, p. 401) found that ‘aging in place’ and family care were considered as the best approaches to LTC which could help to balance the values of dignity, family integrity and social sustainability.

LTC services are provided by various providers in Hong Kong, including both public, non-governmental organisations (NGOs), and private providers (Chung et al., 2009). Services cover two categories: (1) residential care and (2) community care (i.e. non-residential care) (Table 1).

Table 1. Long-term care services for the elderly in Hong Kong

Community Care and Support

Services

Community Care Services1. District Elderly Community Centre(s)2. Neighborhood Elderly Centre3. Social Centre for the Elderly4. Holiday Centre for the Elderly5. Day Care Centre/ Unit for the Elderly6. Enhanced Home and Community Care Services7. Integrated Home Care Services

Community Support Services1. Support Teams for the Elderly2. Carer Support Service3. Opportunities for the Elderly4. Home Help Service

Residential Care Services

1. Hostels for the Elderly2. Homes for the Aged3. Care and Attention Homes for the Elderly4. Nursing Homes (and the Nursing Home Place

Purchase Scheme)5. Contract Homes6. Private Homes (Bought Place Scheme and Enhanced

Bought Place Scheme)Source: Social Welfare Department (2016b)

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In Hong Kong institutional care for LTC services has traditionally been mostly provided by the public or non-profit sector, the latter directly subvented by the former (Chung et al., 2009). Later, private sector also provides residential care services for the elderly on either self-financed basis or through Enhanced Bought Place Scheme introduced by the government (Kwong & Kwan, 2002, p. 79) to provide the same on subsidized rates. However, the enormous demand for residential care services has yet to be met (Chu & Chi, 2006). Both residential care services and community support services get public funding; however, financing arrangements for the public, not-for-profit sector, and private (for profit) sector are different (Chi, 2002, p. 144). Community care services include social centres for the elderly, multi-service centres, day care centres, home-help teams, as well as home-care teams; residential care services include hostels, homes for the aged, combined homes, care-and-attention, as well as nursing homes. According to Yuen (2012), community long-term care in Hong Kong is provided predominantly by non-governmental organisations (NGO’s) receiving funding mostly from the government, supplemented by donations and users fees.

Residential facilities are preferred because they provide 24-hour care with multi-disciplinary professionals (Lou, 2014, p. 17). Private for-profit homes got public funding through a “bought places” scheme if they meet the quality requirements (Chan & Pang, 2007, p. 405; Kwong & Kwan, 2002, p. 79). Both the older person and his or her family caregivers should be treated as service targets (Lou, 2014, p. 21).

Provision of LTC services in Hong Kong faces at least two imbalances: Imbalance between home care and residential care in terms of volume and government expenditure ‐ high institutionalization rates; over‐reliance on publicly funded (tax-based) provisions ‐ imbalance between public and private LTC services (Chi et al., 2011). These imbalances have posed considerable challenges to LTC industry in Hong Kong.

The LTC system in Hong Kong is imbalanced since it depends heavily on residential care (Cheng et al., 2013, p. 527). As at end-March 2016, Hong Kong had 73,595 residential care places, including: (1) 41,717 places in private homes (57% of the total), (2) 18,764 places at subvented, self-financing and contract homes (subsidised places)(25%), (3) 7,999 places at places under Enhanced Bought Place Scheme (EBPS)(11%), and (4) 5,115 places at self-financing and contract homes (non-subsidised places)(7%) (Social Welfare Department, 2016a). Most LTC services are

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financed by the government through the following means: direct subvention to nonprofit provides, buying beds from for-profit providers, or indirect financing to the for-profit sector when the elderly use welfare benefits to pay for stay at nursing homes (Cheng & Chan, 2003).

Both the government and service providers from public, non-governmental and private sectors face a number of issues related to LTC. The issues mentioned below is not exhaustive yet still reveal general problems and challenges of LTC industry in Hong Kong, as well as open potential opportunities for private services providers to achieving better quality and socially responsible service delivery.

Singh (2016, p. 39) reveals that the LTC services is now facing serious challenges. They are (1) health status of citizens, including prevalence of disability in the population; (2) birth and mortality rates; and (3) availability of financial resources and priority of their use. Other literatures also discuss the challenges and problems of LTC industry in general. They are summarized as the following: (1) inadequate services to meet the demands, poor service matching, and no prioritisation of service recipients (Lou, 2014, p. 17; Chi, 2002, p. 147; Kwong & Kwan, 2002, p. 78); (2) poor service coordination; (3) no standardised assessment or referral criteria among providers (Leung, 2002, p. 164); (4) poor integration among different service sectors; (5) no quality control over services (Chan & Pang, 2007, p. 421; Leung, 2002, p. 164); (6) limitations in funding sources and questionable affordability (Chan & Pang, 2007, p. 422; Chou et al., 2005, p. 87; Chi, 2002, p. 148), including absence of LTC insurance coverage (Chi, 2002, p. 142; Leung, 2002, p. 164); and (7) weakening family care for the elderly (Leung, 2002, p. 164). Later sections of this book chapter would explore the challenges and problems faced by LTC service enterprises in Hong Kong.

FROM SOCIAL RESPONSIBILITY, CORPORATE RESPONSIBILITY TO CORPORATE SOCIAL RESPONSIBILITYSocial ResponsibilityBased on the classical view of social responsibility, Milton Friedman argued that managers’ primary concern is to operate the business in the best interests of the stockholders whose primary concerns are financial (Friedman, 1970, p. 13). Political scientist Robert A. Dahl (1972, p. 18) states that every large corporation should be thought of as a social enterprise which also serves public or social purposes. However, based on the socioeconomic view, managers need to go beyond making profits to include protecting and improving society’s welfare (Robbins & Coulter,

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2016, p. 184).

