Your Parents Are Ageing and Nobody Is Talking About It, with Winnie Chan and Lizzie Chan

After 30 years as a barrister in Hong Kong, Winnie Chan's second career began at her father's bedside. Caring for him through cancer taught her that even the closest families fall into conflict over treatment, money, accommodation and, hardest of all, where a parent will die. She became an elder mediator to help families have those conversations before a crisis forces them.

She is joined by Lizzie Chan, the first Asian elder mediator qualified by EMIN and a trained end-of-life doula. Together we explore why families do not really know each other until a crisis, Hong Kong's fragmented households, the sandwich generation, why peers matter more than children in later life, and why a good death starts with living well today.

All episodes and transcripts: https://www.danieleforni.com/podcast

If you want to know more about Daniele Forni, go to www.danieleforni.com

Transcript

SPEAKER_00 0:09

When the meadows full of strangers, and the loudbirds take the stage.

SPEAKER_01 0:17

So thank you everyone for joining. This is the Sage and the CEO, and I'm here with Winnie Chan and Lizzie Chan. And I think you're not related. Right?

SPEAKER_03 0:29

I feel like we are though. It's been a long time family friend.

SPEAKER_01 0:36

I see. I I sp I speak Chinese and I lived in China many times, and we often s I often hear that the Western world has got a hundred names and thousand surnames. And in China it's the other way around in Asia where you have maybe just a handful of surnames and lots of names.

SPEAKER_03 1:01

Exactly.

SPEAKER_02 1:04

Both of us are surname Chan. Uh, because Chen is a huge uh family kind in China. We haven't had the same family name, but we are a good friend of Lizzie's father.

SPEAKER_01 1:20

Excellent, excellent. So in the past episode we already covered and interviewed Lizzie. So this for this time uh Winnie, we're gonna put you in the spotlight and ask you a little bit about yourself and what you do. So before to like get into the details, can you please introduce yourself and tell us a little bit about your life from maybe what you studied and how ka how did you arrive where you are right now?

SPEAKER_02 1:49

Oh okay. I I have been a barrister in Hong Kong for 30 years, like everybody else. Well perhaps not like everybody else, because I started off having a social science degree and then with a minor in psychology. But then after I graduated a close on a job which I can put my my learning in use, I ended up working in the courts, judiciary. And assigned law is something that I may enjoy. After that, I changed to become a court prosecutor, which by which force I can actually conduct trials without having a uh a proper legal qualifications. Uh the prosecution that I handle are those at the lowest level of the courts in Hong Kong, the magistrates' courts. So after a year or so, I decided to pursue a law degree in UK and then I come back and become a barrister. So that basically is my career track in the past. So for 30 years I have been enjoying court work. And um and then in about I I think his train, my father developed cancer. I have to look after him. Not that I have to give up my job, but it took up a bit of my time. And luckily, because it was a COVID period, I didn't have so much work, and so I can have the time to look after him for three and a half years. And in that journey I learned about what it means for aging. I know what it means to be in the end of life, all sorts of difficulties, all sorts of decisions the patient has to make, and all sorts of responsibility as the primary carer has to take up. And of course there are disagreements. I had a very close relationship with my father, but even we have so much disagreement over care of him, what treatment to receive, where to receive the treatment, whether or not to to do exercise, how many times he has to turn on bed, you have to keep turning your your you to prevent bed sores. So all those things. And the worst part of it I find was to it comes to a stage I really have to make decisions for him, whether he had died at home or die in hospital, and that's the major decision. All this I find it's very difficult because I it seems to me that I was handling I have a life at my head. I have to de decide for him which I have never done, and I don't think I I I should do that. The decision of one's life should be one's own decision. You don't leave it to somebody else to decide we. It is through all these experiences, I somehow it occurred to me that maybe mediation is a good tool to help in this sort of situation and given the thought that in a close relationship that I had with my father, I still have so much problem. What it would be like in other families when relationships can be very complicated. So I decided to pursue I first pursue a general mediation qualification with IMI and then after that I searched online and I and I got training in elder mediation. And I got lately interested in the same pursuits and both of us become elder mediators. But Lizzie is different because she is properly qualified as an elder mediator. In fact, she is the first Asian elder mediator qualified by Eamon, the Elder Mediation International Network. I'm still on the process of um getting past that assessment. I haven't found f haven't found the time to do it, but I'm gonna do it probably this year. So that's how I come to this stage when I had the elder mediation training and vigorously promoting elder mediation in Hong Kong. So in a way, it's my father would change my track, gave me the inspiration, and I have to say this could be a second career for me, and I'm very much devoted in it. Maybe it's all down to I call it the inheritance that I received from my father.

