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The following is a speech by Secretary for Health and Welfare, Dr E K Yeoh, at the 8th Annual Congress of Gerontology today (November 25):
The proportion of older persons in Hong Kong aged 65 and above is projected to increase from the current 11% to 15% in 2020. In numerical terms, the increase is even more striking - from 759 200 this year to 1 267 300 in 2020. Based on the Deloitte study conducted in 1997, about 10% of our elders have some physical or cognitive impairments, and require assistance from others in performing some activities of daily living. Although we expect our future elders to be healthier, live longer and be better educated, the absolute number of elders who will require care will increase in the decades to come. Care for these elders - to enable them to lead healthy, satisfying and productive lives - will present us with a special challenge.
It is our priority to provide quality long term care service for our elders who need assistance in activity of daily living. We have already in place a full range of residential, home and community care services which cut across the medical, health and social service sectors. Our direct expenditure on providing long term care service for elders increased from $766 million in 1992/93 to $3,407 million this year - a 4.4. fold increase. Yet we still have a waiting list of some 28 000 elders for subsidised residential care places, and another 5 000 elders for infirmary places.
This points to the challenge of equilibrating needs with resources, and to the need to innovate services which are responsive, appropriate and cost-effective. Hong Kong is fortunate in the sense that there is a strong tradition of families taking care of their elders - about 70% of our older persons live with their adult children. We will continue to reinforce this tradition. The provision of formal care services is to complement, not replace, the support system of families and friends.
We have studied extensively overseas experience in providing long term care service for elders. We have drawn reference from such experiences where applicable in our efforts to put in place a system that suits Hong Kong' circumstances. I will outline below the major policy directions we have taken in order to achieve the overall objective of providing a comprehensive and integrated long term care service for our frail elders.
The first policy direction is moving to a more appropriate mix of care from institutions towards the community. This shift of emphasis will achieve the dual objectives of meeting the elders' preference to age at home and their families' wish to take care of them, which in turn will strengthen family cohesion.
In line with this policy, we are now inviting interested service operators to submit proposals on provision of integrated enhanced home and community care services, to support frail elders who may otherwise be inappropriately admitted to long term residential care. In this exercise, we further encourage service operators to use their existing and new resources in a flexible and innovative manner. We also encourage them to form partnership and strategic alliances with other agencies to achieve higher integration and efficiency in service delivery.
The second policy direction concerns a move within residential care to integrate various levels of long term care provided by different institutions. We have developed a funding formula to take into account the difference in resources required to take care of elders at different stages of frailty. To support ageing in place, we have invited three subvented residential care homes to participate in the scheme of 'continuum of care'. This is the first step towards the idea of building only one type of residential care home in future, which will provide a continuum of care services to cater for elders of different care needs at different stages of their lives.
Thirdly, we have just introduced a standardised care need assessment mechanism for both residential and home and community care services. This new mechanism is capable of identifying common long term care concerns, for example, skin care and falls, which can be addressed by well researched care protocols. Care protocols provide a more structured and standardised approach in the care of clients. They help to reduce the variance in care practice and therefore, help to enhance the quality of care. Some well researched care protocols such as care practice guidelines also come with outcome measures which are useful in evaluating client care outcomes.
Next comes carer support. This is an important strand of our policy given the large number of frail elders being cared for at home by their families in Hong Kong. Providing long term care for frail elders within a family can be very stressful, if there is not enough support or relief arrangement. In the coming year, we plan to strengthen carer support by providing information, training and respite services.
As most frail elders in need of long term care are at the same time suffering from chronic illnesses, they are also in need of medical care. Our fifth policy direction is to strengthen the interface between the health system and the long term care system. Experience worldwide has demonstrated that if inadequate health support is given to the long term care system, or if the quality of service is unsatisfactory, many elders receiving long term care would become frequent users of acute medical care services - the so-called 'revolving door syndrome'. Other than having an adverse impact on the health of the elders, this syndrome poses heavy burden on the health sector.
Recognising the problem, the Hospital Authority has been sending Community Geriatric Outreach Teams to visit regularly all subvented care and attention homes and a large number of private care homes in the past few years. With additional resources in 2001-2002, the Community Geriatric Outreach Teams will further extend their coverage to the majority of private care homes.
With the introduction of enhanced home and community care services to take care of frail elders at home, adequate medical and allied health support will become very important. We will continue to explore and pursue initiatives to improve the interface between medical, and residential and home and community care services.
The sixth strand in our policy concerns manpower training. With the advancement in medical technology, many elders can survive their associated illnesses and disabilities but require complex care on a long term basis. To meet this new challenge, we need to upgrade the care capability of both our residential and home and community care services, by strengthening the multi-disciplinary approach, and through equipping the professional and non-professional staff with the requisite skills and knowledge. During the past year, we have identified areas where training for professional social workers and frontline care workers could be strengthened. We are taking steps to improve and develop the training programmes.
We should not lose sight of our goal in long term care - which is to improve the quality of life of our elders. Even when we cannot reverse the elders' chronic health conditions or functional dependency, there is plenty of room for innovation in aspects like helping the elders to regain self esteem, feeling of control and sense of coherence. We will continue to encourage the service providers to share this common goal - that is, not only to add years to life, but more importantly, to add life to years.
Before I leave the subject of long term care, I would like to say a few words about a common concern, namely, how to finance long term care in anticipation of a rise in elderly dependency ratio. In the short term, our focus will be on re-engineering existing home and community care services to meet the three-fold objective of improving service integration, cost-efficiency and access to service.
In parallel, we will continue to facilitate private care homes to upgrade their service quality to provide choices to individual and their family members with some means. We will also mobilise community resources to provide better support to frail elders and their family carers.
In the longer term, we will need to review the financing of long term care service. The Harvard study on financing of public health care services in Hong Kong has taken the first step to look into this area and will be examined further in the context of the public consultation exercise to be conducted later this year.
Long term care addresses people's functional dependency problems. More importantly, care for elders should emphasise health promotion and disease prevention, to reduce and delay the number of people becoming functional dependent and requiring long term care.
This is why we have taken on healthy ageing as one of the major initiatives for the year. We will develop strategies to dispel the common misconception that ageing is inevitably associated with physical and mental decline. There are ways to facilitate our elders to remain productive and participating members of our community. Health protection and promotion can reduce the prevalence of illnesses and disability in older persons. Even for elders with disabilities, we can help them to optimise the functional ability of their body's systems to enhance their quality of life.
I have just outlined our policies on long term care for elders. I would welcome your views and suggestions on any aspect of our policies.
Thank you.
End/Saturday, November 25, 2000
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