Businesses have been facing increasing pressure for social responsibility in recent decades. Other than creating wealth, business must serve society and contribute to social needs and satisfying social expectations towards business (Crane et al., 2008, p. 49). Business and society exist and operate in a shared environment, firms should be socially responsible (Crane et al., 2008, p. 53). Drucker (2008, pp. 213-214) argues that social responsibilities emerge either out of the social impacts of the institution or arise as problems of the concerned society. Management is responsible for an institution’s social impacts. Ihlen (2013, p. 208) promotes that “it is expected that companies do and will behave ethically” (italics in original).

Lussier (2017, p. 51) states that socially responsible companies should provide safe products and services with value to customers and improve the quality of life for the society. Customers are particularly susceptible to CSR initiatives (Bhattacharya & Sen, 2004). Robbins & Coulter (2016, p. 187) advises managers need to consider social issues and goals as they perform managerial roles. Businesses are viewed as creators of value that they can share with society in a mutually beneficial relationship (Dess et al., 2012, p. 21).

Social responsibility of business comprises of economic, legal, ethical, and discretionary expectations that society has of organisations at a given point in time (Carroll, 1979, p. 500) while Crane et al. (2008, p. 42) views social responsibility as having ethical, moral, and business components. Lussier (2017, p. 50) defined social responsibility as a conscious effort to operate in a manner that creates a win-win situation for all stakeholders. Robbins and Coulter (2016, p. 184) defined social responsibility as a business’s intention, beyond its legal and economic obligation to do the right things and act in ways that are good for society. Montana and Charnov (2015, p. 45) defined social responsiveness as the extent to which an organization is responsive to perceived social obligations. A socially responsible enterprise has better access to key resources, such as creative employees, whose behaviour and qualifications are fundamental for the success of the innovative projects (Firszt, 2015, p. 116). Drucker (2008, p. 216) argues that the most significant opportunities for converting social problems into business opportunities may lie in social innovation that benefits and strengthens the company or the industry. It is believed that the concept of social responsibility is also applicable to private health care service enterprises.

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Social entrepreneur is an individual or organisation that seeks opportunities to improve society by using practical, innovative, and sustainable approaches (Robbins & Coulter, p. 203). Grimes et al. (2013, p. 460) view social entrepreneur as a social responsibility initiative that uses market-based methods to solve social problems. Compassion encourages social entrepreneurship and is viewed as a prosocial motivation that connects the individual with a suffering community and triggers sensitivity to the pain and needs of others (Miller et al., 2012). Kroegner & Weber (2014) found that there are increasing numbers of social entrepreneurs who combine concern for social issues with desire for financial rewards.

Corporate ResponsibilityThe term “corporate responsibility” has been gaining prominence. According to OCED (2016), corporate responsibility involves the search for an effective “fit” between businesses and the societies in which they operate. Corporate responsibility refers to the actions taken by businesses to nurture and enhance this symbiotic relationship – businesses and the societies. Corporate responsibility is the manifestation of a corporate’s social and environmental obligations to its society (Argenti, 2016, p. 2). ESG, which stands for “environmental, social, and governance,” is also used to describe corporate responsibility initiatives (Argenti, 2016, p. 4). Porter and Kramer (2006) argue that corporate responsibility is a strategy that can enhance a corporation’s competitiveness, producing maximum social benefit and business gains.

Other than fulfilling all formal and legal requirements, responsible enterprises also need to include bigger investments in human resources, environmental protection, and relations with stakeholders (Woźniak, 2015, p. 52). Health care service enterprises which supply health care goods and services also carry corporate responsibility.

CORPORATE SOCIAL RESPONSIBILITYDefinitions of CSRThe term corporate social responsibility (CSR) is easily and commonly understood but difficult to encapsulate in a definition (Amaeshi et al., 2013, p. 27). CSR has been regarded as a popular concept among businesses, policymakers, and academics (Petersen, 2006). However, interest in CSR may be contributed by power business behaviours towards customers, unfair treatment of employees, as well as ignorance of consequences of organisational actions (Aras & Crowther, 2012, p. 64).

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However, the concept of CSR is neither unanimous (Crane et al., 2008, p. 47) nor there is an embracing definition (Van Marrewijk, 2003). CSR is a dynamic and holistic notion that conveys a wide variety of meanings in different contexts (Camilleri, 2016, p. 22). CSR is a fluid concept; it is both a means and an end (Chandler & Werther, 2014, p. 9). The nature and meaning of CSR are still evolving (Okpara & Idowu, 2013, p. 4). CSR varies across industries, cultures, firms, and even among individuals (Sievänen, 2013). CSR is a contestable concept term or issue (O’Riordan & Fairbrass, 2008, p. 746; Windsor, 2006). CSR is an emotionally loaded and vague concept (Balcerowicz, 2015, p. 15). The word “social” within CSR gives the impression that it is good by definition (Aquinis & Glavas, 2012). A commonly accepted definition of the CSR concept is still outstanding (Brammer et al., 2012, pp. 8-9). The imprecise definition of CSR is one of the limitations of the concept (Karnani, 2011).

It is also difficult to differentiate what organisations are doing for business reasons or social reasons (Crane et al., 2008, pp. 20-21). Management theorist Peter Drucker (1984, p. 64) was skeptical on businesses that turn a social problem into economic benefit, productive capacity, human competence, well-paid jobs, and wealth.