SPEAKER_01 6:24

This career. I see. That's very interesting, and Alice, congratulations for the certification. Um I have a question that maybe I have as Italians, I'm Italian originally, we tend to have live every family house where different generations live together. So I've always I grew up with my grandmother, I sort of like there were always people around us, and of course with all the things that come with it. When it comes to mediation, what does it mean in this context? Is it about disagreeing on decisions? Is it about medical care?

SPEAKER_02 7:10

What is it about elder mediation deal with almost every issue surrounding older persons at home? And of course it can the skill can also apply to care home settings, to apostrophe settings, to relationship between uh care professional care providers and the older person. But i if we let's let's confine ourselves to be home setting. Um what has so far developed in Hong Kong is that um family members tend to live separately. For example, my father independently in in the flats where we grew up, I have my old slats and other siblings have their own family and live apart. So that's sometimes where the difficulty arises because we seem to know our parents, but actually we don't know them. Because we don't live with them, and uh like us, we just leave him to his own devices. He likes to spend his time with his peers, he likes to discuss his own personal affairs with his peers. It's only for I think for only 10% of his decision, he comes to us and asks for advice, and most of the time he discusses with his peers and then he enjoys the he follow advice from his peers. So when it comes to crisis when they when his health um is in question and he needs to change his lifestyle, then that's where all the disagreements arise because as siblings, I don't know my siblings so very well because I have my own life, they have their own life. And my father, he had his own life. So when a crisis arises and bring all families together, we have to decide what to do with my father. That's when the problem magnifies in Hong Kong. And probably I don't know if it had all family members live together like Chinese used to do in the past. I don't know whether the problem would have been better, but um this is the situation we have to deal with. And I find that um elder mediation, uh in a sense, communication, bringing resources together, and making family members understand what internal resources they have, what external resources there are that can support their situation, and then decide what options to take, what financial arrangement should be made, and um ultimately for the of the older parents or grandparents and that's what b and sums up what elder media elder mediators do.

SPEAKER_01 9:56

I can while you were talking, I was picturing my mind that elder mediation probably it is as much as siblings mediation because you have a lot of healthy disagreement, I think.

SPEAKER_02 10:12

Yes. Some elder mediators actually describe elder mediation as mediation among siblings mainly. But it may not be the case because while we say that elder mediation are there to protect the voice of the older person, to make sure that his his wishes and his are heard, but we do come across strong opinionated older persons. So the difference between the older generation and the younger generation can be quite wide, and in some cases we we really need to close the gap by proper communication, facilitation of communication.

SPEAKER_01 10:57

I I I completely understand. I have now a public question that I would ask I would like to ask you, Winnie, and then I would move to Lizzie because it's similar. Do you think you there are like different generations? So your parents the media the mediation style, the way to deal with is kind of like very heavy and complicated uh issues. Is it different from younger generations?

SPEAKER_02 11:33

I think so. I don't think so. When I discuss out the mediation with people from all walks of life, from of different ages, they all agree at least when I talk to people in Hong Kong, they all agree that the uh family members do not know each other that well. Until there are crisis. I think about situations where families sit together in a restaurant, they don't talk to each other. They are they focus on cell phone. All of them say that it's a good thing that there is someone there who can facilitate conversations among family. It's something they know that they need, but then they don't know how to start it. So I don't think it is a the skill itself is not generational. It's just that as elder mediators we have to under understand different thinkings, thinking mode or lifestyle of different generations, expectations of different generations, and then try to bring them together to agree on what to do about then older member of the family.

SPEAKER_01 12:41

Understand. Lizzy, maybe your perspective on this. Do you think that different generations towards their elders, like they have very different approaches, or it is actually quite human nature like in terms of how that dealt?

SPEAKER_03 13:03

I'm often a little hesitant about drawing commonalities only on generational lines, but I do think a distinguishing feature is the stage of life that a person is in and that may have things on a generational basis. So I would say that so I'm in my late 30s, and I would say that a lot of people in my peer group and a bit older are very concerned about the welfare and the care of our parents. So actually, it's quite often that the adult child will come and approach us for elder mediation and for advice. It's not always, sometimes it is, but it's not always from the older adults in their generation. And I do think that there are different experiences on a generational basis because of when say the external conditions in which we live that makes a difference. For example, I would say that in in my generation, for example, I think people tend to have children later and later. So it's very common among my peers for people to have children in their late 30s and early 40s. This often coincides with our parents getting older as well. But of course, older adults are also living much longer. So the average life expectancy in Hong Kong is about 85 to 88, I think, for men and women. But it does create this sandwich generation where you're both trying to raise young children and look after your parents. I don't think this is due for my generation, but I do think there are patterns. There are patterns because of external economic conditions that lead to, or another that lead to later fertility or not having children that impacts our experience of growing old. I would also say that things are going to change because a lot of people are not having children at all. So I can imagine that the number of single older adults, which is already quite significant. I think the SCMP recently has statistics on this. But I think that number is likely to grow. But I also think that how society arranges itself is also going to change. I think we will have different understandings of what it means to maintain healthy social relationships as we go as we grow older. So I guess the baby room is now growing older. And as the adult children were trying to figure out how to care for them, I think those care needs will be different again once honestly that you and I once you and I grow older, I think our care challenges will be different again.

SPEAKER_01 15:54

Absolutely. I am going to Italy again, go to London and then go to Italy to visit my parents and so on. And it's everyone is getting older and getting older, they're getting older. Different problem, different things that are sort of. But thank you, Lizzie. And I think Winnie would like to go back to you on uh the picture that you painted.

SPEAKER_00 16:25

Yes.

SPEAKER_01 16:26

Which surprised me because I thought uh let's say as a again generalizing, people in Asia tend to be much more family-oriented and more much more like connected and whatnot. And that surprised me. Do you think this is like a specific thing on Hong Kong or there is something else?

SPEAKER_02 16:51

Uh we the fragmentation of family housing we attribute it to the limited space in Hong Kong because where the large family spaces are rare and nature of very rich. And then as they get married, they move out of that small unit and have their own uh flat. So uh I I think in my even in my own experience, I think that is the way it developed. So it ends up with uh people of my generation, my friends, most of them um living apart from their parents. Our parents have their own flat live independently and we live independently. Chinese, of course, Hong Kong, the majority of the population are Chinese, you know and but at the same time, because of the and the limitation of the environment, the pressure of the work, working hours, that make us develop into something slightly different from what Chinese family used to be. We we used to have a family house with a court, open court in the middle, and different siblings or family are organized around this court. We no longer have that. When I was a baby, I lived in a a courthouse like that in Hong Kong, but it disappeared. Yes, as time progresses, as and the environment develops and highly economic growth, I think families tend to live spread all over. And not just inside Hong Kong. Nowadays you find a lot of parents living in Hong Kong and their children spread all over the world, UK, English, any part of Canada. And family network. When we do our elder mediation nowadays, we say that we can do elder mediation online. Why? Because if you want the family to meet together while they are in different places of the world, Zoom is the best way to get them together.

SPEAKER_01 19:08

That is that that makes up so much.

SPEAKER_03 19:11

Can I add to this? Of course, please. So I would say that household structures are more diverse. Not necessarily that all families are more fragmented because there are different ways of staying in touch with different family, with different family members without necessarily staying in the same place. But for the reasons that Winnie mentioned, household structures are certainly changing. So we still have some multi-generational families who live in the same place, but that is not the most necessarily like the most common trend or the majority trend, which means that you can no longer assume that family support is going to either be there or be sufficient for to care for aging members of the family. And it's also the case that people generally are living longer. Decades ago, most people did not live and into their 80s. You might have one or two elders in the family to look after, but now many people are living into the 80s, 90s, and hundreds. So there are more people to look after and more stretched family resources. So you have different generations living in different places. Winnie mentions that people live overseas as well, and not necessarily in Hong Kong. Space is definitely a premium in Hong Kong as well. And some of the very troubling statistics that we see is that old age is also correlated with poverty. So you do have a lot of older adults who are struggling and who may not have family support. The other implications of changing household structures and changing social structures is that there are other people filling the gap for care. So, for example, the number of friend caregivers or your friends who caregive for you in some way, like providing transportation or meal, like that's also growing. And of course, what we know is that a lot of this caregiving done by family, done by friends is actually unpaid. So then we have to add who is bearing the burden of caregiving in our society. Is that burden fair? What kind of support do they need? Like these are the questions I think that our society really needs to grapple with. And then of course, there's like the public services as well. And do we have the public services to provide the care that our aging population requires? Hong Kong actually has many different services provided by many different groups of people. And one of the challenges is also for individual families when they're facing later life challenges to know even where to start to find those services.