In his landmark book, Bowen (1953, p. 6) defined CSR as the obligations of businessmen to pursue those policies, to make those decisions, or to follow those lines of action which are desirable in terms of the objectives and values of the society. Carroll (1979, p. 500) defined CSR as the social responsibility of business encompasses the economic, legal, ethical, and discretionary expectations that society has of organisations at certain time. The European Commission on CSR defined CSR as “the responsibility of enterprises for their impacts on society” (European Commission, 2011). Daft & Marcic (2017, p. 159) defined CSR as the management’s obligation to make choices and take actions that will contribute to the welfare and interests of society, not just the organisation. CSR is an umbrella term for exploring the responsibilities of business and its role in the society (Filatochev & Nakajima, 2014; Scherer & Palazzo, 2007). CSR refers to socially and environmentally friendly actions not only required by law, but going beyond compliance (Crifo et al., 2014). Visser (2011) defined CSR as the way in which business consistently creates shared value in society through economic development, good governance, stakeholder responsiveness and environmental improvement. Woźniak (2015, p. 50) views CSR as a management strategy which aims at using the non-financial capital and the integration of development processes in intra- and inter-organisational dimensions.

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Drivers of CSRNeergaard & Pedersen (2003) identifies three groups of motives for CSR: instrumental, institutional, and emotional. Some companies are motivated by market potentials to build a socially responsible image (Pedersen, 2007). Some CSR motives are driven by personal views and beliefs (Hemingway & Maclagan, 2004; Bansal & Roth, 2000; Judge & Douglas, 1998; Baden et al., 2009). Swanson (1995) identifies three CSR motives: delivering operational excellence – in terms of profitability, return on investment, and sales volumes; negative duty motivation – conformance to stakeholders’ expectations; internal self-driven motivation – presence of CSR orientation and ethos. CSR strategy constitutes a part or the company strategy due to dynamic changes, more intense competition, and the need to increase efficiency of economy activities (Filek, 2015, p. 35). Companies in Asia have been engaged in CSR practices for their business reputation as a good citizen (Chapple & Moon, 2005).

It would be useful to examine whether the motives on CSR for health care service enterprises would be different from their counterparts in the other business sectors.

Principles of CSRAras & Crowther (2012, pp. 67-70) proposed three principles of CSR: (1) accountability – organisations assume responsibility for the effects of their actions; (2) transparency – open reporting and disclosure of pertinent facts; and (3) sustainability – present actions have options available in the future.

Lussier (2017, p. 52) proposes that managers can choose to operate the business at one of the three levels of CSR: (1) legal CSR – focus on maximising profits while obeying the law; (2) ethical CSR – focus on profitability and going beyond the law to do what is right, just, and fair; (3) benevolent CSR – focus on profitability and helping society through philanthropy.

Benefits of CSRAcademic studies shown mixed results for the relation of CSR and firm performance (Cunningham & Harney, 2012, p. 170; Amaeshi et al., 2013, p. 76). It is debatable whether social responsibility contributes to financial and economic performance (Seigel, 2014). Organisations cannot achieve the benefits of CSR practices without effective communication (Maignan & Ferrell, 2004). Aquinis & Glavas (2012) recommends paying more attention to the internal impacts of CSR.

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McWilliams & Siegel’s study (2000) found that social responsibility had a neutral impact on a company’s financial performance. Participation in social issues not related to the organization’s primary stakeholders was even negatively related with shareholder value (Hillman & Keim, 2001). Manilla and Miles (2005) argue that enforced CSR may result in a loss of sustainable competitive advantage, long-term reputation damage, and internal managerial and strategic conflicts. Visser (2015, p. 104) states that CSR is a peripheral function in most companies and there is a lack of top management commitment. CSR makes sense for both business and society (Bhattacharya et al., 2008; Carroll & Shabana, 2010). Firszt (2015, p. 117) states that implementation of CSR may be beneficial to the relationship between an enterprise and its external stakeholders such as clients, suppliers, and other business partners. The effects of CSR vary with firm size, industry, and market budget (Arendt & Brettel, 2010).

Manos & Drori (2016, p. 7) opined that there is a strong link between corporate social actions and the firm’s core managerial policies and practices. Some firms are motivated to engage in CSR activities when the benefits outweigh the costs (Schreck, 2011). There is a positive link between corporate social actions and corporate financial performance (Henisz et al., 2013). Aquinis & Glavas (2012) finds an overall small but positive relationship between corporate social actions and policies and financial outcomes, as well as affecting several non-financial outcomes such as improved management practices, product quality, operational efficiency, etc.Firszt (2015, p. 117) states that an entrepreneur who implements CSR practices and consolidates the relationship with clients can build up confidence in the enterprise and its products, as well as lowering risks. Promoting CSR is a key element in ensuring long-term employee and consumer trust (Sørensen & Brand, 2011, p. 323). Engagement in CSR activities may strengthen legitimacy (Carroll & Shabana, 2010) and enhance reputation of firms (Carroll & Shabana, 2010; Stephenson, 2009).

Enterprises implementing CSR are more successful in performing innovative activities (Luo & Du, 2012). Some corporations used CSR as a strategy to increase profits (Doh & Quigley, 2014). CSR is increasingly used as a component of management strategy (Filek, 2015, p. 33). Eisenegger and Schranz (2014) states that promotion of the CSR good that a corporation does has the potential to gain rewards such as enhanced reputation in the minds of stakeholders. Research findings suggest that CSR programmes could enhance employee’s organisational commitment, satisfaction, and identification with their employer (Rupp et al., 2013).

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Pivato et al. (2008) demonstrated that CSR initiatives enhance brand loyalty.

Health care service enterprises, being private in nature, can also be benefited from CSR activities. Implementation of corporate social responsibility (CSR) may be beneficial to the relationship between an enterprise and its external stakeholders such as clients, suppliers, and other business partners (Firszt, 2015, p. 117). It is believed that the long-term care enterprises in Hong Kong can also benefit from adopting best practices of CSR and adopt sustainable solution in the future.

Implementation/Phases of CSRNewell (2005, p. 556) suggests that CSR practices can only work “for some people, in some places, on some issues, some of the time.” Spence (2007) finds the lacking of codification of CSR in small and middle-sized enterprises (SMEs). Banerjee (2008) opined that few managers have absolute freedom in CSR implementation since organisational interests and best practices are often predefined at higher organisational levels. Companies usually develop, implement, and manage CSR based on top-down initiatives in which companies’ leaders decide what to do and how (Bhattacharya et al., 2008).

Porter & Kramer (2011) introduced a new framework for considering the business case for corporate responsibility by policies and operating practices that enhance the competitiveness of a company while simultaneously advancing the economic and social conditions in the concerned communities.

There are four phases of CSR: awareness-raising of top management, development of CSR vision and values, organizational changes, and the anchoring of the new behaviour (Werre, 2003). Implementation of CSR requires conducting business activity based on relations that are transparent, stable, derived from dialogue and mutual respect among all interested parties (Hohnen & Potts, 2007, p. 4). For social responsible and ethical organisations, external engagement should be integrated into decision making at every organizational level (Dubrin, 2016, p. 190).

Zadek (2004) argues that organisations pass through five stages or organisational learning in reaching sustainable levels of CSR, namely: defensive (deny responsibilities), compliance (adopt policy-based compliance), managerial (embed social issues in management processes), strategic (integrate social issues into strategies), and civil (promote broad industrial participation in corporate responsibility). Milliman et al. (2008) proposed a five-step process for implementation

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of a strategic CR programme: (1) identify how firm can translate societal issues into corporate advantage; (2) list options for creating opportunities through CR programmes; (3) analyse options; (4) implement selected programme through coordination with other organisations and sectors; (5) measure outcomes and report results to internal and external stakeholders. Best Practices of CSR ProgrammesCompanies want to imitate successful organisations as a normal business practice (DiMaggio & Powell, 1983). Health care service enterprises, being private companies, can learn from best practices of enterprises in the other sectors. There are six categories of best practices that may assist companies with their CSR programmes: (1) cause promotion (increasing awareness and concern for social causes); cause-related marketing (contributing to causes based on sales); (3) corporate social marketing (behaviour change initiatives); (4) corporate philanthropy (contributing directly to causes); (5) community volunteering (employees donating time and talents in the community); and (6) socially responsible business practices (discretionary practices and investment to support causes) (Kotler & Lee, 2005; Perrini, 2005).CSR requires leaders to demonstrate attributes in leadership, ethics, personal responsibility, and trust (Mostovicz et al., 2011).

CSR FRAMEWORKS AND SUSTAINABILITY REPORTINGSustainabilitySustainability is a long-term strategic goal which allows companies to gain advantage in competition (Nidumodu et al., 2009). Leading firms gives attention to sustainability more than other terms (Ricart et al., 2005). Sustainability refers to economic development that generates wealth and meets the needs of the current generation while preserving the environment and society (Daft & Marcic, 2017, p. 162). Sustainability is a business buzzword (Nadam & Lussier, 2012). From a sustainable perspective, managers are now required to address interconnected concern for the natural environment social welfare, and economic prosperity of the firm (Hahn et al., 2014).

Sustainability is one of the major and pressing issues of the twenty-first century (O’Riordan et al., 2015, p. 25). The creation of sustainable enterprises is a socially mature management practice that connects the strengthening of competitive ability with CSR (Bal-Woźniak, 2015, p. 90). On sustainability, organizations are asked to report to their stakeholders on multiple accounts known as TBL to provide

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disclosures about the social, environmental and economic sustainability of their performance (Hopwood, et al. 2010; Gray et al. 2014). For healthcare enterprises, sustainability help providing safe quality, compassionate, and cost-effective care resulting in patient health and well-being (Schiver & Cantiello, 2016, p. 157). Viable sustainable solutions would be proposed to the LTC services enterprises in Hong Kong in the Solutions and Recommendations section.

Origin and Development of Sustainability Reporting With the growing importance of social responsibility in business context, a number of CSR frameworks have been proliferated to conceptualize previous fluid ideas. These frameworks explain relationship between companies and society and set out various responsibilities for companies to manage in a socially responsible way. Before the emergence of a formal way of sustainability reporting, some companies had engaged in philanthropic programmes and convey their commitment to their stakeholders through public relations (Waddock, 2008; Alonso-Almeida et al., 2014) since the 1960s. Two decades later, companies have started to implement their code of ethics and publicly expresses concerned over social issues (Alonso-Almeida et al., 2014). The disclosure of these information to stakeholders could be perceived as a preliminary attempt to demonstrate corporate social responsibility.

In the 1990s, the focus of CSR shifted from encouraging corporate’s voluntary involvement in some kinds of CSR activities to formalizing social responsibility through reporting commitment to CSR in a company’s annual report. For instance, chemical and energy sectors were accused of the environmental and social problems stemmed from their business activities; while the public image of the financial sector was seriously damaged after the financial crisis. This gave birth to various standard-setting bodies which in turn provide some ways to restore their public image. CSR reporting is the presentation of the performance of a firm and a means of communication to stakeholders such as shareholders (Chan & Welford, 2005; Ziek, 2009), employees, clients or communities. Since then, different guidelines and standards of CSR reporting are released to promote better governance, enhance transparency and accountability, social and environmental responsibilities among companies (GRI, 2002).

Codes and standards serve as a map to guide companies towards greater transparency and accountability (Leipziger, 2016, p. 19). The standards developed by standard-setting bodies are usually based on well-known CSR framework, with designated social and environmental performance indicators for companies to

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measure their performance (Laufer, 2003; Norman & MacDonald, 2004; Alonso-Almeida et al., 2014). In this volume, three commonly used CSR frameworks – (a) Triple Bottom Line Framework, (b) Strategic CSR Framework, (c) ESG Framework (Argenti, 2016) and their application in sustainability reporting in both international and Hong Kong context are discussed below.

Application of CSR Frameworks in Sustainability ReportingTriple Bottom Line (TBL) FrameworkThe TBL framework measures CSR performance by integrating financial, social and environmental aspects into measurement (Elkington, 1994). To ensure sustainability, it is assumed that companies have to take all three aspects into account and evaluate their performance against the TBL (Aras & Crowther, 2012), and spot economic, social and environmental issues before they become crisis (Savitz & Weber, 2006).