SPEAKER_01 21:57

Of course. Every day now in the UK, in Europe, that ancient society, and all of these themes are coming up, like family structures changing. How do we take care from a societal point of view for people that are now living longer, getting older, with different problems that probably we never ever thought they were going to be? I in my mind, in my experience, I often see the potential issues for elderly sort of like life is about, of course, care in terms of like continuous care. Maybe there are some medical conditions, medical situations that require attention. And also like money, because there is always these inheritance and things, how we spend the money, because all of these things tend to be relatively expensive. And Winnie, I was wondering, like, in Hong Kong, is there a specific issue that is more let's say that requires more mediation, or what are the key issues that come up in the conversations?

SPEAKER_02 23:10

Issues, as I as I said earlier, we can divide the issues broadly into three areas. Money, uh, accommodation and care. They are actually in intertwined because uh you uh you cannot you you cannot decide on care without looking at how much money you have to support this care. You cannot decide on accommodation without understanding what sort of care is needed and what money is needed to support that accommodation and the care. So they can't be separated and it's a question of uh in each case we look at what is needed for the uh older person and then to look back into the care what sort of care support, what sort of common accommodation available and how much money is available, and then uh to look at what external supports are available, just as what Lizzie has mentioned, there could be milon wheel, uh delivered back to home or doctors, nurses, physiotherapies, uh visiting home to carry out all these services. Of course, these are these are also expensive services as well, uh without government subsidy. So you have to look at government subsidies what services mean acting like that. So is a whole uh I can say that is for each case is a is a holistic approach to what can be done for the older person. But I uh for my part, I think this is the major uh scenarios that we deal with in elder mediation. Of course, there are other different things. The other thing that could be the other matter that can be uh an issue is funeral. People argue about funerals. Even uh before the death of the older member, they argue about where the burial should take place, how long it it required the surviving family members to pay visit or to pay dresses and worship every year. That that is also a major dis disagreement too. But when we look at end of life, uh there are different issues that a the older person have to have to think about, have to overcome, and all these issues can create uh decision-making uh difficulties requiring elder mediation services.

SPEAKER_01 25:41

I see. For what you are like explaining this. Again, I didn't know much about elder mediation apart from what I thought it was going to be. But it sounds like you're basically a consultant. You look at the situation, you look at what could fit in and align a particular dynamic and whatnot, and you could provide different options and whatnot, in addition to actually making sure that people take a decision. Am I right or wrong?

SPEAKER_02 26:17

Both, both. Because uh well as as mediator, we cannot advise, we cannot uh actually make proposals for them. We uh we ask questions to make sure that we do the research uh before coming to the mediation, and then we can refer to them for uh expert opinions, uh everything uh all information resources available in their mind before they step into the mediation room and start discussing. Partly is we help them to find out the necessary information or advisors, professional advisors, and then uh in the mediation process we facilitate communication, mutual understanding, and then to to have them work out the auctions from the information they gathered and then make a decision about what to do need be hold up.

SPEAKER_01 27:16

Understood. Understood. Thank you. This was very useful. I have a different question now. Based on your experience in Isaiah, what have you learned up to now that maybe about life, about things that you would like to give to the audience?

SPEAKER_02 27:36

Let's go first or I go first.

SPEAKER_01 27:38

After you.