To report on CSR based on the TBL framework, Daft & Marcic (2017, p. 65) set out four criteria to gauze corporate social performance (CSP), namely; “(1) economic responsibility- be profitable; (2) legal responsibility – obey the law; (3) ethical responsibility- be ethical, do what is right, and avoid harm; (4) discretionary responsibility- contribute to the community and be a good corporate citizen.” Going beyond the TBL framework, Sroufe & Ramos (2015, pp. 251-252) proposes an Integrated Bottom Line (IBL) concept which is the analysis and disclosure of financial, social, and environmental assets and liabilities to the internal and external stakeholders of a firm. CSR and corporate codes of conduct must be integrated for TBL reporting (Painter-Morland, 2006).

ISO 26000:2010 is one of the well-known reporting standards based on the TBL framework. It was published by the International Organization for Standardization (ISO) in 2010. ISO 26000:2010 is an international reporting standard on corporate social responsibility. It covers three dimensions of social development - economic, environmental and societal. It provides companies with guidelines on how companies operate responsibly and practice social responsibility effectively (ISO, 2014).

Strategic CSR FrameworkThe Strategic CSR framework emphasizes the importance of engaging stakeholders in organizational management (Amaeshi et al, 2013). Through incorporating a holistic CSR perspective within a firm’s strategic planning and core operations, it

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enables businesses to manage in the interest of abroad set of stakeholders (Chandle & Werther, 2014, p. 65).

Strategic CSR goes beyond good corporate citizenship and risk mitigation, identifying strategic CSR initiatives with sizable social and business benefits (Argenti, 2016, p. 21). Thus, if CSR activities are financially sustainable, it would get better chance of being incorporated into an organization’s long-term strategic plans (Carroll & Shabana, 2010).

Most commonly used sustainability reporting standards include stakeholder involvement as one of the key components of CSR. For instance, ISO26000:2010 provides a detailed guideline on various stakeholder engagement issues. It is also stated that “an organization should respect, consider, and respond to the interests of its stakeholders” (ISO, 2010, p.12). The Global Reporting Initiative Guidelines also introduce the principle of stakeholder inclusiveness by engaging them in the reporting process (ISO, 2014). ESG FrameworkThe ESG framework considers environmental, social, and governance issues and is a term for criteria used in socially responsible investing (Argenti, 2016, p. 22). Companies would face increasing pressure to improve their metrics for the ESG impacts of their business practices if customers become increasingly educated about ESG impacts (Argenti, 2016, p. 46). Bonini et al. (2009, p. 66) found that ESG programmes can create value by contributing to business growth, improving a corporations’ return on capital, mitigating risk, and improving corporate management.

The Global Reporting Initiative Guidelines are one of the international reporting standards based on the ESG framework. Its guidelines provide directions for companies to operate in a more sustainable way, thus leading to sustainable development (ISO, 2014). Although the original idea of the GRI framework focused on environmental reporting, but the scope was further extended to cover social, economic and governance issues a year later. In 2000, the first version of the GRI Guidelines was emerged as the first framework for sustainability reporting. Its latest version of guidelines, G4, was released in May 2013 (GRI, unknown year).

Based on the ESG Framework, the Hong Kong Exchanges and Clearing Limited (HKEX) also published the Environmental, Social and Governance (ESG) Reporting Guide (the Guide) in 2012, which is aimed at “achieving better and more

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comprehensive ESG reporting among issuers” (HKEX, 2015). The Guide has received a strong market support since its release in 2012. In December 2015, the revised Guide with strengthened disclosure obligations were released in, in which some recommended ESG disclosures are upgraded to “comply or explain” provisions.

The Guide contains two levels of disclosure obligations, which are recommended ESG disclosures and “comply or explain” provisions. Listed companies in Hong Kong are required to report on the “comply or explain” provisions, while they are encouraged to report on the recommended ESG disclosures. Besides the two levels of disclosure obligations, the Guide also addresses two subject areas, which are Environmental (Subject Area A) and Social (Subject Area B). In each subject area, it contains several aspects. Listed companies have to report on their ESG performance with reference to the rules on “general disclosures” and key performance indicators (KPIs) stipulated in the Guide (HKEX, 2015).

To achieve a better and socially responsible LTC service delivery in Hong Kong, strengthening legal responsibility through regulations and ordinances can scrutinize companies to comply with basic legal requirement, but may not be a desirable drive for private LTC services providers to excel further and even excellence in their service delivery. Thus CSR can serve as a way to achieve the same in an assertive way.

CSR PRACTICES IN LONG-TERM CARE SERVICE ENTERPRISES IN HONG KONGTo explore the understanding on CSR, practices, and its various aspects related to LTC, 32 invitations were sent to four categories of residential care homes under administration of the Social Welfare Department in Hong Kong, namely: (1) Subvented, Self-financing and Contract Homes Providing Subsidised Places for Elders; (2) Residential Care Homes for the Elderly Providing Non-subsidised Places for Elders; (3) Private Homes for the Elderly Participating in Enhanced Bought Place Scheme (EBPS); and (4) Private Homes issued with Licence. In-depth Interview was adopted because it can provide deep, rich, individualised, and contextualised data that are important to qualitative research (Ravitch & Carl, 2016, p. 146). Patton (2015, p. 426) asserts that qualitative interviewing allows the interviewer to enter the other person’s perspective, i.e. the “inner perspectives”. This is useful for gauzing opinions on the LTC industry in Hong Kong.