SPEAKER_02 27:39

I'm in a lot. I'm 67. I'm the young old I'm I uh within the young o category already. So my future depends on how much I know about aging, ageism, how to do with ageism, and then what what end-of-life different end-of-life difficulty decisions I have to make. So throughout my entire elder mediation training, I'm actually learning how to plan for my future, what obstacle I may have, how money I should accumulate for my own good, and then uh the most important thing is to build up a social circle because uh according to the the surface studies that we we look into, the most important part of the growing goal is to have the support of your peers. Statistics say that what meant most for an older person, the support they look for in an older person is not their spouse, is not their children, is the peers, is the peers who gave them the most emotional support. Like my father, he liked to discuss with peers about his problems, um building up a social circle, fostering um a friendship and neighborhood that we're talking about in Hong Kong because as we say it's so fragment fragmented and encouragement are focused on Odef to reach out to to build social connections so that their action to the very end of their lives can be um more I can say their well-being can be increased.

SPEAKER_01 29:38

Interesting. So is one of the key items. Yeah, that's very interesting. And Lizzy, what do you think? What about you? What do you think people might not think or what's your advice to them?

SPEAKER_03 29:53

Yeah. I think when you think about a good death and a good end of life, you actually have to think about living well today. And that is my great takeaway. That thinking about how our loved ones can pass away in death and dignity and for ourselves too. We need to think about what a healthy life looks like today. For example, looking after our finances. We're living longer and longer, and honestly, it's getting harder and harder to make money today. So we have to be really careful about how we save, how we earn, and how we invest. And that's going to set us up better to be able to look after ourselves and our loved ones in later life. That is the same with health. So the research shows that while we are living longer, we're often also living in greater pain. Modern medicine has become extremely successful in keeping us alive. But we're often hooked up to machines, often in great pain. There's often life-sustaining treatment that keeps us alive in conditions which may not feel like living in dignity and respect. So the things that we can do today would include strength training. I had the support of very good friends, including personal fitness trainers, who said, Lizzie, you're in your 30s now. You really need to think about how your bone density is actually decreasing. And I know you like ballet and you like yoga, but that actually might not be enough. So I've thought about, yeah, I've started personal training, started doing weights. I have encouraged my parents to start doing personal training as well. And this is going to help us to maintain capacity when we grow older. And by which I mean when I think about living well, I want to be functional. I want to be able to get out of my chair. I want to be able to walk myself to the bathroom. I want to be able to spend time with my children. And I want to maintain my mobility for as long as possible. And then it's not just finances and the physical aspects. For me, I am someone who lives with great anxiety about many things, including death. It scares me terribly to not know with certainty about what's going to happen in the afterlife. And so I think doing this work in outer mediation has actually forced me to confront that question. And even though I I don't know what's going to happen, but I can at least think about the way that I might get there. I think some of the some of the maybe not so good deaths are the ones that everybody's trying to like just keep you alive and like you're on CPR and then you gain like two more days of living and then you're gone, and there's been like no real time to talk to your family. And I've been reading books by hospice nurses and also trained and undertaken a certification as an end-of-life doula. And a lot of it is about actually you can die peacefully. You can die well. And many people do. And one of the things that surprised me is that some people before they die, they actually see visions, they see their loved ones. And someone knows exactly what they're seeing. But the point is that in your end of life, it may not be all bad and sad. You may see your loved ones again. You may be able to say die in a hospice home where you don't have the life-sustaining treatment, but you have pain relief and you and that might give you a little bit more time and that before you die to bring your family together and say the things that you want to say, and to think the things or make the arrangements that you want to make. So when I think about how I want to die, I've actually told my husband now that I would rather die somewhere comfortable, maybe in a home or maybe in a hospice, wherever I am, but maybe somewhere quiet and not stressful and have my family there. This is assuming I have a choice, but the reality is also that more and more people are going to have this choice because of modern medicine. So actually you're more likely to die from a terminal illness or from aging than you are to just die from an accident. So many of us will actually be in a position where we can decide. Or unfortunately, what often happens is that we lose capacity because we lose cognitive ability to make decisions. And so then we end up dying not with respect and not with dignity because we haven't actually communicated to our family members and our loved ones how we want to die and what would be a good death for us. So I think in terms of my advice for people is do think about these questions. They do feel really far away, but think about the life that you want to have now and do have the conversations with your family. And on our website, the Outer Mediation Outer Law website, we've created these question cards, the conversation prompts for family to start having these conversations in a light-hearted and fun way.