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Two in-depth-interviews based on convenient sampling were conducted in August 2016. Both informants were experienced personnel in the industry at executive and supervisory levels. The first informant was the ward-in-charge of a subsidised nursing home with 300 places in Hong Kong. He got over 20 years of experiences in the LTC industry in Canada and Hong Kong. The second informant was the deputy service director of a non-subsidised residential place for the elderly with 90 places in Hong Kong. She got over 18 years of experience in the LTC industry in Hong Kong. However, generalisation of results should be careful since opinions were collected from limited number of informants

Business Environment of LTC Services in Hong KongThe business environment of LTC services needs improvement. First, it is difficult to find a premise with all-round environments suitable for running LTC facilities. Many premises were established in second floor or above of old buildings. Second, private LTC service providers have to search for a suitable premise in their own to provide LTC services. They face high operating costs, in particular high rental costs of the LTC premises. Third, LTC service providers find it difficult to secure government funding. The current mechanism provides funding on the basis of actual enrolment of residents incur competition among operators.

Difficulties or Challenges Faced by LTC Service Providers in Hong KongThe current overall service quality of LTC in Hong Kong is satisfactory but nursing care varies among private and subvented LTC. To maintain its service quality, LTC service providers face a few difficulties. First, the service providers find it difficult to recruit and retain frontline staff such as care-takers for the elderly, cleaner, and chef. This has been contributed by long working hours, unpleasant task nature, and more importantly commitment to the jobs. Hiring of supervisory staff and experienced staff in this labour-intensive industry are also difficult. Second, training takes time but new recruits are unable to take up job tasks and care the elderly quickly so that service delivery is affected. Third, increasing operating costs which include high rental costs, wages, and food costs force LTC service providers to run in difficulties. Fourth, but not the least, LTC service providers have to cater for changing and more demanding customer expectation. Due to societal and technological changes in recent decades, LTC service providers are now dealing with customers who are knowledgeable in elderly care and demand accountability of the LTC personnel. While it may be arbitrary to conclude that there is a “complaint culture” among customers, LTC service providers have to carefully deal with customers who are now willing to pay for better services from a worth for money perspective.

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Overall Views on CSRPrivate LTC service providers demonstrate CSR and are basically accountable to their stakeholders, such as the elderly and their family members. In general, personnel in the LTC share the vision, mission, and values (VMV) of their sponsoring organisations. The following paragraphs would discuss the views of practitioners of the LTC service providers in three aspects: economic (financial) aspects, social aspects, and ethical (human rights) aspects.

Economic (Financial) Aspects of CSREconomic (financial) aspects of CSR are one of the three elements of the TBL framework of CSR (Elkington, 1994). The ISO 26000:2010 standard also advocates various activities that promote the economic aspects of CSR.

LTC service providers in Hong Kong see a positive impact of the economic (financial) aspects of CSR. Good performance helps survival from market conditions. Contracted residential care homes for the elderly (RCHEs) in Hong Kong commonly engage in a “5+5” contract with the HKSAR government – i.e. a fixed contract for five years and then another five years for renewal. While performance in the initial five years is guaranteed, that of the remaining five years depends on the profitability considerations of the operators.

Based on the ISO 6.8.1 to 6.8.9 of the ISO 26000:2010 standard, LTC service providers need to perform certain activities for promotion of the economic aspects of CSR. First, the “employment creation and skills development” dimension (ISO 6.8.5) regards employment as an internationally recognized objective related to economic and social development while skills development assists people to secure decent and productive jobs (ISO, 2010, p. 65). This dimension can be viewed together with the dimension of “human development and training” (ISO 6.4.7) under social aspects of CSR. LTC service providers offer flexi-time for citizens who need a job at the community levels. The “human development and training” dimension includes the process of enlarging people’s choices by expanding human capabilities and functioning, thus enabling workers to be knowledgeable and to have a decent standard of living. LTC service providers in Hong Kong rely on in-house training and mentoring. They focus on job-related skills such as serving the elderly and are extended to soft skills including sympathy and a serving attitude. It is also common in subvented nursing homes that front-line staff are under annual evaluation of their skills.

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Second, the “technology development and access” dimension (ISO 6.8.6) promotes advancement of economic and social development through full and safe access to modern technology (ISO, 2010, p. 65). For LTC service providers in Hong Kong, some special technologies or equipment have been in place to enhance overall service delivery. These have been viewed as basic requirements for operations.

Third, the “wealth and income creation” dimension (ISO 6.8.7) emphasises enterprises create wealth in the community and distribute benefits of economic activities fairly (ISO, 2010, p. 66). LTC service providers in Hong Kong promote recruitment at the community level. They also help in this aspect by relieving pressure of the family members, so that the latter can continue to go to work and retain economic productivity.

Fourth, the “health” dimension (ISO 6.8.8) emphasises promotion of health of customers and employees. LTC service providers in Hong Kong put health issues in the first priority. They are aware of the occupational health and safety of the employees and provide the later with information on health talks. Regular health talks are organised for customers and monitoring with residential doctors.

Lastly, the “social investment” dimension (ISO 6.8.9) encourages organisations to invest resources in initiatives and programmes which aimed at improving social aspects of community life (ISO, 2010, p. 68). LTC service providers in Hong Kong perform social investment indirectly by collaborating with the concerned District Councils when the latter organize social activities that help engage elderly people into the society through site visits, buffet, etc. Cooperation between NGOs in social activities is common. Some homes establish an “operations fund” to support social activities.

Social Aspects of CSRSocial aspects of CSR constitute the second elements of the TBL framework of CSR (Elkington, 1994). ISO26000:2010 (ISO 6.4.1 - 6.4.7) advocates various activities that promote the economic aspects of CSR. LTC service providers see a positive impact of the social aspects of CSR with corporate image. Elderly care services gradually become one of the foci of non-governmental organisations (NGOs) or service organizations in Hong Kong. Serving the elderly is viewed as a corporate social responsibility.

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First, the dimension of “employment and employment relationships” (ISO 6.4.3) emphasises the importance of employment for human development and encourages employers to improve living standards of employees through full and secure employment and decent work (ISO, 2010, p. 34). LTC service providers in Hong Kong would try to maintain employment with existing staff as long as they get subsidy from the HKSAR government.

Second, the dimension of “conditions of work and social protection” (ISO 6.4.4) states that the conditions of work such as wages and different forms of compensation greatly affect the quality of life of workers and thus social development (ISO, 2010, p. 36). In Hong Kong, LTC service providers tend to provide the basic and minimal conditions of work after fulfilling mandatory legal requirements. Residential facilities compete fiercely for the same pool of LTC workers. They cannot compete with Hospital Authority which provides more desirable pay, remuneration package, and condition of work than those of the RCHEs.

Third, the dimension of “social dialogue” (ISO 6.4.5) concerns with exchange of ideas with major stakeholders which including the government, customers, employees, and others. Other than fulfilling requirements, LTC service providers would communicate with the regulatory bodies for service improvement. Regular meetings with customers and their family members are held to gauze on opinion on service quality. In addition, annual or even seasonal meetings are held for staff at different levels for communication.

Fourth, the dimension of “health and safety at work” (ISO 6.4.6) concerns the promotion and maintenance of the highest degree of physical, mental and social well-being of workers and prevention of harm to health caused by working conditions (ISO, 2010, p. 38). By nature, LTC service providers concerns about health and safety of their workers since they are operating in the health care industry. Different types of equipment are in place to ensure health and safety at various levels. Health of workers is further protected by resident nurses and doctors (no matter 24-hour on duty or on call service).

Fifth, the dimension of “human development and training” (ISO 6.4.7) concerns with the improvement of employees’ abilities by training and development. For frontline staff, LTC service providers provide regular job-specific training on rotary hold, feeding, bathing techniques for the elderly. Capturing of skills of workers is constantly reassessed. For supervisory staff, LTC service providers provide

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management, leadership, and performance appraisal training on a regular basis.

Ethical (or Human Rights) Aspects of CSREthical aspects of CSR emphasises that an organisation should behave ethically (ISO 4.4) while its behaviour should be based on the values of honesty, equity, and integrity (ISO, 2010, p. 11). Since LTC service providers in Hong Kong have to follow the Service Quality Standard (SQS16) set by the Social Welfare Department, they regard this standard as the guiding principles for service provision. Certain service providers set additional requirements at nursing level for frontline care-takers. Written staff manual which includes ethical behaviours are demonstrated. Formal performance appraisal is conducted and may be followed by tangible and intangible recognition. Mutual scrutinisation among workers ensures enforcement of ethical standards.

On the other hand, “fair operating practices” (ISO 6.6) of ISO 26000:2010 concerns ethical conduct in an organization's dealings with other organizations such as partners, suppliers, contractors, customers, competitors, and so on (ISO, 2010, p. 48) and respect for property rights of various groups (including the customers)(ISO, 2010, p. 51). IT is common that LTC service providers in Hong Kong help one another in contingent situations among competition. As operators in the service industry, LTC service providers endeavour to maintain a good relation with their customers.

Regarding consumer issues and social responsibility (ISO 6.7.1.2), organisations need to address the following areas: fair marketing practices, protection of health and safety, dispute resolution and redress, data and privacy protection, addressing the needs of vulnerable and disadvantaged consumers, and etc (ISO, 2010, p. 52). Riding on SQS16 standards, LTC service providers in Hong Kong nowadays in general protect privacy of customers and their human rights in accordance with the Hong Kong laws.

RECOMMENDATIONSPrevious studies link CSR with health care services. Longest & Lin (2005) finds positive association between good corporate citizenship and financial performance in the nonprofit hospitals in the United States. That is, health care organisations can do well simultaneously financially and engage in corporate citizenship activities. Ahn & Park (2016) finds that sustainable CSR practices facilitate long-term survival. Based on literature review on LTC and CSR, as well as opinion collected from LTC service

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provides, a few policy recommendations were made.

First, the government should scan and review the business environment of the LTC industry. The government needs to explore and introduce more government-funded places for subvented service providers so as to enhance the overall quality of service delivery. It was suggested that the government perform this at the land planning stage for every geographical district in Hong Kong. Borderline service providers should also be subsidised so that they can provide reasonable long-term care services in the market.

Second, the government needs to review and improve the competitive bidding mechanism for RCHEs. The current mechanism favors LTC service providers which can submit bids with the lower prices among all tenders. This may lead to monopolisation by sizable operators and limits the survival space for small-and-medium sized NGOs. It also affects the quality of services provided and the salary of employees working in these contract RCHEs. To ensure reasonable service delivery, it is suggested that the bidding mechanism set a cap to the lower acceptable cost for RCHE contracts based on certain standards and allocate contracts based on past experience and quality levels.

Third, the government should also review the training courses for healthcare service industry offered by the Employees Retraining Board (ERB). It was complained that the passing rates of training courses have been low due to stringent requirements set by the ERB. The ERB needs to strike a balance in maintaining the quality of trainees and helping to fuel new labour forces for the LTC industry.

FUTURE RESEARCH DIRECTIONSWhile there are researches into CSR in private businesses at large, there are few literature research into the relationship between CSR and the LTC industry. Many studies on LTC in Hong Kong focused on the service quality, individual characteristics of the elderly customers, or policy-related issues of the LTC industry.

Some studies focused on the service quality of existing caring facilities. For example, Cheng & Chan (2003) conducted a socio-ecological investigation into the quality of care of nursing homes in Hong Kong. Chi et al. (2011) used both quantitative and qualitative data analyses to examine ways to strengthen community care services (CCS) for elders through a more flexible approach and diverse mode of service delivery by gauzing views from a diversified portfolio of informants which covered

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government officials, the elderly, carers, and employees of operators.