SPEAKER_01 34:50

No, thank you. I just have one final question. I just realized that nowadays that we're talking about that. And that's because of course agree, please.

SPEAKER_02 35:01

Yeah, that b that brings us to the topic of social prescribing. So nowadays they're on um social services consisting of medical teens, social work teams, and I think that's about it. And when patients go to them for some mild illness or something, they do not prescribe medicine. Or medicine is just part of the prescription. What they prescribe is different social activities. Going out for different ball games, doing some exercise, meeting up with friends, and things like that. That that goes back to my earlier explanation about how Pierce of Paul's social activity is more important to the we call it the part two of our lives. Yes. And what Lizzie explains about doing exercise, keeping herself healthy is also part of the philosophy within the the coming up of this social prescribing.

SPEAKER_01 36:10

See that just absolutely makes sense. We often don't don't necessarily think about how we're gonna look when we are older, but it's gonna be a factor of who we are right now, effectively. I'm a coach, so people come to me always asking how can I achieve more, how can I become better at work or in life, and so on. And we had this conversation about end on life care, like all of these conversations, but we have not touched upon how the achievement of a person's life, how do they factor in? What do you think?

SPEAKER_02 36:59

Achievement in personal life, is that what you say?

SPEAKER_01 37:03

Yeah, so we are talking about end of life, we're talking about an elderly person or elderly people that collect their specific needs. And I was wondering if there is still space for these people to continue their achievement, to continue to improve themselves. Because I don't know, I just wonder what are your thoughts about it. Because we all live to achieve something. I was wondering, does it stop at a second point?

SPEAKER_02 37:30

Can I just say it from my personal experience? I mean, I I don't think I'm in a position to give any such advice to other people. Every pe every person's life is very different. But I have to say, I'm I'm the lucky one. By chance, I become a lawyer. And as it turns out, I enjoy my legal work enormously. It gave me a lot of satisfaction. And of course I I lost legal battles, but I do enjoy doing legal search, canning planning strategy for each legal battle, and then when I won for my clients, of course, is a happy event. Even if I lost sometimes, I I I do get good comments from my client and also from the judge. So I enjoy 30 years of legal work. And I and as I turned to elder mediation is also something that I don't somehow I I have a natural devotion in this and there had been some experienced elder mediators who saw me in the practice. They say that I could be good in the job. I think I had been lucky and the doors that was available for me to push open turn out to be in a way successful and also self-satis satisfying. I I actually have no regret in my life. Of course I have a very good father. This I I keep repeating over and over again. He gave me support in every turn of my life. I I can't ask for more, actually.

SPEAKER_01 39:18

Thank you. This was very beautiful. Is there anything brief that you would like to add to this? Because it's a bit of a again, a philosophical question, I guess.

SPEAKER_03 39:26

I think achievement and notion of success is going to be different for everyone. What I would say is that absolutely you can continue to do what you want to do and to live a life according to your values as you age, but that is where the preparation becomes really important. Look after yourself now, look after your loved ones now so that you have the capacity and the ability to do the things you want to do so that you can maintain your cognitive ability for as long as possible, so that you can maintain your physical mobility for as long as possible, your emotional health for as long as possible. Winnie has mentioned the importance of social networks. The reality is, as Winnie said, we're kind of given a second child's at life because of our longevity. There's a guy called Peter Lazlitt who theorized about aging, and he he said we often associate aging with being like decrepit and like dependent on drugs and medicine. But actually, there's now increasingly a long period between empty nesting for those who have children, retirement for those who have work, and the part of their life where they're really in decline and about to die. So this could be 20, 30, 40 years onwards. That's a lot of time to do what I whatever you want to do. And then this quote that I love, I forgot who said it, but she was like, if you had told me that I would live to 100, I would have started the violin at 17. So my point is absolutely you can of achievement is important to you, success is important to you, whatever it means to live a life in alignment of your values. You can absolutely continue to do that as you age. But in order to put yourself in that position, you do need to live a good life now.

SPEAKER_01 41:14

Thank you, things are so beautiful. So let them want to be a good thing. Thank you very much for your happy. It's been a pleasure. You really opened the door onto something in the world. I've not been thinking of a while. So thank you very much.

SPEAKER_03 41:29

Thank you so much, Danielle.