Some studies focused on the individual perception and characteristics of the elderly clients. For example, Chou et al. (2004) examined the retirement economic status of three groups of elderly based on financial dependency. Ho & Sam (2007) researches into the perceptions of elders, family members, as well as healthcare professionals and administration providing care in different LTC facilities in Hong Kong.

Some studies focused on the policy-related issues of the LTC industry. For example, Chi (2002) sees the opportunities for containing residential care and building a care system based on community services. Chou et al. (2005) proposed a local voucher system for LTC. Chung et al. (2009) used simulation to analyse data from government departments, Hospital Authority and other LTC service providers to identify key cost drivers of LTC expenditure in Hong Kong. Cheng et al. (2013) advises policymakers to understand that societies have a duty to protect the dignity of the elderly and cater for their needs.

Previous studies on LTC in Hong Kong did not particularly use a CSR framework or international standards (such as ISO 26000:2010 and GRI guidelines) as a basis for research into the healthcare services. More studies are recommended to research into the relationship between LTC service quality and CSR dimensions base on international standards. In addition, the LTC industry currently highly relies on on-the-job training and mentorship within the service providers, training needs may not cater for high quality delivery but for fulfilment of job duties. It is recommended that more researches be conducted into the training needs, knowledge, and skills for practitioners in the LTC industry.

CONCLUSIONBased on literature review and opinions collected from in-depth interviews with experienced practitioners of LTC service providers in Hong Kong, concluding remarks are presented below.

Current Profile of the LTC Industry in Hong KongLTC service providers in Hong Kong find it difficult to search for a suitable premise for operations at reasonable costs. High rental costs stack up the operating costs of LTC service providers. Since the government is one of the most proximal and influential stakeholder of the industry, it is recommended to proactively plan for

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elderly residential care premises at the district level and introduce more government-funded places for subvented service providers.

The government needs to address the concerns of the LTC service providers on the current competitive bidding system for RCHEs; it was opined that the system favours certain resourceful service providers which play the tactics of low-price bidding. The government should review and further improve the competitive bidding mechanism so that commissioning of contracts for RCHEs would also take past experience and unique quality services of service providers into account.

Besides, LTC service providers find it difficult to recruit and retain frontline staff while supervisory staff take time to train. Such human resource gap is further aggravated by competition among service providers on labour, less active working attitude of younger new recruits, as well as higher customer expectation based on value for money perspective. The government and its agencies including Employees Retraining Board should consider reviewing its training initiatives to further improve the quality of healthcare workers, in particular LTC frontline workers, to meet the changing human resource environment of the industry.

Current CSR Practices among LTC Service ProvidersBased on the economic (financial), social, and ethical (or human rights) aspects of CSR under the ISO 26000:2010 standard, LTC service providers in Hong Kong understand and fulfil CSR in the broad sense. However, they as practitioners are not aware of the definitions, drivers, and framework of CSR in details.

In the economic (financial) perspective of CSR, LTC service providers in Hong Kong do not particularly view CSR initiatives as fulfilling financial objectives. They fulfil the “employment creation and skills development” (ISO 6.8.5) and “wealth and income creation” (ISO 6.8.7) dimensions by recruiting local residents at the community level and provide job-specific training to both supervisory and frontline staff. Economic productivity of the Hong Kong society is facilitated since family members of the elderly living in residential care facilities can continue to work. Regarding the “technology development and access” dimension (ISO 6.8.6), LTC service providers view service-related technology and hardware as basic requirements for operations. This echoed the efforts made by LTC service providers in promoting health of customers and employees under the “health” dimension (ISO 6.8.8). Under the “social investment” dimension (ISO 6.8.9), LTC service providers in Hong Kong perform social investment indirectly by collaborating with the concerned District

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Councils, NGOs, and other parties in organising social activities that engage the elderly and their family members.

In the social perspective of CSR, LTC service providers see a positive relation between CSR activities and corporate image since serving the elderly is primarily viewed as a social responsibility. For the “employment and employment relationships” (ISO 6.4.3), “human development and training” (ISO 6.4.7), and “conditions of work and social protection” (ISO 6.4.4) dimensions, LTC service providers endeavour to maintain employment with existing staff as long as they get subsidy from the HKSAR government amidst fierce competition among providers. Flexi-time, tailor-made in-house training, and mentoring were offered to employees. Regarding the “social dialogue” (ISO 6.4.5) dimension, LTC service providers fully aware of and actively communicate with major stakeholders of the industry which include licencing unit of the government, as well as elderly residing in their facilities and their family members. Regarding the “health and safety at work” (ISO 6.4.6) dimension, LTC service providers highly concerns about health and safety of their workers and customers with the support of equipment and resident healthcare professional such as nurses and doctors.

In the ethical (or human right) perspective of CSR, LTC service providers view the Service Quality Standard (SQS16) set by the Social Welfare Department of the Hong Kong government as guiding principles for service provision. They step up service quality via internal staff manual and various guidelines for different types of frontline staff. Riding on SQS16 standards, LTC service providers in Hong Kong protect privacy of customers and their human rights in accordance with the Hong Kong laws.

This chapter also reviews two future research gaps for LTC services in Hong Kong. First, more studies on the relationship between LTC service quality and CSR dimensions base on frameworks or international standards are needed. Second, more researches are recommended for the training needs, knowledge, and skills for practitioners in the LTC industry.

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KEY TERMS AND DEFINITIONS

Aging in place: A government policy which enables older people to remain living in familiar physical and social environments.ESG: A framework that considers environmental, social, and governance issues; criteria used in socially responsible investing.Social entrepreneur: An individual or organisation that seeks opportunities to improve society by using practical, innovative, and sustainable approaches.Social responsibility: A business’s intention to do the right things beyond its legal and economic obligations and act in ways that are good for society.Sustainable reporting: Organisations adopt codes and standards and publicly express over social issues towards greater transparency and accountability.

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